Everyday life following long term psychiatric hospitalisation
Clare Hocking
School of Occupational Therapy, Auckland University of Technology, Auckland, New Zealand
Janet Phare
Multiple Sclerosis Society, Auckland, New Zealand
Jan Wilson
Health and Environmental Sciences, Auckland University of Technology, New Zealand
PP: 297 - 305
Abstract
Although the immediate benefits of deinstitutionalisation are well documented, few studies have focused on the long term effects of lengthy psychiatric hospitalisation on everyday living. This narrative inquiry involved eight people who had spent more than four years in a New Zealand psychiatric institution. At the time of interview, they were living in unsupported accommodation in the community.
Key findings reported here are that participants had few social contacts, and most reported not having enough to do. However, their belief that others know best and their acceptance of 'taking one day at a time' precluded expressing the need or desire for change or taking action to improve their situation.
The provision of long-term support is recommended, along with further research to confirm the findings, investigate causative factors, and explore whether people deinstitutionalised from psychiatric hospitals and now resident in supported accommodation face similar issues.
Keywords
narrative inquiry, mental illness, deinstitutionalisation, friends, family, activity
Article Text
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A number of studies have confirmed that close supportive relationships are highly beneficial for people with chronic illness. The findings of this study, however, reveal a dearth of close family relationships and friendships amongst individuals with a history of chronic mental illness and extended psychiatric hospitalisation in New Zealand. Despite their acceptance of their present life circumstances, the participants in this study experienced having insufficient activities to fill their time, a degree of social isolation resulting in loneliness, and a high level of reliance on support workers for meaningful conversation and social contact. In addition, most considered others to be responsible for any change in their circumstances, and appeared to have formed this view over periods of up to thirty-five years.
This combination of factors would seem to make this group particularly vulnerable and therefore deserving of the support of paid workers long term, perhaps for the rest of their lives. The focus of such support might usefully be on assisting them to establish a network of relationships. However, while belonging within one's culture and community has been recognised as an essential element in making friends (Fitch 1998; Williams & Robinson 2002), the process by which friendships are formed remains unclear and warrants further research. Nonetheless, we assert that key workers and community support workers may need to re-orient their efforts from exploring work and leisure options to creating opportunities from which a sense of belonging and close friendships might develop. To enable this to occur, policies and service funding decisions need to take into account that some people require long term support and encouragement before they become ready to even consider setting personal goals, let alone initiating movement towards those goals.
It is acknowledged that this study has told the stories of only eight people, and that what they said, and how they said it, was influenced by their interaction with the researcher (Bruner 1990; Riessman 1993). This is because story tellers are aware of their audience, and consciously or unconsciously shape the story in response to the listener (Frank, 1995; Mishler, 1986). Nonetheless, the findings bear a remarkable similarity to a recently completed 15-year follow up study of 138 people who had been residents of a psychiatric hospital in Sweden in the 1980s and are now living in the community (Bülow, Svensson & Hansson 2002). The Swedish study showed that participants had low levels of participation in work and other occupations, and that ‘social contacts remain scarce' (Bülow, Svensson & Hansson 2002: 21). Based on the findings, the researchers concluded that ‘the group under study requires much local community support and is obviously extremely vulnerable to cuts in the welfare system' (Bülow, Svensson & Hansson 2002: 21).
Further research with larger samples of this group is needed in New Zealand. A particular focus of such studies might be to determine the proportion of the group who tell restitution narratives, and to attempt to discern whether past institutionalisation is a causative factor in participants' acceptance that others will take care of their needs. In addition, research into the everyday lives of people subjected to prolonged psychiatric hospitalisation could be extended to include individuals who are now living in supported accommodation. Such research would lend support to our finding that people who were institutionalised in psychiatric hospitals for lengthy periods lead impoverished lives, and lack close social relationships and meaningful ways to fill their time. If our findings were supported, so too would be our assertion that many deinstitutionalised people require ongoing, even life-long support from community workers. In turn, professional and community support must be backed by adequate government program funds.
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