Analysis of a support group for children of parents with mental illnesses: managing stressful situations.

We report an ethnographic analysis of a psycho-education and peer-support program for school-aged children of parents with mental illnesses. We conducted a critical discourse analysis of the program manual and observed group interactions to understand whether children shared program goals predetermined by adults, and how, or if, the intervention was responsive to their needs. Children were expected to learn mental illness information because "knowledge is power," and to express difficult feelings about being a child of a mentally ill parent that was risky. Participants used humor to manage group expectations, revealing how they made sense of their parents' problems, as well as their own. Suggestions are made for determining good mental health literacy based on children's preferences for explaining circumstances in ways they find relevant, and for supporting children's competencies to manage relationships that are important to them.

A Narrative Inquiry Into Global Systems Change to Support Families When a Parent Has a Mental Illness.

The issues that confront families when a parent experiences mental illness are complex. This often means that multiple service systems must be engaged to meet families' needs, including those related to intergenerational experiences of mental health and illness. A multisystem approach to public mental health care is widely recommended as a form of preventative intervention to address the effects of mental illness and its social, psychological, and economic impact upon parents, children, and families. Globally, a multisystemic approach to care requires a change in the way systems are currently organized to support families, as well as the way systems are interacting with families, and with each other. This qualitative secondary analysis emerged from a primary study examining global systems change efforts to support families, including components of change that were common and considered successful in different countries. A narrative inquiry method was used to re-analyze the data by compiling the stories of change described by individuals from participant countries. The data were interrogated to ask questions about story content, and to identify who was telling the story and how they described important changes across different geographical and cultural contexts. The individual stories of 89 systems change experts from 16 countries were then compiled into a shared global narrative to demonstrate international progress that has occurred over time, toward multisystemic change to support families where parents experience mental illness. While the global narrative demonstrates considerable overlap between pathways toward change, it is also important to document individual stories, as change pertains differently in different contexts. The individual stories and the global narrative illustrate how countries begin a journey toward change at different time points and may have various outcomes in mind when they commence. Study findings raise questions about the extent to which systems change can be standardized across countries that have unique social, cultural, political, and economic features. This study provides several potential points of reference for countries considering, or currently undertaking systems change to support families where a parent has a mental illness. It also provides an important story about international efforts undertaken to improve outcomes for families.

Children's Experiences of Cancer Care: A Systematic Review and Thematic Synthesis of Qualitative Studies.

PROBLEM IDENTIFICATION: Improvements in pediatric cancer survival have increased interest in the experiences of children undergoing treatment; however, no review of the qualitative literature describing these experiences has been conducted. LITERATURE SEARCH: Databases were searched from January 2000 to January 2016 for qualitative studies describing the experience of children with cancer aged 18 years or younger. DATA EVALUATION: Two reviewers assessed abstracts for relevance and rated reporting comprehensiveness. Participant quotations and descriptions of participants' comments and behaviors were coded. Coded data were pooled to provide a thematic synthesis. SYNTHESIS: 51 studies were included. Five themes were identified. IMPLICATIONS FOR RESEARCH: Results provide data related to the experience of children with cancer that can inform practice changes and research activities aimed at enhancing quality of life.

Issues encountered in a qualitative secondary analysis of help-seeking in the prodrome to psychosis.

Primary data are rarely used explicitly as a source of data outside of the original research purpose for which they were collected. As a result, qualitative secondary analysis (QSA) has been described as an "invisible enterprise" for which there is a "notable silence" amongst the qualitative research community. In this paper, we report on the methodological implications of conducting a secondary analysis of qualitative data focusing on parents' narratives of help-seeking activities in the prodrome to psychosis. We review the literature on QSA, highlighting the main characteristics of the approach, and discuss issues and challenges encountered in conducting a secondary analysis. We conclude with some thoughts on the implications for conducting a QSA in children's mental health services and research.

Understanding help seeking delay in the prodrome to first episode psychosis: a secondary analysis of the perspectives of young people.

First episode psychosis represents a critical period for intervention to prevent future impairments and to initiate optimal interventions. Using an interpretive interactionist framework, a secondary analysis of interview transcripts was conducted based on the narratives of youth experiences of psychosis. Our goal was to better understand the factors involved in the decision to seek help (or not) from the mental health system. Findings suggest that help seeking is a social process involving a wide range of influences; two such influences are highlighted in this paper, an individual avoidant strategy of ignoring and hiding early symptoms, and the persuasive influence of significant others in the social network.

Interpreting narratives of motivation and schizophrenia: a biopsychosocial understanding.

BACKGROUND: The concept of motivation involves a complex interplay of biopsychosocial and environmental determinants. For individuals diagnosed with schizophrenia, motivation has traditionally been approached from a neuro-biological standpoint, obscuring this complexity. The findings from this study underscore the importance of broadening our understanding of motivation and schizophrenia through an exploration of individual perspectives and identification of the psychosocial factors that clarify the experience of diminished motivation.

The dialectic of friendship for people with psychiatric disabilities.

In the psychiatric literature, the meaning and importance of friendship has remained largely unexplored, subsumed under the rubric of social support or viewed as a component of community integration. Twenty-one qualitative interviews were conducted with individuals suffering from psychiatric disabilities focusing on the meaning of friendship as they described it. Analysis revealed the contrasts, contradiction and paradox of friendship for this group of people. The ongoing struggles of people with psychiatric disabilities regarding the need to connect with others and have friends, and conversely, the need to be alone and to withdraw from others, was highlighted.

The Knowledge Resource Base: beginning the dialogue.

The Knowledge Resource Base (KRB) is a conceptual approach to the various types of knowledge used to understand and make sense of mental illness. It is an attempt to go beyond the everyday notion that real knowledge is in the hands of clinical experts and that consumers/survivors, families, and the public have little to contribute. There are four components to the KRB, each of which represents a different perspective or type of knowledge about mental illness; medical/clinical, social scientific, experiential, and customary/traditional. The purpose of this paper is to explore the medical/clinical and experiential components of the KRB by initiating a dialogue between consumers/survivors, families, and mental health professionals regarding these components. The strengths and weaknesses of each component are identified through individual interviews and a focus group.

Youth at ultra high risk for psychosis: using the Revised Network Episode Model to examine pathways to mental health care.

AIM: This paper aims to identify the ways in which youth at ultra high risk for psychosis access mental health services and the factors that advance or delay help seeking, using the Revised Network Episode Model (REV NEM) of mental health care. METHODS: A case study approach documents help-seeking pathways, encompassing two qualitative interviews with 10 young people and 29 significant others. Theoretical propositions derived from the REV NEM are explored, consisting of the content, structure and function of the: (i) family; (ii) community and school; and (iii) treatment system. RESULTS: Although the aspects of the REV NEM are supported and shape pathways to care, we consider rethinking the model for help seeking with youth at ultra high risk for psychosis. CONCLUSIONS: The pathway concept is important to our understanding of how services and supports are received and experienced over time. Understanding this process and the strategies that support positive early intervention on the part of youth and significant others is critical.

Reflections of young people who have had a first episode of psychosis: what attracted them to use alcohol and illicit drugs?

AIM: To identify factors that contribute to the initiation of alcohol and street drug use from the perspective of people who were enrolled in early intervention programmes for a first episode of psychosis. METHOD: Eight focus groups were conducted involving an average of four to six participants per group, with each group consisting of young people who met provincial inclusion criteria for early intervention programmes. Thematic analysis was used to systematically code transcripts from the focus groups for concepts, patterns and themes related to early use of illicit substances. RESULTS: Participants included 45 young people diagnosed with affective psychosis or non-affective spectrum disorders. Seventy-three percent were male, with a median age of 23 years. In general, substance use was an important topic that emerged across all focus groups. Participants talked about three main factors attracting them to initiate use of substances, most predominantly cannabis: (i) using within a social context; (ii) using as a self-medication strategy; and (iii) using to alter their perceptions. CONCLUSIONS: The need for social relationships, coping strategies and pleasurable experiences appear to be important reasons for initiating substance use. Additional research is needed to identify whether prodromal youth report the same factors that attract them to initiate use in order to develop more effective prevention strategies.

Children's experiences of parental mental illness: a literature review.

AIM: This paper provides a review of published qualitative research on children's experiences of parental mental illness. METHODS: We undertook a comprehensive search of Medical Literature Analysis and Retrieval System Online, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts and Applied Social Sciences Index and Abstracts databases, as well as citation searches in Web of Science and manual searches of other relevant journals and reference lists of primary papers. RESULTS: Although 20 studies met the search criteria, only 10 focused exclusively on children's descriptions of their experience--the remainder elicited adults' perspectives on children's experiences of parental mental illnesses. Findings are organized under three themes: the impact of illness on children's daily life, how children cope with their experiences and how children understand mental illness. CONCLUSIONS: Despite references to pervasive knowledge gaps in the literature, significant information has been accumulated about children's experiences of parental mental illness. Considerable variability in research findings and tensions remain unresolved. For example, evidence is mixed as to children's knowledge and understanding of mental illnesses and how best to deploy resources to help them acquire optimal information. Furthermore, children's desire to be recognized as important to their parents' well-being conflicted with adults' perceptions that children should be protected from too much responsibility. Nevertheless, the cumulative evidence remains a key reason for advocating for psychoeducation and peer-support group interventions for children, which are endorsed by child and adult study participants alike.