Support as Possibility: Lived experiences of support in the lives of young persons with mental health problems: A hermeneutic phenomenological study

Abstract

Support is at the core of social and welfare services for young persons with mental health problems who are partly or wholly out of school and work. In recent years, a variety of models and initiatives have been developed in order to support young persons with mental health problems to regain or maintain their footholds in school and work. However, these young persons do not always get the support they need, when they need it. Further, the ‘support’ they receive is not always experienced as supportive by the young persons themselves. While supportive models (e.g. supported employment, individual placement and support, and supported education) and their effects have been extensively examined and explored in literature, less attention has been given to the existential meanings of the experience of support. This PhD dissertation adds to the existing body of knowledge by exploring the meanings of support as a human experience, in order to contribute to a deeper and more nuanced understanding of support. Ultimately, the study’s purpose is to lead to more thoughtful and tactful support for young persons with mental health problems.

This study employed a hermeneutic phenomenological approach inspired by the Utrecht School, and in particular, Max van Manen’s phenomenology of practice. The study sample was young persons living in a small locality in Norway. The 14 participants were recruited from services for young persons in need of support. Individual interviews with the participants were conducted and formed the basis for the exploration. The study also included a competence group consisting of young persons and practitioners with personal and relevant experiences of the topic. The competence group contributed to the process of hermeneutic phenomenological exploration and creation of understanding through collaborative reflection and dialogue.

Three sub-studies evolved from the original research question. Each of these sub-studies resulted in an article exploring a previously unknown aspect of support that was uncovered during the research process. The insights from the sub-studies contributed significantly to understanding the overall research question and are briefly summarized here.

The first sub-study explored support as a relational phenomenon. Using a phenomenological approach to analyse two contrasting personal accounts, we examined how “support” is used in everyday language and how support is understood through a variety of ways of being together. This analysis implies that support is a relational phenomenon. The relationship holds the potential for support to take place. The experience of being supported seems to be connected to being noticed and attentively known by someone. This attentive knowing involves true presence and a sensitive notknowing and non-judging attitude. The sub-study suggests that support, as an existential experience, is not guaranteed in pre planned models, programmes or initiatives intended to support. Models and programmes are only potentially supportive, but not sufficient for true support to be given and received. The existential insights of this study invite professionals to trust uncertainty as a way of being open and to embrace an attitude of wonder as the “method” of support.

The second sub-study explored whether and how support and lived space might be related. It asked whether some ways of providing support might shape young persons’ sense of lived space. By adopting a hermeneutic phenomenological approach and moving reflectively between the experiential accounts and the methodological processes of epoché and reduction, the potential interrelatedness between space and support was explored. Three phenomenological themes evolved through the reflective hermeneutic process, and became aspects for further exploration: personal and shared space, the importance of a safe home, and the release from being enclosed in problems to become actively involved in one’s own future and in the community. The study implies that support and lived space are related in complex ways. Helpful support might create space to live in, room for nourishment and growth, and freedom to be and become. Helpful support seems to be anchored in care, autonomy and respect, while simultaneously being open to the everyday unpredictability and nonlinear realities of life.

The third sub-study explored the potential of “nourishing communion” as a possible aspect of support. Data were analysed using van Manen’s hermeneutic phenomenological approach to uncover possible meanings of nourishing communion in lived life. The analysis revealed that in the moment of nourishing communion there is a feeling of trust and holding, a mutual participation, an acceptance in felt togetherness, a sense of being found and received, and a sense of attuned resonance. This sub-study suggests that “nourishing communion” can emerge in relationships and communities both within and outside professional services. This highlights the importance of everyday life as the orientation point for social and mental health support to young persons.

Based on an overall reflection and discussion combining the three sub-studies, this dissertation suggests that supporting young persons with mental health problems partly or wholly out of school and work needs an approach that resembles and resonates with life as the young themselves know it. Services to provide support need to focus on the experiences of the young persons and be based on an understanding of what support might mean for them. Support is a relational process that calls for mutual exploration with young persons to find out how they can be supported in their life situation. This encourages practitioners to embrace a wondering attitude in every encounter with a young person in need of support, refraining from assuming that they know what support is.