Holistic treatment during a first episode psychosis (FEP) can significantly impact the longevity and chronicity of the illness, as well as reduce the risk of premature death by suicide. However, treatment can only be effective if the young person participates. Given that 19-40% of young people disengage from early intervention services for FEP, this qualitative study aimed to understand how young people experienced engagement with case managers at an early intervention service. Semistructured interviews were conducted with seven young people and themes were identified using interpretive phenomenological analysis. Young people detailed how engagement with a service could be viewed as a process, following different stages between initial referral and discharge. Throughout this process, a number of factors influenced young people's decision to engage with, or disengage from, their case manager. This created a push-pull dynamic with periods of good engagement and poor engagement. Discussion of this dynamic adds nuance to established scholarship about engagement, including shifts over time in the importance of client empowerment and valued features of therapeutic relationships. Awareness and understanding of these concepts may guide changes to early intervention services and address the core issue of engagement.
In an era of mental health service reform, co-design is emerging as a leading framework to guide the design and implementation of new services. Co-design uses the expertise of clinicians, those with lived experiences of services (both consumers and carers) and provocateurs (curious questioners) to understand a 'problem' and develop innovative strategies to address it. It relies on the creation of a safe environment where power imbalances are acknowledged and mitigated, and decisions are made collaboratively. Understanding how to do this effectively within the mental health sphere, where experiences of uneven power distribution and trauma are common, can feel overwhelming. Building a shared understanding of the opportunities and limitations within co-design is also important to establish its place within broader mental health reform. This paper uses an experiential approach to reflect on a co-design process, offering an opportunity to learn from a specific example. Factors that enhanced co-design included formal, remunerated roles, the allocation of time to establish and maintain an intimate, trusting team culture, and the capacity for all team members to be vulnerable. Equally important, strategies needed to be employed to mitigate the challenges inherent within the process, including the impact of power differences, a push to make fast-paced decisions, and a sense of cynicism remaining from previous projects or experiences. When these factors are attended to, the process of co-design can be dynamic, innovative, and transformational for the people participating in it, the project and the mental health sector.
There is a critical need to stimulate discussion around this multifaceted phenomenon, including a continued focus on the roles of key stakeholders and clinical models that may further facilitate collaboration in treatment plans and recovery.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.