Inpatient mental health services in the United Kingdom are currently dissatisfactory for service-users and staff. For young people with psychosis, being hospitalized is often distressing, and can lead to disengagement with mental health services. This article describes how we took three qualitative research studies about hospitalization in early psychosis (exploring the perspectives of service-users, parents, and staff) and translated them into service improvements developed in collaboration with a range of stakeholders, including service-users, carers, community and inpatient staff, and management. We used an adapted form of experience-based co-design (EBCD), a participatory action-research method for collaboratively improving health care services. The use of EBCD is still relatively novel in mental health settings, and we discuss how we adapted the methodology, and some of the implications of using EBCD with vulnerable populations in complex services. We reflect on both the disappointments and successes and give some recommendations for future research and methodological development.

This article shares a research methodology that we argue supports human science researchers in their aim to understand lived experiences more fully. Drawing on MerleauPontian thinking, the paper outlines three dimensions of sense experience that underpin our approach: the felt-sense, aesthetic aspects of language, and visual imagery. We then detail this approach: the data-collection phase is a creative interviewing method, adapted from Imagery inMovement Method (Schneier, 1989) and focusing technique (Gendlin, 1997). This results in multimodal data: drawings, bodily and verbal accounts, rich in imagery. The analysis is an expanded hermeneutic-phenomenology, and in this article we focus in particular on our method for interpreting visual data. Three examples taken from a case-study about feeling guilty are provided to illustrate the potential of the approach. The paper concludes with some reflections on the impact of using a multimodal approach in human science research. KEYWORDS: multimodal, phenomenology, guilt, focusing, metaphor This article describes a methodological approach that we believe may be useful to other human science researchers, who, like us, are interested in exploring lived experience as fully as possible.There are a growing number of researchers who are committed to moving beyond the reflected ACCEPTED MANUSCRIPT ACCEPTED MANUSCRIPT2 upon and languaged dimensions of experience, to additionally explore pre-reflective, bodily, felt experience through various means. This paper argues that one way these felt dimensions become (at least partially) accessible to qualitative researchers is by using a multimodal approach to datacollection and analysis. In this paper we describe and reflect upon one such approach, and to illustrate its potential, draw on material from a case-study about what-it-is-like to feel guilty.Through attention to the multi-sensory, aesthetic aspects of an experience, and how they are disclosed in our research encounters, we argue that researchers can gain a fuller understanding of lived experiences. Firstly, we will briefly situate our research approach within the landscape of hermeneutic-phenomenology.Phenomenology is a branch of philosophy interested in our encounters with phenomena as they appear to us in consciousness (Langdridge, 2007). It was articulated in the early twentieth century primarily by Husserl, Heidegger, Merleau-Ponty and Sartre. The principles of phenomenology were applied to psychological research by Van Kaam (1966), Fischer (1974) and Giorgi (1970) who aimed to illuminate the human condition through understanding lived experience (Langdridge, 2007). Phenomenological psychology offers a way to access human experiences that are often difficult and complex (Giorgi, 1997), particularly to explore subjectivity and embodiment, which are limited by the discursive paradigm (Willig, 2007). A phenomenological approach allows researchers to focus on how we perceive the world in all its fullness and richness; our lived experience (Langdridge, 2007). ...

Some aspects of experience can be challenging for research participants to verbalise. Interpretative phenomenological analysis (IPA) researchers need to get experience-near to meet their phenomenological commitments, capturing the "texture" and quality of existence, and placing participants in relation to events, objects, others, and the world. Incorporating drawing into IPA designs provides a vehicle through which participants can better explore and communicate their lifeworlds. IPA researchers also require rich accounts to fulfil their interpretative commitments. Drawing taps into multiple sensory registers simultaneously, providing polysemous data, which in turn lends itself to hermeneutic analysis. This article outlines a multimodal method, the relational mapping interview, which was developed to understand the relational context of various forms of distress and disruption. We illustrate how the approach results in richly nuanced visual and verbal accounts of relational experience. Drawing on an "expanded hermeneutic phenomenology," we suggest how visual data can be analysed within an IPA framework to offer significant experiential insights.

BackgroundApproximately half of service users with schizophrenia or bipolar disorder do not fully follow treatment recommendations. Studies of adherence have not adequately explored the frequency, consequences and meanings of non-adherence behaviours from service users’ perspectives. This study contributes to a more fine-grained understanding of treatment choices and the support service users require in order to maximise benefit from their medications.MethodsThis was a mixed-methods questionnaire study, employing quantitative and thematic qualitative analyses. Thirty-five individuals with a diagnosis of, and receiving psycho-pharmaceutical treatment for, schizophrenia or bipolar disorder answered online or telephone questions about whether, how, and why they deviated from their treatment recommendations, and what support they currently and would like to receive.ResultsOver half of participants identified themselves as being non-adherent, however when asked in detail about intentional and unintentional adherence, 77% reported deviating from treatment recommendations. Critically, 29% were non-adherent and satisfied with being so. Service users’ satisfaction with their support was positively correlated with satisfaction with their medication. Participants’ made treatment choices in order to live well. Both side-effects and symptoms could be obstacles to adherence, but feeling well also impacted on participants’ treatment choices. Treatment choices were often made in the context of living well day-to-day, and did not necessarily take into account longer-term effects of non-adherence. Participants wanted more information about their medications, better emotional support (including better access to psychological therapies) and stability in their relationships with health professionals.ConclusionsThis study suggests that non-adherence, both intentional and unintentional, is common amongst individuals with diagnoses of schizophrenia and bipolar disorder, and that this often occurs without health professionals’ knowledge or support. Treatment choices reflect a desire to live well, but are often driven by short-term needs. Given access to more information, and importantly to emotional support, service users could be helped to make treatment choices that adequately reflect the long-term risks of non-adherence, as well as allowing them to live well day-to-day. More research is required better to understand the meanings and complexities of service users’ treatment choices.