Nine participants with severe and enduring mental illness gave informed consent to be part of this research studying their experiences of attending therapeutic groups. Ruggeri, Leese, Thornicroft, Bisoffi, and Tansella’s (2000) research defines severe mental illness (SMI), although their research includes only people who experience psychosis. In this study, SMI includes people who have experienced schizophrenia, psychosis, personality disorders and bipolar affective disorder where mental illness symptoms have interfered with functioning, following the definitions of SMI offered by the Department of Health (1996).
The number of participants was influenced by Smith (2004), who suggests between five and ten participants could be considered a suitable sample. Nine participants were selected as a middle option, balancing Smith and Osborn’s (2007) suggestion that ‘a detailed interpretative account’ is the aim of the research, with few participants ‘sacrificing breadth for depth’ of analysis (Smith and Osborn, 2007, p.56).
2.11.1 Participant inclusion criteria
The criteria for inclusion in this study were that participants speak English, have participated in their therapeutic group at least twice, and not to be felt to be experiencing overwhelming mental health symptoms by the centre staff. These criteria were arrived at following discussion with the staff and group facilitators who felt that attending their group twice enabled participants to settle into their groups and to reflect on their experiences of being in such groups. In fact, all the research participants had attended their therapeutic groups for longer than two weeks, as recorded on the participant demographic sheets in Appendix 8.
2.11.2 Participant recruitment
I made weekly visits to the centre (discussed in Section 2.13) and left flyers and a sign-up sheet (available in Appendix 9) with details of the study and my research contact details for participants to discuss any stage of the research process. In fact potential participants spoke to me in person as I visited each week. The participants were known to the centre and were a self-selecting, opportunistic sample who voluntarily signed the informed consent form agreeing to their data being recorded, transcribed and disseminated.
Potential research participants were informally screened by me as they made enquiries about the study before they were interviewed for the research, to assess whether any of the individuals might have been experiencing current mental health difficulties, such as symptom intrusion, medication side effects or other preoccupying circumstances and to minimise the potential for distress. The screening took place at the centre. My screening assessment was not scripted and resembled an informal discussion about confidentiality, recording and dissemination where the individual asked questions and I was curious and open about whatever emerged. I discovered that the participant criterion to attend a therapeutic group twice before participating in the study allowed participants to feel settled in their groups. If an individual had wanted to participate when the staff or I considered them mentally unwell, it had been decided I could meet them privately to discuss their safety and stability. In fact, none of the potential participants were unable to participate because of mental health difficulties.
Some research participants described experiencing more than two decades of in- patient and out-patient treatment, spanning changes in mental health legislation (including increased patient agency, user-led assessments and the Care Programme Approach (CPA)), which was operationalised following the Department of Health (2008) policy review. The participants described experiencing community service teams such as Home Treatment, Community Mental Health, Assertive Outreach and Early Intervention. They described vital mental health care and support from friends and family. The participants’ ages spanned from early thirties to early seventies, and their ethnicities included British, Irish, European, Mixed- Race, Caribbean and Persian. The participants were not intended to represent all ages, ethnicities and experiences of MHSU as IPA data is ideographic and not intended to generate universally applicable theories (Smith, 2004). Four participants were women and five were men. Four participants were employed part-time, one was retired, one was a volunteer and three were on courses. One participant had a degree and another participant was a carer for another MHSU. Participant demographics are included in Appendix 8.
Participants spoke of knowing others in their groups and of being known by their group facilitator. Some participants described re-joining their therapeutic groups after receiving mental health treatment and re-engaging with some of the original group members. Other participants discussed taking part consistently in their therapeutic groups.
2.11.3 Participant diagnoses
I did not actively collect diagnoses from research participants, having become aware they could reinforce the researcher’s power and become another lens through which to view the research data. Parker (1999) suggests diagnoses ‘lure the reader’ since they constitute labels (Parker, 1999, p.2) and could be limiting and distract attention away from meaning. Research participants chose whether or not to discuss their diagnosis and I remained curious but did not ask directly about diagnoses. My ontological position is that diagnosis may not signify common elements between individuals and that the research participants are unique and unclassifiable, as Bentall (1993) and Byrne (2000) posit. During data collection research participants reflected on the conflicting and changing diagnoses they had received, expressing confusion and ambiguity about their possible meanings.
2.11.4 Participant homogeneity
The participants in the present study could be considered a homogenous group according to Smith and Osborne (2007), since they could all respond to the research question in particular depth from their experiences of attending therapy groups and from their shared insight into being diagnosed and living with severe mental illness.
In the present study, homogeneity extends to the participants’ shared experiences of severe and enduring mental illness symptoms, being sectioned, in-patient and out-patient treatments, living with severe mental illness in the same local community and attending group therapy; however their individual differences mean they do not view their groups the same way. Thus, the present participants appear to constitute a ‘purposive’ sample who have sufficient common knowledge of their therapy groups to respond meaningfully to the research area as Smith and Osborne (2007, p.56) suggest. Moreover, the participants attend different longer-term therapy groups, (Appendix 8), and have differing relationships with their facilitators and each other and this could be considered somewhat less homogenous than the participants all discussing the same group. Homogeneity and the extent to which there may be transferability of the findings are discussed within the Research Limitations below. On balance, Arrow et al. (2004) and Brabender and Fallon (2009) suggest avoiding researching a single group since it may review only the facilitator’s style with those particular group members. The chapter now moves on to explore the therapeutic groups within the study.