The long sleep-over: the lived experience of teenagers, parents and staff in an adolescent psychiatric unit

Abstract

Adolescents are in a particular life cycle stage that involves numerous psychosocial changes. When this stage of life is compounded by serious mental health difficulties, the effects can have significant repercussions for both teenager and family. For some adolescents, an extended inpatient stay is necessary in order to address these difficulties. This research investigates the subjective experience of adolescents, their parents and staff who live, work and have a child in such a facility; the Barrett Adolescent Centre (BAC) located in Brisbane Australia. The qualitative study was completed by the sole social work practitioner who was employed at the Unit for over eight years. The Unit was a long stay residential facility and provided the opportunity to collect data over an extended period of time. The research therefore emerges from an insider, practitioner-researcher context. The primary research question focused on how the collective experiences of adolescent consumers, parents and staff can inform mental health practice in adolescent residential settings. A review of the literature suggests that there is a strong tendency to incorporate concepts from the adult mental health literature into adolescent mental health practice. The notion of recovery is an example, which is heavily influenced by conceptualisations of adult experience. Consequently, the aim of the present research was to better understand the participants holistically, but also in the appropriate developmental context; incorporating the social, emotional and experiential domains that form the lived experience of inpatient life. Broadly speaking, the key areas of interest included how the notion of recovery was experienced by the adolescents, the experiences of the parents during their child’s inpatient stay, and the experiences of the staff while helping the adolescents. The research emphasises and values subjectivity as well as the interpretation of significant personal experience. Subsequently, the study is located within an interpretative phenomenological analysis frame. It is also informed by critical realism that posits that mental illness is an objectively real phenomenon, though experienced uniquely by each individual affected by it. Semi-structured interviews formed the basis of the data, involving the three population groups of adolescent inpatients, their parents and staff. A total of 13 adolescents, 10 staff and 8 parents were interviewed. Single interviews were utilised for all participant groups as well as a small focus group of the three primary staff professions; that of Allied Health, Nursing and Education. The use of photography was also utilised with the adolescents in order to explore various facets of the therapeutic milieu from their perspective. The adolescents were also offered successive interviews over a number of months to enrich the picture of inpatient life. Elements such as family, education, consumer-staff relations as well as the recovery process were investigated. Hermeneutical thematic analysis uncovered rich experiences unique to each participant group, as well as common experiential domains for all. The results also demonstrated a complex interplay of relationships between the adolescents, parents and staff. The use of photography in particular, created powerful imagery that helped capture these complex and often hard-to-articulate experiences. Results highlight the crucial role relationships play for adolescent recovery, as well as the necessity of incorporating a developmentally-informed framework. The concept of ambiguous loss was a most notable experience for the parents, while the narratives of the staff brought to light concepts such as the ‘BAC personality’; the professional who is able to embrace workplace pain while remaining hopeful for a better future. Drawing on the above data revealed a range of elements crucial to adolescent mental health recovery such as the importance of fit between adolescent and hospital environment, a supportive management that contains the anxieties of staff while valuing a developmentally-informed practice, and an open collaboration between parents and staff. The study reinforces the importance of a developmental lens in understanding the requirements of adolescents with mental health problems and the supportive needs of parents during their child’s recovery. Adolescent mental health recovery can be conceptualised as a developmental reconstruction, expressed through the 5 principal themes uncovered in the study. The importance of a reflexive stance for practice is also emphasised. The study contributes to the knowledge base of clinicians and researchers who work with adolescents in mental health settings at individual, family and organisational levels. It also contributes to the body of insider/practitioner research by detailing the vicissitudes of conducting research in one’s own organisation.