Lived Experience Of Mental Illness Research Articles

Designing community sports-based programmes for men with mental illness: A qualitative study of the Offload rugby league programme

Despite the increasing appeal of community sport programmes which focus on men's mental health, the key design characteristics of these programmes, and the roles played by delivery staff in their conception and development, have not yet been systematically or widely studied. In this qualitative paper we address this gap in knowledge by reporting on interviews with stakeholders (n = 18) from north-west of England involved in designing a men's rugby league community-based mental health programme, Offload. Findings suggest that tacit forms of knowledge, developed through years of professional practice and co-production activity, was critical to how men's mental health was conceptualised and the use of existing non-clinical community assets (e.g. professional club stadia) as delivery sites for the programme. The use of non-stigmatising language, supported by opportunities for men to engage in non-threatening and solutions-focused activities, were central to programme design. The use of former professional sportspeople who recall their own lived experience of mental illness, and personal adversity, in programme sessions was deemed important for engendering trust among men and enabling them to engage in modelling alternative forms of masculine behaviour which can enhance mental health and encourage greater help-seeking. The paper concludes by arguing for a relational understanding of community sport and mental health programmes, since our data indicate that by focusing on the networks of relationships involved in Offload and the social contexts in which it was to be delivered, the programme designers effectively leveraged the benefits of their collective expertise to maximise men's engagement.

Consumer experiences of community-based residential mental health rehabilitation for severe and persistent mental illness: A pragmatic grounded theory analysis.

Semi-structured interviews were used to explore the consumer experience of community-based residential mental health rehabilitation support at Community Care Units in Australia. These clinical services provide recovery-oriented residential rehabilitation to people affected by severe and persistent mental illness. Typically, nurses occupy the majority of staff roles. However, two of the three sites in the study were trialling a novel integrated staffing model where the majority of staff were people with a lived experience of mental illness employed as peer support workers (PSWs). The interviews explored consumers' experiences of care 12-18months after admission. Fifteen interviews were completed with an independent interviewer. Most participants were diagnosed with schizophrenia or a related psychotic disorder. The analysis followed a pragmatic approach to grounded theory. Consumers viewed the CCU favourably, emphasizing the value of the relationships formed with staff and co-residents. No major differences in consumers' experience under the traditional versus integrated staffing models were identified; however, those from the integrated staffing model sites valued the contributions of the peer support workers. The understanding of the consumer experience emerging through this study aligned with their expectations of the service at the time of commencement.

Simulated Patient Role-Plays with Consumers with Lived Experience of Mental Illness Post-Mental Health First Aid Training: Interrater and Test Re-Test Reliability of an Observed Behavioral Assessment Rubric.

Mental Health First Aid (MHFA) training teaches participants how to assist people experiencing mental health problems and crises. Observed behavioral assessments, post-training, are lacking, and the literature largely focuses on self-reported measurement of behaviors and confidence. This study explores the reliability of an observed behavioral assessment rubric used to assess pharmacy students during simulated patient (SP) role-play assessments with mental health consumers. Post-MHFA training, pharmacy students (n = 528) participated in SP role-play assessments (n = 96) of six mental health cases enacted by consumers with lived experience of mental illness. Each assessment was marked by the tutor, participating student, and consumer (three raters). Non-parametric tests were used to compare raters’ means scores and pass/fail categories. Interrater reliability analyses were conducted for overall scores, as well as pass/fail categories using intra-class correlation coefficient (ICC) and Fleiss’ Kappa, respectively. Test re-test reliability analyses were conducted using Pearson’s correlation. For interrater reliability analyses, the intra-class correlation coefficient varied from poor-to-good to moderate-to-excellent for individual cases but was moderate-to-excellent for combined cases (0.70; CI 0.58–0.80). Fleiss’ Kappa varied across cases but was fair-to-good for combined cases (0.57, p < 0.001). For test re-test reliability analyses, Pearson’s correlation was strong for individual and combined cases (0.87; p < 0.001). Recommended modifications to the rubric, including the addition of barrier items, scoring guides, and specific examples, as well as the creation of new case-specific rubric versions, may improve reliability. The rubric can be used to facilitate the measurement of actual, observed behaviors post-MHFA training in pharmacy and other health care curricula.

The impact of lived experience on health care workers' knowledge, attitudes and behaviour regarding mental illness

Background/Aims The literature suggests that many health care workers hold stigmatising attitudes towards mental illness. This study aimed to ascertain information regarding the impact of lived experience on health care workers' knowledge about mental illness, attitudes towards mental illness and intended behaviours towards people who experience mental illness. Methods This quantitative study used a questionnaire survey of health care workers employed in four National Health Service Trusts (n=2073). Statistical analyses were conducted. Results Lived experience of a mental illness (self or family member) was associated with more favourable knowledge about mental illness, attitudes towards mental illness and intended behaviours towards those with a mental illness. Conclusions The lived experience of mental illness among health care workers could be harnessed as a resource to improve service delivery. There should be a long-term commitment to capitalising on the benefit to patient care of lived experience among health care workers.

Narrative review of mental illness in cricket with recommendations for mental health support

IntroductionEpidemiology reporting within the cricketing medical literature has emerged over the past 2 years, with a focus on physical injuries. Despite mental health in elite sport gaining increasing recognition, few...

Health care providers and people with mental illness: An integrative review on anti-stigma interventions.

Health care providers are an important target group for anti-stigma interventions because they have the potential to convey stigmatizing attitudes towards people with mental illness. This can have a detrimental impact on the quality and effectiveness of care provided to those affected by mental illness. Whittemore & Knafl's integrative review method (2005) was used to analyze 16 studies investigating anti-stigma interventions targeting health care providers. The interventions predominantly involved contact-based educational approaches which ranged from training on mental health (typically short-term), showing videos or films (indirect social contact) to involving people with lived experiences of mental illness (direct social contact). A few studies focused on interventions involving educational strategies without social contact, such as mental health training (courses/modules), distance learning via the Internet, lectures, discussion groups, and simulations. One study investigated an online anti-stigma awareness-raising campaign that aimed to reduce stigmatizing attitudes among health care providers. Anti-stigma interventions that involve social contact between health care providers and people with mental illness, target specific mental illnesses and include long-term follow-up strategies seem to be the most promising at reducing stigma towards mental illness among health care providers.

VA Peer Providers Supporting Physical Health and Wellness Among Aging Veterans With Mental Health Conditions

There is a growing evidence base for the utility of peers in supporting physical health outcomes among aging Veterans with mental illness. This talk will consider two questions: (1) what does it mean to be a “peer” when the focus is improving physical health, and (2) how does peer support promote health behavior change? In considering these questions, select peer-delivered interventions recently or currently being tested in the VA will be discussed. Data from qualitative interviews (N=16; ages 47-75) from a recent RCT of Living Well, a peer co-facilitated group intervention promoting illness self-management, will be presented. These data shed light on the peer role, especially the role of peer self-disclosure in promoting group cohesion, social learning, self-efficacy, and health behavior change. Notably, when physical health is the focus, participants relate to peer providers across diverse characteristics, and not necessarily based on a shared lived experience of mental illness.

The Acousmatic Gap as a Flexile Path to Self-Understanding: A case for experiential listening

Since Schaeffer’s development of musique concrète, there has been an ongoing debate regarding the value of the acousmatic reduction for engaging with real-world sound in music, and its relevance for composers and listeners. This article presents a way of working with acousmatic sound that is more meaningful to me as a composer, which I have labelled experiential listening. In understanding acousmatic sound through the lens of experientialism (as opposed to Schaeffer’s use of phenomenology), I have devised this method to form a dialogue between sound, composer, and listener through the use of metaphor, to explore concepts beyond the experience of just sound in itself while composing. It accounts for the felt sense of intuition that can form through working with acousmatic sound, presenting a way of using this as a tool for self-understanding. It highlights Brian Kane’s ontology of acousmatic sound as the being of a gap, exploring where this gap can take the mind of the composer and listener. This is illustrated through my use of experiential listening to gain insights into lived experiences of mental illness and trauma, which reveals inner wisdom about the listening self that can be negotiated through acousmatic sound.

Stop. Rewind. Replay.: Performance, police training and mental health crisis response

Can performance be the means by which a ‘Use of Force‘ paradigm in police training is decentralized? Footage of lethal force encounters between police and individuals in mental health crisis is ceaselessly in the news cycle, dispersing eyewitness accounts to millions who watch the endless replay of these incidents on social media. In the replay of these incidents, spectators observe with bewilderment the missed opportunities, the alternative courses of action that seem so apparent to the outside eye–all that could have been done differently. What if officers themselves could hit rewind and replay on the lethal force encounter with an individual in mental health crisis? Can performance be a vehicle for embodied replay and repetition that generates and makes tacit new forms of bodily knowledge? When performance is made the operative framework in police training, it can set the stage for scenarios that seem reassuringly familiar. But in its high-fidelity repetition of the familiar, performance can de-realize patterns of recognition, altering the course of entrained decision-making to make alternative pathways towards peaceful resolution conceivable, actionable and possible. In this article, Alvarez examines the methodological implications of a four-year research study she conceived in 2016 and initiated in 2017 in Toronto, Canada to design and measure the efficacy of a scenario-based training programme to improve police response to individuals in mental health crisis, with co-investigators Dr Yasmine Kandil (University of Victoria) and Dr Jennifer Lavoie (Wilfrid Laurier University), and a national team of theatre makers; people with lived experience of mental illness; experts in communication, anti-discrimination and cultural safety curriculum design; community advocates; forensic psychologists; clinicians; and police trainers. The training is grounded in the belief that the deceptively familiar hypotheticals of scenario-based training can unsettle sedimented habits, stigmas, and assumptions and naturalize ways of knowing premised on procedural justice.

Impact of dynamic greenspace exposure on symptomatology in individuals with schizophrenia.

There are currently many tools available for capturing and defining the context of one’s environment. Digital phenotyping, the use of technology and sensors to capture moment-to-moment behavior, has shown potential in quantifying the lived experience of mental illness and in the identification of individualized targets related to recovery. Environmental data suggests that greenspace may have a restorative capacity on mental health. In this paper, we explore the relationship of greenspace derived from geolocation with self-reported symptomatology from individuals with schizophrenia as well as healthy controls. Individuals with schizophrenia had less exposure to greenspace than controls, but their exposure demonstrated a dosage effect: high greenspace environments were associated with lower symptoms for anxiety (Cohen’s d = -0.70), depression (d = -0.97), and psychosis (d = -0.94), whereas effect sizes for healthy controls were all negligible or small (d < 0.38). The notion that greenspace may have a more pronounced effect on individuals with mental illness presents both potential areas for recovery as well as implications for health care policy, especially in cities with a broad range of greenspace environments.

Pharmaceutical industry, academia and people with experience of mental illness as partners in research: a need for ethical guidance

Background: Several social and policy developments have led to research partnerships in mental health research, which depart from traditional research models. One form of such partnerships is among research institutions, industry (pharmaceutical and biotech) and people with lived experience of mental illness (RIPs). There are several benefits but also ethical challenges in RIPs. An ethics-based approach to anticipating and addressing such ethical issues in mental health research is lacking. Given the expansion of RIPs in treatment development for mental health illness, guidance to support ethical and trustworthy collaborative mental health research projects is essential. Methods: To develop a moral framework for evaluating the ethics of RIPs, we systematically searched PubMed for peer-reviewed literature discussing good practices in research partnerships. Searches were also conducted in websites of known organizations supporting patient engagement with industry in mental health research and in the references of short-listed articles. Following application of exclusion criteria, remaining articles were critically examined and summarised to synthesise principles for ethically acceptable RIPs and inform clear guidance and practices. Results: Critical analysis and synthesis of the short-listed articles highlighted the need for two sets of principles to guide ethical RIPs: principles for (a) RIPs as a trustworthy enterprise (e.g. public accountability, transparency) and (b) fair RIPs (e.g. effective governance, respect). We discuss the application of these principles in problem-solving strategies that can support best practice in establishing fair and successful mental health research partnerships among research institutions, industry and people with lived experience of mental illness. Conclusions: Ethical guidance is needed to prevent and address challenges in RIPs and to promote the scientific and social benefits of these new research partnership models in mental health research. We show how the proposed moral framework can guide research partners in designing, sustaining and assessing ethical and trustworthy collaborative mental health research projects.

Physical health assessment and cardiometabolic monitoring practices across three adult mental health inpatient units - a retrospective cohort study.

Australians with lived experience of mental illness die on average 10 or more years earlier than the general population. Cardiometabolic disorders, including cardiovascular disease and diabetes mellitus, are common causes of premature death in this cohort. Little is known about cardiometabolic monitoring practices in mental health inpatient units. The aim of this study was to examine the characteristics of cardiometabolic monitoring and physical health assessments of adult mental health consumers within the first 72hours of admission to an inpatient unit. We implemented a retrospective descriptive exploratory design by medical record audit. Data were collected using a pre-validated audit tool, adapted with recent literature and policy, from a randomly selected sample of consumers admitted to three acute mental health adult inpatient units of a large Australian metropolitan health service in 2016. Of 228 consumers, the mean age was 37.5 (range 18-64) years and 51.3% were women. Cardiometabolic risks were common, yet most consumers received incomplete cardiometabolic monitoring. While few consumers (15%) were diagnosed with cardiometabolic comorbidities, 67.5% were prescribed psychotropic medications with high cardiometabolic risk. Compliance with recommended cardiometabolic monitoring varied considerably between risk factors: for example, blood pressure was measured in 56.1% of consumers, whereas waist circumference was never recorded. There were no statistically significant associations between cardiometabolic monitoring completion and sex or cardiometabolic risk. These findings demonstrate the need for increased education and awareness of cardiometabolic risk and identify a critical gap between physical health assessment practices and recommendations for this cohort.

Student beliefs about their practice within a non-traditional mental health clinical placement

Therapeutic recreation programs utilize leisure to maximize a person's overall health and well-being. The focus of this study is a professional experience placement held within an outdoor recreation center involving student nurses and people with a lived experience of mental illness. The study aimed to explore student nurse's beliefs about their practice within the program setting. An ethnographic case study approach was used to focus on the development of student nurse practice in this setting. The analytic strategy derived the themes of the ethnographic case study, namely ‘who's who’, ‘clinical contrast’ and ‘recreation as practice’. A non-traditional mental health clinical placement would seem to have the potential in providing a new set of skills and experiences to these future nurses that may complement the scope of recovery-orientated care. The therapeutic recreation program provided the student with an experience where they could develop therapeutic relationships with people a lived experience of mental illness.

What are the barriers to, and enablers of, working with people with lived experience of mental illness amongst community and voluntary sector organisations? A qualitative study.

There is increasing emphasis on psychological and social approaches to managing and treating mental illness, including a growing evidence base on the effectiveness of community-based social interventions including arts and heritage activities, library programmes, volunteering schemes, nature-based activities and community groups. However, there is a gap in understanding of what the barriers to, and enablers of, working with individuals with mental illness might be for the community and voluntary sector. A qualitative approach was used involving focus groups with non-profit organisations delivering social activities within communities across the United Kingdom. Behaviour Change Theory, the COM-B model and the Theoretical Domains Framework, were employed as the theoretical framework, to develop interventions to address the barriers raised. Representatives of the organisations reported being motivated by the mental health needs of others, and by seeing the benefits of participation. Further motivations included expanding inclusion, and economic motivation to ensure sustainability. Strengths identified included offering innovative, responsive services that were distinct from conventional mental health services. Running these services demanded new and potentially challenging skills, such as understanding statutory responsibilities, and being able to train and support staff. Further challenges included maintaining boundaries between their roles as community organisations and clients' mental health needs and avoiding burn-out. Ability to deliver this work was enhanced by support of peer organisations and opportunities to share practice. However, funding was often short term, and complex to obtain, which could destabilise organisations' sustainability. Lack of transparency around the process, differences in language between the community and health sectors, and confusion around commissioning pathways undermined the potential opportunity offered by social prescribing policy. Interventions to address these barriers were identified, including long term funding to support core costs, training on engaging with the commissioning process, around mental health support and safeguarding, and developing mentoring schemes and local co-operatives of organisations for developing partnerships with the health sector.

Omunanamwengu (The Mad One): A Multiple Case Study of Individual and Familial Experiences of Madness Among the Northern Namibian Aawambo

To understand mental illness in cultural contexts, research should focus on locally informed concepts of illness and the lived experiences of such conditions. Understanding mental illness, its prevalence, and its influence on people’s lives in Namibia represents one such context where attention to the lived experience of mental illness remains understudied. The purpose of the current study was to build upon ethnographic findings about mental illness as madness ( eemwengu) among the Namibian Aawambo. To that end, a multiple case study design was used to explore the lived experience of being omunanamwengu (the mad one). Data were collected from four cases that were bound by the experience of mental illness. Within each case, the individual experiencing illness ( omunanamwengu), family members, and both omunanamwengu and family members were interviewed formally (via a semi-structured interview protocol) or informally due to participants’ preferences for not being recorded. Using Stake’s suggested approach to multiple-case study cross-case analysis, each individual case is described and cross-case themes (Development and Symptoms of Mental Illness; Marginalization and Omunanamwengu; Family Roles in the Lives of the Distressed and Eemwengu; Belief in Treatment) were identified. Findings are discussed in light of the role of beliefs in treatment as well as family involvement, the potential influence of discrimination on mental illness, and implications for practice and cross-cultural psychology.

Alternative mental health clinical placements: Knowledge transfer and benefits for nursing practice outside mental healthcare settings.

To explore whether nursing student's experiences at Recovery Camp have impacted their current nursing practices. Recently, there has been a move towards more holistic models of nursing care, which seek to break down barriers of stigmatisation and embrace the tenets of self-determination, to acknowledge people with lived experiences of mental illness and their ability to manage their recovery. In that regard, future health professionals such as nursing students will need to be educated in a manner that recognises the importance of lived experience. In this paper, we propose that Recovery Camp, an alternative clinical placement setting model, enhances clinical practice in multiple domains and is beneficial for both nursing practitioners and people with lived experiences of mental illness, as well as offering an effective nontraditional alternative to conventional clinical placement opportunities. This study employed a phenomenological research design, involving individual semi-structured telephone interviews. The Standards for Reporting Qualitative Research (SRQR) checklist was adhered to. Three main themes were identified from the analysis: (a) engagement, (b) understanding mental health and (c) holistic care. "I definitely look at people with mental health conditions in a different light." At Recovery Camp, participants felt that they had greater opportunities for engagement with people with lived experiences, and through this engagement, their preconceptions of mental illness began to change. Recovery Camp may have facilitated the transfer of knowledge that is more person-centred among nursing students, consequently impacting their current nursing practices. Nurses should be equipped with mental health skills regardless of their career trajectory. While Recovery Camp represents a promising approach to facilitate knowledge transfer, further investigation will be required to determine which other factors are instrumental. This approach may have wider implications for nursing education.

Peer Support in Mental Health: Literature Review.

BackgroundA growing gap has emerged between people with mental illness and health care professionals, which in recent years has been successfully closed through the adoption of peer support services (PSSs). Peer support in mental health has been variously defined in the literature and is simply known as the help and support that people with lived experience of mental illness or a learning disability can give to one another. Although PSSs date back to several centuries, it is only in the last few decades that these services have formally evolved, grown, and become an integral part of the health care system. Debates around peer support in mental health have been raised frequently in the literature. Although many authors have emphasized the utmost importance of incorporating peer support into the health care system to instill hope; to improve engagement, quality of life, self-confidence, and integrity; and to reduce the burden on the health care system, other studies suggest that there are neutral effects from integrating PSSs into health care systems, with a probable waste of resources.ObjectiveIn this general review, we aimed to examine the literature, exploring the evolution, growth, types, function, generating tools, evaluation, challenges, and the effect of PSSs in the field of mental health and addiction. In addition, we aimed to describe PSSs in different, nonexhaustive contexts, as shown in the literature, that aims to draw attention to the proposed values of PSSs in such fields.MethodsThe review was conducted through a general search of the literature on MEDLINE, Google Scholar, EMBASE, Scopus, Chemical s, and PsycINFO. Search terms included peer support, peer support in mental health, social support, peer, family support, and integrated care.ResultsThere is abundant literature defining and describing PSSs in different contexts as well as tracking their origins. Two main transformational concepts have been described, namely, intentional peer support and transformation from patients to peer support providers. The effects of PSSs are extensive and integrated into different fields, such as forensic PSSs, addiction, and mental health, and in different age groups and mental health condition severity. Satisfaction of and challenges to PSS integration have been clearly dependent on a number of factors and consequently impact the future prospect of this workforce.ConclusionsThere is an internationally growing trend to adopt PSSs within addiction and mental health services, and despite the ongoing challenges, large sections of the current literature support the inclusion of peer support workers in the mental health care workforce. The feasibility and maintenance of a robust PSS in health care would only be possible through collaborative efforts and ongoing support and engagement from all health care practitioners, managers, and other stakeholders.

Mental health nursing and the prenatal diagnosis of a congenital anomaly; a narrative of experience.

Many parents find out that their unborn baby has a difference in their health, development, or genetics. This news is often unexpected and can be distressing and traumatic, which can lead to anxiety. There is a gap in support for parents. This paper offers a story of the lived experience of the first-author, a mental health nurse who was told that her baby had a difference late in pregnancy. The narrative moves through the anxiety and difficulties faced when falling between gaps in the systems. This paper identifies the need for more support for parents who receive a prenatal diagnosis. This support is within the mental health nurse scope of practice across a range of settings and services. People who have been given a psychiatric diagnosis have been excluded from other studies that explore the experience of the unexpected news of a congenital anomaly. Research in this area is indicated. Mental health nurses are well-positioned to address the gap in psychosocial support for parents who have received a prenatal diagnosis. As clinicians who are recognized to deliver federally funded pregnancy support counselling, psychosocial support is within the mental health nurse scope of practice. Some parents will require a higher level of support, assessment and intervention when they experience reactive mental illness or pre-existing mental illness is exacerbated. Furthermore, people who have received a psychiatric diagnosis have been excluded from studies that explore the experience of receiving a prenatal diagnosis. This exclusion has resulted in a gap in knowledge. Introduction Expectant parents who receive a prenatal diagnosis of a congenital anomaly often experience shock, distress and a heightened risk of mental illness. Aim This paper aimed to highlight the gap in psychosocial support for parents who receive a prenatal diagnosis through the personal narrative of a mental health nurse who received a third-trimester diagnosis. Method The first-author reviewed her medical records and photos to recall moments of the experience and prompt reflection. Findings The narrative moved through the shock, guilt and subsequent pathological anxiety that followed a prenatal diagnosis at 32-week gestation and the option to terminate. Discussion The gap in psychosocial supports for parents who receive a prenatal congenital anomaly diagnosis raises the risk to parental mental health and potentially confounds the risk to the baby. Mental health nurses are well-positioned as service providers to fill this gap. Implications for Practice The provision of psychosocial support after a prenatal diagnosis is within the mental health nurse scope of practice. This support may be provided through pregnancy support counselling, innovative nurse-led perinatal mental health services or as additional support to a parent with the lived experience of mental illness who receives a prenatal diagnosis of a congenital anomaly.

Towards clinically actionable digital phenotyping targets in schizophrenia

Digital phenotyping has potential to quantify the lived experience of mental illness and generate real-time, actionable results related to recovery, such as the case of social rhythms in individuals with bipolar disorder. However, passive data features for social rhythm clinical targets in individuals with schizophrenia have yet to be studied. In this paper, we explore the relationship between active and passive data by focusing on temporal stability and variance at an individual level as well as large-scale associations on a population level to gain clinically actionable information regarding social rhythms. From individual data clustering, we found a 19% cluster overlap between specific active and passive data features for participants with schizophrenia. In the same clinical population, two passive data features in particular associated with social rhythms, “Circadian Routine” and “Weekend Day Routine,” and were negatively associated with symptoms of anxiety, depression, psychosis, and poor sleep (Spearman ρ ranged from −0.23 to −0.30, p < 0.001). Conversely, in healthy controls, more stable social rhythms were positively correlated with symptomatology (Spearman ρ ranged from 0.20 to 0.44, p < 0.05). Our results suggest that digital phenotyping in schizophrenia may offer clinically relevant information for understanding how daily routines affect symptomatology. Specifically, negative correlations between smartphone reported anxiety, depression, psychosis, and poor sleep in individuals with schizophrenia, but not in healthy controls, offer an actionable clinical target and area for further investigation.

Anthropological perspectives on the trajectory from institutionalisation to community care in Irish psychiatry.

The trajectory of the anthropology of Irish psychiatry, like the trajectory of Irish psychiatry itself, is indelibly shaped by the history of Ireland's mental hospitals. This paper focuses on three works concerning the anthropology of psychiatry in Ireland: Nancy Scheper-Hughes's book, Saints Scholars and Schizophrenics: Mental Illness in Rural Ireland, an anthropological study (1977/2001); Eileen Kane's paper, 'Stereotypes and Irish identity: mental illness as a cultural frame', from Studies: An Irish Quarterly Review (1986) and Michael D'Arcy's conference paper, 'The hospital and the Holy Spirit: psychotic subjectivity and institutional returns in Dublin, Ireland' (2015), based on his PhD dissertation. All three publications explore the relationship between institutional and community psychiatric care in Ireland, concluding with the work of D'Arcy which, like much good anthropology, is rooted in the lived experience of mental illness and combines deep awareness of the past with tolerance of multiple, ostensibly contradictory narratives in the present.