Rethinking rehabilitation: the lived-experience of service users in mental health rehabilitation services

Introduction: Community-based mental health rehabilitation is increasingly viewed as
occupying a central position within the spectrum of care available to people with 'severe
mental illness' (DH, 1999, pp.5). The definitions of rehabilitation informing this care
primarily originate from service providers; service user understandings and experiences of
rehabilitation have been inadequately explored, and the relationship between it and the
potentially related concept of 'recovery' has not been examined. This study begins to
address these issues by exploring the lived-experience in mental heath rehabilitation
services, with specific attention to understandings and experience of rehabilitation. In
doing so, it seeks to promote a fuller understanding of rehabilitation, benefiting the
development and delivery of services, whilst providing a foundation from which the
desirability of a unified definition of rehabilitation can be considered.
Method: Semi-structured, audio-recorded interviews were undertaken with eight
participants (seven men and one woman) recruited from 24-hour nurse-supported
community mental health rehabilitation provisions. Interviews were transcribed verbatim
and analysed using Interpretative Phenomenological Analysis (Smith & Osborn, 2003).
Results: Analysis yielded the three master themes of (i) 'Positioning of Power'; (ii)
'Moving Forward' and (iii) 'A Conducive Setting'. Within these themes respectively, the
six subordinate themes of (i) 'Control' and 'Meeting Standards', (ii) 'Being Involved in a
Process' and 'Independence through Skills' and (iii) 'Relationships, Re-engagement and
Togetherness' and 'Nurturing Environment' were identified.
Discussion: The analysis is discussed in relation to the extant literature base, with
particular focus on relationships, power, independence, and moving on through services.
Implications are identified and recommendations for clinical practice and research are
considered.
Critical review: The study is reviewed with specific attention to its limitations, quality and
control, and the impact of researcher factors on the research process.

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