ENTER Webinar 2024:2 Invitation to the next generation mental health researchers
The March 2024 webinar, once again considered the theme of the ‘next generation of mental health researchers and research’. We invited 4 young researchers to discuss their research project. The webinar focused on research ideas, beliefs about research actions in the future, collaboration between doctoral students within the ENTER network and challenges, which young researchers face today and how it impacts their research choices. The presentations will be followed by a conversation on what are the needs of researchers in the ENTER network, how can the network support young researchers and what can the network learn from young researchers. ​Videos from the presentations are available below.
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Emanuela Nadia Borghi (St. Andrews)
Rethinking the female body after violence
My doctoral project, Rethinking the female body after violence, lies at the intersection of medical anthropology, anthropology of gender and violence, and explorations of mental health problems among marginalised and vulnerable women. This project speaks directly to research on global mental health and future actions within trauma-informed care settings.
I focus on how trauma is embodied by survivors of gender-based violence and how it shapes their everyday trajectories. I am analysing the impact of the medicalization of trauma and mental illness stigma on survivors across their daily lives as well as therapeutic and medical domains. During my long-term fieldwork in Italy (Milan, February 2018- March 2019 and June 2021-June 2022) I participated in the psychotherapy sessions of about 40 survivors of gender-based violence. I combined ethnographic methodology (long-term participant observation, semi-structured interviews) with the collection of survivors’ narratives of violence and mental health problems, as well as professionals’ narratives of medical knowledge.
Through qualitative data, my research offers a nuanced and person- centred understanding of the intersection between gender-based violence and trauma in shaping female mental health. Female survivors are most frequently diagnosed with mental disorders (post-traumatic stress disorder, anxiety disorder, depressive disorder, eating, and substance use disorder) and injuries (fractures, wounds, contusions, burns, and poisoning) (Istat, 2023). The impact of gender-based violence on mental health is an important precipitant of mental health problems in women. Responses to severe forms of trauma are highly varied and subjective, further reflected in the diversity of trauma-related symptoms experienced by survivors. In my research, I unpack the variety of embodied responses to trauma to expand on the complexity and plurality of the human experience of gender-based violence. I analyse women’s ways of ‘being-in-the-world’ while experiencing mental health problems within a specific non-governmental and institutional framework; the humanitarian system in Lombardy.
The aims of my current and future projects are:
· To provide a multi-layered and person-centred understanding of vulnerable people’s experiences of trauma and an acknowledgment of the impact of mental health problems on vulnerability.
· To provide qualitative data which are able to inform more targeted interventions and trauma-informed services for vulnerable people.
· To increase health professionals’ expertise in the field of trauma in order to conduct more effective counselling and care for vulnerable people across public health and non-governmental organisations.
· To promote a more inclusive and trauma-informed setting to conduct research with vulnerable participants by enhancing the understanding of cultural diversity within a group of research participants.
This anthropological knowledge about lived experiences of trauma will provide a human-centred perspective and will illuminate trauma-informed approaches for recovery and research with vulnerable people. This contribution will highlight the value of subjective accounts collected in the field as data that offers a nuanced understanding of mental health and vulnerability.
Ann-Marie Bright (University of Limerick)
Prison-based mental health services: perspectives of women in prison and prison personnel
Background
It is estimated there are approximately 744,000 women and girls detained in prison settings at any given time. The World Health Organisation estimate of this number greater than 80% will experience mental health problems. Most crimes committed by women are in the context of trauma, poverty and vulnerability.
Aim
The aim of this research is to explore the experiences of women in prison and the perceptions of prison personnels in the context of Irish prison-based mental health services.
Methods
Forty-five (n=45) semi-structured interviews were conducted in the Republic of Ireland; n=25 with women in prison and n=20 with prison personnel. Data were analysed using Reflexive Thematic Analysis. Ethical approval was granted by the Irish Prison Service (07_21) and Education and Health Sciences Research Ethics Committee, University of Limerick (2021_10_09_EHS_OA).
Findings:
Five key themes were identified. From women’s accounts, prison can provide safety from domestic violence, substance use and poverty. However, women have little knowledge of what services are available to them. Barriers to accessing mental health services in prison include a lack of mental health service provision, staff shortages and challenging relationships.
Conclusion and impact
There is a need to further develop the mental health services in women’s prisons to better meet the needs of this vulnerable population.
Elissa Thompson (City, University of London).
Two sides of the same coin? Disentangling the similarities and differences between Autism and Personality Disorder in women and people socialised as female.
International authors have theorised that there are five key areas of apparent overlaps between autism and personality disorder: emotions, behaviour, cognition, identity and interpersonal interactions – potentially leading to diagnostic overshadowing, missed or misdiagnoses (Parker 2019; Gordon and Lewis 2020; Hofvander et al 2009; Lai and Baron-Cohen 2015; Lugnegård et al 2012; Takara 2015).
This mixed methods investigation aims to use lived experience evidence from 41 women, or people socialised as female, to look at any potentially important yet under-investigated differences between Autism and ‘personality disorder’; a clearer understanding of which is vital for more accurate diagnosis and more appropriate treatment. Under-recognition of Autism in women diagnosed with a personality disorder may stem from a lack of understanding of how Autism presents in women.
This primarily qualitative project uses exploratory interviews and validated quantitative clinical screening and diagnostic measures such as the AQ10 (Baron-Cohen et al 2001) and SCID (First, 2014), aimed at investigating the lived experience of the areas of overlap outlined above – a first of its kind. In addition, we incorporated cognitive interviews to investigate participants’ experiences of completing these validated assessment tools. Data was collected in the United Kingdom between the months of February and November, 2022.
Analysis has begun; descriptive statistics are being used to characterise the self-report data. and ‘Ideal Type’ analysis is being applied to the lived experience interviews. Triangulation of qualitative and quantitative data will involve presenting quantitative and demographic data alongside Ideal Type ‘typologies’ or groups of participants that share similar characteristics. Preliminary results indicate complex interrelationships between Autism and personality disorder that are difficult to disentangle and often relate to individual heterogeneity.
The author takes a critical stance to the conceptualisation of separate categorical diagnoses and engaging with emerging theories from the work of Sven Bolte (Bolte et al 2019; 2021) and the International Classification of Functioning, Disability and Health (ICF). ‘Personality disorder’ as a diagnosis has been increasingly criticised by many due to its lack of validity and evidence base. While analysis of the empirical data continues, the significant overlaps suggest a lack of clarity and the author hypothesises, rather than differentiating between Autism and personality disorder, we may need to consider improving recognition of Autism or autistic experiences within people who attract a ‘personality disorder’ diagnosis. The important role of complex trauma will also be discussed.
Heidi Rantanen, (Tampere University)
Child Maltreatment
Child maltreatment(CM)is a global and serious ethical problem. However, relatively little research has been done on the early prevention of CM. The Finnish Nursing Research Foundation (NRF)has updated and published in 2022 a Clinical Practice Guideline: “Identification of risk conditions of child maltreatment in a family” regarding CM prevention in the family context. It is based on a systematic literature review and includes evidence-based risk factors for CM, where one major risk factor is the varying degrees of mental health challenges faced by parents. Based on this evidence, in the EU project (ERICA) a Family Needs Checklist(FNC)and its online application were developed for parents to assess their needs.
My dissertation study aims to validate the FNC and produce information on living in family conditions that increase the risk of CM from the perspective of parents and science.
In the first phase of the study, research data on the experiences of parents (experts-by-experience) who live or have lived in CM risk conditions (n=20) are collected by interview, and the data is compared to the research evidence contained in the Clinical Practice Guideline. Additionally, data on the suitability of the checklist is gathered by the survey from the parents and is utilized to finalize the checklist.
In the second phase, the checklist is tested in dialogue between the parent(n=160) and various social and health care professionals (n=16).Its suitability is assessed using interview data collected from professionals and used to finalize the checklist. The interviews are analyzed using a qualitative content analysis method. The survey data is analyzed using both qualitative and quantitative methods.
In the third phase, the results are examined from the point of validity, the checklist is brought to its final form, and its contents and instructions for use are presented in the summary section of the dissertation.