Conversion Factors re-examined: Using the Capability Approach as an analytical framework for qualitative research in mental health

Brunner, Richard (2014). 'Conversion Factors re-examined: Using the Capability Approach as an analytical framework for qualitative research in mental health' Paper presented at the annual conference of the HDCA, 2-5 September 2014, Athens, Greece.

The WHO identify mental distress as both a direct cause of mortality and morbidity and a significant risk factor for poorer economic, health and social outcomes, with depression being a key morbidity by 2020. While macro level data indicate that those experiencing mental distress face social and economic injustices, empirical questions remain about the mechanisms at personal, social and structural levels that generate these injustices, and about the qualitative experiences of individuals. This paper offers some preliminary findings from an in-depth qualitative study in Scotland using the Capability Approach as an analytical framework to explore what a sample of people with experience of the psychiatric system are subsequently able to do and be in life.

Sen and Nussbaum successfully argue for human diversity, disability and health differences to be accounted for in the Capability Approach. However, neither author fully engages with the experiences and lives of those with mental distress. It can be argued that each author also underplays the normative power of the state. Yet state structures and resultant policies and practices can be of particular significance in shaping the agency and wellbeing of people with mental distress, especially those who have formal contact with the psychiatric system, including diagnosis and hospitalisation.

Other writers have considered the possibilities within the Capability Approach to fully explore the injustices experienced by those with mental distress. Wallcraft (2010) suggests that by analysing the power of diagnosis and treatment to create capability deprivation the Capability Approach may reconfigure social understandings of mental distress. She also suggests that personal experience as evidence is needed to explore the actual hopes, needs and wishes for a full life of people with mental distress. Hopper (2007) argues for the application of capabilities to social recovery in schizophrenia due to its ability to engage agency, structure and diversity. Davidson et al (2009) suggest that the capabilities principles of self-determination and diversity offer a significant new conceptual framework for explaining how the lives of people with mental distress living in the community are shaped. The U.S mental health consumer movement has increasingly drawn on capabilities to advocate for social justice, and several small-scale U.S studies have indicated potential for qualitative approaches in mental health framed by the Capability Approach.

In the present study, twenty two people aged between 24 and 64, who have spent varying amounts of time in psychiatric hospital and received a wide range of psychiatric diagnoses, were interviewed about their lives. Reconfiguring Sen's Conversion Factors has proved analytically fruitful for the interpretation of findings. In particular it has facilitated understanding of how agency for people in the sample is structured in complex ways through personal experiences, social relations and structural norms, leading to more freedoms for some participants and more constraints for others. The paper concludes by reflecting on how social justice outcomes for different people with mental distress are produced, and on the methodological implications of the study.

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