Evaluating threshold domain achievement: methodological findings from a qualitative study with people that have been in psychiatric hospital
Brunner, Richard (2018). 'Evaluating threshold domain achievement: methodological findings from a qualitative study with people that have been in psychiatric hospital' Paper presented at the annual conference of the HDCA, Buenos Aires, Argentina 2018.
This paper presents methodological findings from a qualitative study in Scotland adapting the well-established and normative capabilities domains framework to explore what people with experience of being in psychiatric hospital were subsequently able to be and do in life. Across the advantaged world, people with psychiatric involvement tend to experience poor social outcomes, marginalisation and stigma, and reduced substantive choice. Traditional medicalised mental health research tends to focus on service use and to categorise people by psychiatric diagnosis, so minimising lived subjective assays of mental distress, contexts, temporality, and life as including, but not defined by, mental distress. This study sought to apply the domains framework in order to explore how the capabilities approach could work with these broader dimensions.
Twenty-two people aged between 24 and 64 and living in the city of Glasgow, who had spent varying amounts of time in psychiatric hospital and received a wide range of psychiatric diagnoses, were interviewed twice about their lives. First, narrative interviews were used to explore what people were able to do and be in life after psychiatric hospital. This data was then used to inform the development of a Capabilities Domains Diagram for this population group, building on domains previously proposed by Nussbaum (2006) and Burchardt and Vizard (2011). This Capabilities Domains Diagram was then used as a discursive tool to frame individual discussions with participants at interview two. The use of the Capabilities Domains Diagram sought to: enable participants to identify domain thresholds breached across time; operate as a participative device to enable participants to highlight domains of unanticipated significance; explore the operation of corrosive disadvantages and fertile functionings for participants; examine subjective interpretations of domain achievement through capabilities or functionings.
Using the Capabilities Domains Diagram to frame the second interviews drew out distinctive data from the narrative interviews. This included highlighting breaches of the domain ‘enjoying individual, family and social life’ in terms of having children; and that for some people with mental distress caring for an animal is central as a functioning, even to the point of protection of the life domain. The research design therefore enabled subjectivity (voice) on threshold breaches, and on domain interpretation. It also affirmed the domains’ basic value in evaluating how far particular social groups may be from achieving good social outcomes.
In relation to the operationalisation of the domain thresholds concept, the paper offers further insights into: subjectivity, objectivity and the evaluation of threshold domain achievement; security of threshold domains over time; the interpretation of corrosive disadvantages and fertile functionings; and choices in measuring domain achievement using capabilities or functionings. These findings contribute to ongoing dialogue within the capabilities approach in relation to the evaluation of threshold achievement. The findings and method are also applicable to qualitative research with other social groups at risk of domain threshold breaches.