Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support by Advantage Point

Stronger Together:

The Troy Social Club Model of Peer-Led Participation and Mental Health Support Gloria Kirwan and Calvin Swords

Acknowledgements

We would like to acknowledge the participation and commitment of the members of the Troy Mental Health Association Social Club in all stages of this study. This report would not have been possible without the insights, openness and efforts of the members who participated in meeting with the researchers and introducing them to the club, taking part in the data collection strategies, reading drafts of this report and generally making the researchers welcome and supported. Two club members acted as the point of contact for the researchers and we are very grateful to them for their extensive assistance in helping us to complete this study. Thank you. Gloria Kirwan and Calvin Swords

Introduction

Introduction........................................................................................................................... 3 Background............................................................................................................................ 3 Troy Social Club Strategic Plan 2019-2021..................................................................... 5 Rationale................................................................................................................................. 6 Research Questions.............................................................................................................. 7 Methodology.......................................................................................................................... 7 Report Structure.................................................................................................................... 7 Chapter Summary................................................................................................................. 7

Literature Review

Methodology

Introduction........................................................................................................................... 9 Defining Recovery................................................................................................................. 9 Conceptualising Recovery.................................................................................................10 Contextualising Recovery..................................................................................................12 Recovery in the Irish Context ...........................................................................................13 Discussion.............................................................................................................................15 Chapter Summary...............................................................................................................15 Introduction.........................................................................................................................17 Methodology Rationale.....................................................................................................17 Timeline................................................................................................................................19 Semi-Structured Interviews..............................................................................................20 Material Ethnography........................................................................................................21 Research Sample.................................................................................................................21 Researcher Stance...............................................................................................................22 Data Analysis.......................................................................................................................23 Ethical Considerations.......................................................................................................23 Chapter Summary...............................................................................................................23

Findings

Introduction.........................................................................................................................25 Findings.................................................................................................................................25 General Benefits.............................................................................................................25 Recovery-Relevant Benefits.........................................................................................29 Troy Social Club: Future Potential...............................................................................39 Chapter Summary...............................................................................................................42

Discussion and Conclusions References

Introduction.........................................................................................................................45 Discussion.............................................................................................................................45 General Benefits.............................................................................................................45 Recovery-Relevant Benefits.........................................................................................47 Future Potential of the Troy Social Club....................................................................49 Conclusions..........................................................................................................................52 Chapter Summary...............................................................................................................53

References............................................................................................................................54

“I would just like to see, I would just like that people understand mentally ill people better …They are not just over there, they have a mental illness, put them there, putting them there in day centres and forgotten about. People shouldn’t be forgotten about, it’s not right for human beings, it’s not right, and that’s the way I feel about it.” (Member)

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Summary of Findings This study focuses on the views of members of the Troy Mental Health Association Social Club (Troy Social Club) regarding the benefits to them related to their membership of the club. TheTroy Social Club members who participated in the study identified a wide range of personal, social and peer group benefits related to their participation in the peer-led environment and activities of the club. In terms of benefits related to mental health recovery, Troy Social Club members perceived that membership of the Troy Social Club enhances their recovery journey in the following ways: • Through the club activities and the relationships which develop among the membership, members experience a sense of social connectedness which includes having access to an interesting and regularly available social outlet; • Through membership of the Troy Social Club, the members feel hopeful about coping with their mental illness because they no longer feel alone when experiencing what are sometimes very distressing symptoms; • Members of the Troy Social Club reported club membership as providing them with a positive self-identity. • The Troy Social Club members who took part in the study reported that they perceive a culture of support and unconditional acceptance in the Club. Participants described the Troy Social Club as a place and a social context through which they can work on their recovery goals with others who understand what they are experiencing and from whom they can receive meaningful support. Thus, Troy Social Club membership offers members a meaningful role in the support they can offer to each other. Participants also reported feeling more confident to engage in social activities external to the club due to the positive social interactions they experienced arising fro their involvement in the club. • The study found that being a member of the Troy Social Club instils a strong sense of empowerment in members derived from making the effort to attend the Club and, when possible, participating in its activities. The members also expressed feelings of empowerment related to the active involvement of members in deciding the club programme.

“Members of the Troy MHA Social Club know that the keys to recovery are empowerment, being given responsibility in a safe environment, being recognised for one’s skills and having a safe social place to feel involved. This is the essence of Troy MHA Social Club (Troy MHA Strategic Plan, 2019-2021)

The participants in this study expressed a range of views regarding the future of the Troy Social Club. All participants expressed a wish to see the Club continue and some suggested that it has the potential to grow in terms of the times it opens and the range of activities available. Participants highlighted the importance of securing the resources necessary to keep the club in operation while at the same time also wanting the Club’s autonomy to be preserved. Participants expressed the view that there is an unmet demand for similar clubs in many localities across the country and they suggested that the availability of clubs similar to the Troy Social Club would be to the advantage of mental health service users in other locations.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Introduction Introduction.................................................................................................. 3 Background................................................................................................... 3 Troy Social Club Strategic Plan 2019-2021............................................ 5 Rationale........................................................................................................ 6 Research Questions..................................................................................... 7 Methodology................................................................................................. 7 Report Structure........................................................................................... 7 Chapter Summary........................................................................................ 7

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

The Troy Social Club operates as a club for people who are recovering from mental illness including schizophrenia, depression and anxiety (Troy, 2019). In 2018, the Management Committee of the Troy Mental Health Association Social Club (hereafter in this report referred to as the Troy Social Club) embarked on a strategy to document the benefits of club membership and to ascertain if members of the club identified club membership as helpful to them in their individual efforts to work on their recovery objectives. On behalf of the Troy Social Club members, the club’s Management Committee enlisted the voluntary assistance of two researchers, Dr Gloria Kirwan and Calvin Swords, to conduct a study on the views of club members regarding the benefits of club membership. In response to this request, the researchers conducted an independent, small-scale study of members’ perceptions of the club in general and their experiences of club membership.

Introduction

In the chapters that follow, a summary literature review on the topic of recovery in mental health is provided, the methods used to carry out the present study are explained and the findings of the study are set out. A set of conclusions is drawn from the findings of the study and these are set out in the final chapter of this report. The context and background to this study are outlined in the next sections of this chapter.

Background The Troy Social Club is located in Dalkey, a suburb located in the Dun Laoghaire/ Rathdown locality. It was set up by Gordon and Eileen Young in 1999 as a social club for people experiencing mental illness. It was named in honour of a local social worker, Kathleen Troy, whose work in the community was held in high regard. Initially, the Troy Social Club was associated with the Dublin Clubhouse Alliance but in 2010, approximately eleven years after its establishment, the club left this Alliance. At that point, the club was run by a committee of club members in conjunction with the Dun Laoghaire Mental Health Association. In 2018, the Troy Social Club became an independent voluntary organisation with a Trustee Management Committee (see Appendix A). Similar to its early days, the majority of members currently involved in the Troy Social Club are peer members, that is, people who self-identify as mental health service users. A proportion of people who regularly attend the club are supporters, carers or friends of peer members. The Troy Social Club is different from many other clubs for people with mental illness insofar as the peer members are centrally involved in and consulted on the issues relevant to the running of the club.

The club aims to provide members with a stigmafree, peer-led social outlet.

The Troy Social Club aims to recruit as members people who self-identify as experiencing mental illness, many of whom also regard themselves as on a recovery pathway. The club aims to provide members with a stigma-free, peer-led social outlet. Each week of the year, except for a break in the summer and at Christmas, the club is open one night each week from 6-9pm in a community facility located in the centre of Dalkey.

“

The Troy Social Club’s website expresses a general open invitation to new members: Join us every Friday evening - You are invited to join us in Dalkey every Friday evening from 7pm! Get the weekend off to a great start by coming to our social club in Dalkey!

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

In its Strategic Plan (Troy, 2019), the Troy Social Club’s activities are described as being chosen with specific reference to the needs of the peer members:

“

… for people with a mental illness or in recovery. We run a social club where there is no stigma and where members feel they can be themselves. We run pool, table tennis, bingo and snooker competitions. Competitions are run by members; keeping us all motivated and interested in what is going on. There can be up to 45 people in attendance on a Friday night. As well as providing a weekly social club we organise social outings and a couple of holidays each year for our members. In the past we have visited Athlone, Carlow and Listowel.

The Troy Social Club is actively engaged in the wider network of community mental health organisations. For example, four members represented the club at the Mental Health Ireland National Information and Networking Event in December 2019. The club also maintains an active social media presence through its Facebook page (www. facebook.com/troymha) where it posts a blog and also information on its events and community networking activities. In summary, the Troy Social Club is one of the longest running peerled clubs for mentally ill people in Ireland and one of only a small number of social clubs that are independently managed by carers and peer members

In summary, the Troy Social Club is one of the longest running peer-led clubs for mentally ill people in Ireland and one of only a small number of social clubs that are independently managed by carers and peer members. It has been engaged in providing a dedicated peer social space for over 20 years where people diagnosed with mental illness can meet others with similar experiences and through which they can engage in mutually supportive relationships and social activities. The profile of club members indicates that they generally reside in the greater Dublin area as well as North Wicklow and Fingal. Some members travel relatively long commutes in order to attend the club. Members are aged from 18 years and upwards. Generally, Troy Social Club peer members have a history of experiencing mental illness and/or addiction, and a small proportion of members are relatives, carers and friends of people with mental illness. Anyone can contact the listed club contact people to enquire about membership and self-referral is an important route of member recruitment for the club. Some members first hear about the club from their health care providers, social workers, other professionals or family members, although peer referral is the main membership recruitment pathway. In the Troy MHA Social Club Strategic Plan 2019-2021 (Troy, 2019), the resources of the Troy Social Club are listed as follows: 1. We receive our funding from the HSE, small private donations, and small fund-raising activities. 2. The club has no permanent premises or equipment, but rent a parish hall where we can store our equipment. This has been a stable relationship for a number of years. 3. We have no permanent staff, everything is organised by service users. 4. Governance structure is specified in our constitution.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Troy Social Club Strategic Plan 2019-2021 The Troy MHA Social Club Strategic Plan 2019-2021 (Troy, 2019) explains the ethos of the club and the types of activities which it provides in order to meet its objectives of supporting the recoveryof people with mental illness. At the weekly meeting, a range of activities takes place including pool, table tennis, bingo and board games. Members can join in any activity of their choice or they can simply avail of the refreshments while they mingle and chat with other club members. In addition, at specific times during the year, such as during the summer, members can avail of respite breaks and day respite trips organised by the Troy Social Club Management Committee to destinations such as Listowel, Trim and Athlone. The weekly meetings and organised outings are conducted in line with the peer support ethos of the Troy Social Club which is fundamental to all its activities and which defines what it is, what it does and most importantly, how it carries out its functions. The ethos of the Troy Social Club is described as fitting with the concept of peer support, a concept now gaining increasing international recognition for the benefits that flow from it and one which the club has been guided by since its foundation over 20 years ago. The Club’s structure fits with Solomon’s (2004) definition of a mutual peer support group in which opportunities for peer relationships provide a basis for individual and group support and growth. It also fits with Holter et al’s (2004) concept of peer-based organisations where members with experiences of mental illness and service usage support each other. The club operates an open-door policy in that anyone with a history of mental illness may join, and membership is not confined to specific diagnoses. Thus, Troy Social Club members are drawn from a wide spectrum of people who have been diagnosed with different forms of mental illness and this mix is part of its strength as members are at different points on their recovery journey and can offer support to each other as experts by experience. The foundational ethos and underpinning philosophy of the Troy Social Club is the acceptance of members as individuals who are not defined by their symptoms but who may benefit from help with the personal mental health challenges they experience including those arising from their symptoms. This is clearly stated in the Troy Social Club Strategic Plan 2019-2021 (Troy, 2019, p. 2) which describes the club as “the place where members with the same mental condition can meet and support each other in recovery” [‘mental condition’ in this context refers to any form of mental illness].

...the peer support ethos of the Troy Social Club... is fundamental to all its activities and which defines what it is, what it does and most importantly, how it carries out its functions.

...members are drawn from a wide spectrum of people who have been diagnosed with different forms of mental illness and this mix is part of its strength...

However, the Troy MHA Social Club Strategic Plan 2019-2021 (Troy, 2019) also articulates a more ambitious agenda, which aspires to influence acceptance of the role of mutual peer support in the wider, national mental health discourse. The following excerpt from the Strategic Plan articulates the aims of the club and how these aims might potentially inform wider developments in mental health services: The aims of the Troy MHA Social Club are to promote mental health, mental well-being and the social integration of people with mental health illnesses into broader society, by • Supporting those managing a mental illness/ill-health issue and their families and carers through social supports, recreational and educational activities • Promoting positive mental health in the community • Working with Mental Health Ireland in delivering its National Mental Health Projects • Doing all things as may be necessary for or ancillary to the furtherance of the above.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

And subject to the above • Encouraging people who have suffered and/or continue to suffer from mental health issues to re-integrate into society through the promotion of social skills and activities. • Empowering people with mental health issues by supporting them to have responsibility for the governance, operations and social ambience of the club. • Enjoying what the club has to offer and preparing people to join other social and employment activities in the broader community. This key set of goals positions the Troy Social Club as an example of progressive peer support initiatives, which are still relatively rare in the Irish context.

This key set of goals positions the Troy Social Club as an example of progressive peer support initiatives, which are still relatively rare in the Irish context. The impetus to conduct an assessment of the extent to which current members identify recoveryrelated benefits from their membership of the club grew from the process of designing the club’s Strategic Plan and findings from this present study will be used to further progress elements of that plan.

Rationale for this Study The Management Committee of the Troy Social Club, in consultation with the wider Troy membership, identified the need to examine and articulate the benefits of club membership for members, with particular reference to the members’ own views on how club membership contributes to their personal mental wellbeing and recovery journey. The Committee was also interested to learn how the club could better meet the needs of its membership in terms of helping them sustain their mental wellbeing and recovery. The Committee identified the usefulness of engaging independent experts to conduct a small-scale study of these issues in order to gain a valid appraisal of the extent to which the Troy Social Club is currently supporting members or could improve such support into the future. The assessment will also be of use in furthering the goals set out in the Troy MHA Social Club Strategic Plan 2019-2021 (Troy, 2019) as outlined in the previous section.

There are few examples in Ireland of communitybased, peer-dedicated social organisations for There are few examples in Ireland of community-based, peer-dedicated social people with mental health organisations for people with mental illness histories. Furthermore, the delivery of histories. peer-based, mutual support groups is under-researched in the Irish context. An important contribution to knowledge on this issue was published in 2016 (Murphy et al, 2016) but there is a need to build on this information and to fill this knowledge gap. The Troy Club is one of only a small number of social clubs for people with mental illness that are independently run through the combined efforts of carers and peers. The members of the Troy Social Club requested the researchers to conduct an independent analysis of the benefits that peer members perceive they gain from Club membership and the extent to which those benefits assist them with their mental wellbeing and recovery. This report details the findings from this study and it will also contribute to building knowledge on the general and recovery-relevant benefits that members can experience through participation in community-based peer social clubs.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Research Questions As determined by the Troy Social Club Management Committee, this study focused on exploring the benefits which Troy Social Club members perceive they gain from their membership of the Troy Social Club. In tandem with this main guiding question, the study also set out to ascertain what elements of the Troy Social Club programme, if any, are perceived by peer members as helping them to progress their mental health recovery. Furthermore, the study aimed to gather the views of club members regarding the future potential of the Troy Social Club.

Methodology The Troy Social Club Management Committee enlisted the voluntary assistance of Dr Gloria Kirwan, then Assistant Professor in Social Work (now Adjunct Assistant Professor) at Trinity College Dublin. Dr Kirwan was invited to carry out this study because of her previous experience in conducting research on the issue of mental health service user participation and her wider research focus on mental health services (see for example, Kirwan, 2017, 2019; Golightley & Kirwan, 2017, 2019). Dr Kirwan teamed up with Calvin Swords to carry out this study. At the point of his initial involvement in the study, Calvin Swords was conducting doctoral level research in Trinity College Dublin on the concept of recovery in mental health care (see for example, Swords & Houston, 2020). Dr Swords is currently employed as Assistant Professor in the Department of Applied Social Studies, Maynooth University. The preparation and fieldwork stages of the study of the Troy Social Club members’ views were conducted over a period of approximately 14 months from start to finish, using qualitative methods and guided by principles of inclusive research as set out by Wilson & Neville (2009) and Liamputtong (2007). The details of the study’s methodology and research design are provided in Chapter Three of this report.

Report Structure This chapter has introduced the background and context of this report on the views of members of the Troy Social Club regarding the benefits they associate with their membership of the club. The next chapter provides a summary review of the literature on recovery and mental illness. This will be followed by a chapter which outlines how the study was designed and carried out. The findings are then presented, followed by a discussion chapter which also presents a set of conclusions based on the findings of this study.

Chapter Summary This chapter introduced this study on the benefits of membership of the Troy Social Club as perceived by current club members. The background to the study and the history of the club were briefly outlined. The rationale for the study and the questions that guided the study were presented. The structure of the report was summarised.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Literature Review Introduction.................................................................................................. 9 Defining Recovery........................................................................................ 9 Conceptualising Recovery........................................................................10 Contextualising Recovery.........................................................................12 Recovery in the Irish Context ..................................................................13 Discussion....................................................................................................15 Chapter Summary......................................................................................15

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

This report details findings from an independent study of the benefits of being a member of the Troy Social Club as perceived by Troy Social Club members. The aimed to identify the benefits (if any) that club members accrued to them on foot of their club membership, including benefits regarding their mental health recovery. To underpin the study on the benefits regarding mental health recovery, the literature review presented in this chapter focuses on the topic of recovery. Key points from the literature review are presented here in sections dealing with the definition of recovery, the concept of recovery and research on recovery in the international and Irish contexts. The key points relevant to this study are highlighted. The chapter concludes with a short chapter summary.

Introduction

Defining Recovery According to William A. Anthony (1996), the “seeds of recovery” as a concept worthy of consideration were planted and gained increasing traction as the era of deinstitutionalization in mental health services took effect from the 1960’s onwards. This occurred firstly in the USA, then spreading over time to most developed countries. The shift away from segregated care as the primary response to mental illness occurred concurrently with the emergence of the early published literature from the mental health consumerist and survivor movements in which experts by experience began to detail their recovery journeys (Deegan, 1988, 1995, 1996, 2002; Houghton, 1989; Leete, 1989; Lovejoy, 1982; Unzicher, 1989). For example, Patricia Deegan, writing from personal experience, explained that despite the debilitating nature of mental illness, she had discovered a route to recovery by connecting with her renewed sense of self (Stacey & Stickley, 2012). The hope-filled potential of the recovery concept (Turner-Crowson & Wallcraft, 2002) ignited widespread interest in the potential of recovery as a theory and as a practical approach to helping people affected by mental illness. In the intervening decades, the recovery model has been developed, debated and revised. Recovery is now generally understood, in the mental health context, to mean a process of personal growth through which someone suffering with mental illness finds or regains a sense of balance and health in their lives. This re-balancing involves enhancing the individual’s capacity for self-discovery, holistic self-care (Reeve, 1999), the development of a hopeful outlook (Anthony, 1993) and finding meaning in one’s life (Gersie, 1997). As Gersie (1997, p. 6) says, “all of us need to come home to ourselves” and essentially the concept of recovery ushers people affected by mental illness to actively reconnect with a positive self-identity in furtherance of achieving a sense of restoration, rehabilitation and “re-enchantment with life” (Watts, 2012).

Recovery is now generally understood, in the mental health context, to mean a process of personal growth through which someone suffering with mental illness finds or regains a sense of balance and health in their lives.

There have been many different definitions of the recovery concept, which have been underpinned by a positive philosophy. Some of these include:

“ “

It is way of living a satisfying, hopeful and contributing life, even with limitations caused by illness” (Anthony, 1993, p.15) A deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles” (Perkins & Slade, 2012, p. 29)

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

“

A detailed definition is provided by Onken et al (2002):

there is no one set of factors or views which amount to ‘recovery’, but instead, it was vital for the researchers to stay alert to recovery-relevant and recovery-enhancing factors perceived by club members

Recovery is an ongoing dynamic interactional process that occurs between a person’s strengths, vulnerabilities, resources and the environment. It involves a personal journey of actively self-managing psychiatric disorder while reclaiming, gaining and maintaining a positive sense of self, roles and life beyond the mental health system, in spite of the challenge of psychiatric disability. Recovery involves learning to approach each day’s challenges, to overcome disabilities, to live independently and to contribute to society. Recovery is supported by a foundation based on hope, belief, personal power, respect, connections, and selfdetermination” (Onken, Dumont, Ridgway, Dornan, & Ralph, 2002, pp. 2-3).

Drawing on these definitions, recovery can be explained as an individualised journey of growth taken by a person who aims to improve the quality of their life in the context of experiencing mental illness. Thus, recovery is a subjective, unique experience for each person, which incorporates practical, psychological and existential dimensions (Pilgrim, 2008; Ramon et al, 2009). When gathering the views of the Troy Social Club’s members regarding the benefits to them of Troy membership, it was important to be mindful when conducting interviews of the unique and individualised nature of recovery experiences. Also, there are different strands or avenues through which recovery can be understood, with several of these being potentially relevant to how the Troy Social Club might support members’ recovery experiences. In other words, there is no one set of factors or views which amount to ‘recovery’, but instead, it was vital for the researchers to stay alert to recovery-relevant and recovery-enhancing factors perceived by club members as related to or drawn from their experiences of club membership.

Conceptualising Recovery The concept of recovery has been developed in considerable detail since it first appeared in the publications of the survivor literature. It is now clear that recovery can be viewed “as a movement, a philosophy, a set of values or principles, a paradigm and a policy” (Higgins & McGowan, 2014, p.63). Pilgrim (2008) discusses the emergence of the mental health survivor movement in the late twentieth century, and how this movement viewed recovery as the route to reclaiming an acceptable quality of life, including employment, housing, friendships and autonomy (Davidson et al, 2005). Shah et al (2016, p. 121) suggest that the recovery model could provide a “key organising model” for mental health services around which services could be organised and evaluated. However, as yet, there is no single, agreed definition of recovery and the debate continues on how exactly it should be described and measured. David Pilgrim (2008) has referred to recovery as a polyvalent concept because of the various interpretations attached to it by different stakeholders. He suggests that it is a concept which suffers from tensions between the medical conceptualisation of recovery versus the service user experience of personal recovery (Pilgrim, 2009). This has led to a vagueness and “working misunderstanding” of the concept (Pilgrim & McCranie, 2013). It is useful, therefore, to clarify the different conceptualisations of recovery which are found to exist within mental health services. Firstly, and historically, the concept of clinical recovery has focused on the management of symptoms and a return to normal functioning (Higgins & McGowan, 10

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

2014; Pilgrim, 2008; Pilgrim & McCranie, 2013). Clinical recovery is understood to occur when an individual’s symptoms are removed or reduced (Chester et al, 2016; Higgins & McGowan, 2014). Prior to the publication of A Vision for Change in 2006, the biomedical model had framed the dominant approach to mental health service delivery in Ireland (Brosnan & Sapouna, 2015). The introduction of A Vision for Change (2006) steered a policy shift towards a participative model of service delivery, informed by recovery concepts and which incorporated democratic ideals of participation and partnership. Despite this policy articulation, major changes in the day to day delivery of mental health care services have been slow to take hold. In contrast, the functional model of recovery focuses on supporting the development of the individual’s life skills, providing them with the possibility to participate in society through education, work and independent living (Higgins & McGowan, 2014). Functional recovery refers to the skills needed to integrate back into society and live independently, including activities such as being employed. Both conceptualisations of recovery (clinical or functional) position the professional as key in determining and measuring the service user’s recovery outcomes. For many mental health service users, assessing their progress in recovery through only clinical and functional measurements obscures many aspects of their lives and leaves them in a position where their illness, and by extension their personal identity, is defined primarily by their illness symptoms. Some writiers recommend a more holistic interpretation of recovery that is not confined to clinical or functional measurements (Coleman, 2004). Slade at al (2008) support this distinction between elements of recovery that are measured clinically compared to personal experiences of recovery in which the service user is an active participant in decisions regarding diagnosis, treatment and the measurement of outcomes. The personal recovery approach focuses on the service user’s self-assessed quality of life and personal perception of mental well-being – although it can include reference to clinical or functional measures also. In the personal recovery model, the individual is viewed as embarking on a unique journey within, during and after the experience of mental illness. This includes service users developing their capacity to be resourceful and empowered to direct their recovery journey in tandem with a positive selfnarrative.

the functional model of recovery focuses on supporting the development of the individual’s life skills, providing them with the possibility to participate in society through education, work and independent living

Personal recovery is viewed as a process of recovery voluntarily and willingly embarked upon by the individual. It involves the individual taking control of their own recovery plan. Ultimately, it places the individual as the expert on what helps or obstructs their progress towards their desired level of mental wellness (Higgins & McGowan, 2014; Pilgrim & McCranie, 2013). Furthermore, it provides an opportunity for individuals to become central to the decisions (including healthcare decisions) that are made concerning issues which they view as important for them (Chester et al, 2016; Higgins & McGowan, 2014). Essentially, this perspective on recovery recognises the individual as the expert in what is best for them as they navigate the challenges of living with a mental illness of one form or another (Chester et al, 2016; Higgins and McGowan, 2014; Pilgrim & McCranie, 2013). The person who is in recovery is thus positioned as the expert and co-producer of their treatment plan (Gaffey et al, 2016; Hungerford, 2014; Sowers, 2005; Walsh et al, 2008), and their recovery plan is not derived from or based solely on an external opinion. Instead, it is the individual who drives progress in building a positive sense of self (Dalgarno & Oates, 2018). As noted earlier, the literature reveals that recovery is a disputed concept (Gehart, 2012, p.430). The different approaches to interpreting and measuring recovery are described by Slade et al (2008, p. 128) as a “rhetorical consensus” which reveals the existence of distinct and, in certain respects, incompatible models of recovery. The Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

lack of consensus regarding the definition and measurement of recovery is noted by the Mental Health Commission (2008) in Ireland which suggests blending, where possible, these various conceptualisations of recovery in the context of service delivery.

The effects of mental illness on the individual are shaped not only by the actual mental health symptoms they experience, but are also influenced by social experiences related to their mental illness.

The recovery concept is also actively expanding in tandem with an increased understanding of the cultural and social consequences of mental illness. For example, an emerging concept in the recovery literature is termed ‘Social Recovery’ (Ramon, 2018). It is interlinked with personal recovery, but has specific indicators or ideas underpinning its philosophy which position recovery as an interaction between the individual and their social environment. It is epitomised by a focus on individuals interacting with others in society, and a focus on the interdependence of these relationships. These include “connectedness, recovery capital and social capital, as well as the impact of collective culture and the structural elements of our socioeconomic political system” (Ramon, 2018, p.2). From a social recovery perspective, these factors are considered in relation to the individual, their identity, and how others view them in the context of interpersonal interactions (Ramon, 2018). Borg’s (2008) study with people in recovery who were diagnosed with severe mental ill health also revealed recovery as a “social process” which was not a stand-alone process but one, if to be successful, has to be integrated into everyday life experiences. The effects of mental illness on the individual are shaped not only by the actual mental health symptoms they experience, but are also influenced by social experiences related to their mental illness. These social experiences include phenomena such as stigma (Beresford, Nettle & Perring, 2010; Corrigan & Penn, 1997; Karakas, Okanli & Yilmaz, 2016), social exclusion or othering (Boardman, 2011; Hughes, 2002), social isolation and alienation (Ritsher & Phelan, 2004; Salonkangas, 1997). Drawing on this evidence base, Tew (2013) concludes that cultural and social factors play a significant role in the prognosis of an individual’s mental illness. Therefore, recovery is not only about the individual experiencing a reduction or remission of symptoms of mental illness, but is instead a process which Tew et al (2012, p. 444) describe as “a journey … of social (re)engagement” and “rebuilding a worthwhile life” which includes reclaiming a positive social identity. Tew (2013) and Tew et al (2012) pinpoint the factors which can aid recovery in terms of enhancing the individual’s feelings of empowerment, connectedness and positive identity. Tew (2013) refers to the constellation of supportive factors as ‘recovery capital’, which, he suggests, offers a framework for understanding the extent to which an individual has access to the resources (internal and external) which will support their personal recovery journey. This multidimensional framework includes ‘social capital’ and ‘relationship capital’ as two important elements of recovery capital. Social capital, according to Tew (2013), refers to when people experience belonging to a social network. He defines ‘relationship capital’ as meaning “a person’s map of potentially beneficial personal relationships, including family connections, friendships and peer supports”. He also refers to the benefit of relationships that are “respectful, supportive and allow for mutuality” (ibid, p. 371).

Contextualising Recovery Current Irish mental health policy, with its emphasis on the rollout of recoveryinformed services, can be located within wider, international developments in the field of mental health policy at a global level. The World Health Organisation (WHO, 2019) reports that the incidence of mental illness is on the rise across the world and in the context of the European region it is described as a significant health challenge (World Health Organisation’s Regional Office for Europe, 2019). The shift towards deinstitutionalisation has also placed a spotlight on the human rights issues which surround long-standing practices in mental health services regarding the use of 12

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

involuntary incarceration, segregation and sedation. In addition, the World Health Organisation (WHO, 2013) has called for greater efforts by states to address issues such as stigma, prejudice and denial of fundamental rights which can arise in the lives of individuals when they receive a mental illness diagnosis. This rights-based focus has coincided with the promotion, at an international level, of democratic ideals such as participation, equality and social inclusion. In this evolving socio-political landscape, a focus on the rights of mental health service users has brought attention to the models through which mental health services are delivered. In this context, the recovery model is regarded as having much to offer in terms of service user participation, co-production of treatment plans and recognition of service users as centrally-positioned, rights-carrying stakeholders in the context of their contact with services. The shift away from institutionalised service delivery and towards communitybased mental health service delivery has resulted in more people living with mental illness in community-based environments. The recovery discourse addresses the difficult question of how community-based living can be compatible with leading meaningful and fulfilling lives within society while simultaneously experiencing symptoms of mental illness (Pilgrim, 2008). Despite the lack of consensus on aspects of the recovery concept, the literature concerning recovery has expanded year on year since the late twentieth century. This expansion suggests a growth in discussion of the general concept itself and increased recognition of its potential relevance to the development of community-based, human rights oriented mental health service systems (Anthony, 1993; Barker & Buchanan-Barker, 2011; Brosnan & Sapouna, 2015; Gaffey et al, 2016; Higgins & McGowan, 2014; Pilgrim, 2008; Pilgrim & McCranie, 2013).

The shift away from institutionalised service delivery and towards community-based mental health service delivery has resulted in more people living with mental illness in community-based environments.

Recovery in the Irish Context There is now little debate in the literature, both in Ireland and internationally, regarding the central importance of the recovery model in driving mental health policy and practice. In many instances, the translation from policy to practice has been inconsistent and fragmented (Cleary & Dowling, 2009; Gaffey et al, 2016; Higgins & McGowan, 2014; Kartalova-O’Doherty & Tedstone Doherty, 2010; Watts, 2012). Higgins & McGowan (2014, p. 69) note the observation by Walsh et al (2008, p. 251) that while writing the recovery model into policy can be achieved by a “few deft strokes of the pen”, the actual diffusion of policy into practice is considerably more complex. The concept of recovery, including the idea of placing a person at the centre of decisions regarding the implementation of their own recovery plan, was embedded in Irish policy with the publication of A Vision for Change (AVFC) in 2006 (AVFC, 2006; Higgins & McGowan, 2014). A Vision for Change (2006) remains the cornerstone of Irish mental health policy (Higgins & McGowan, 2014; Shah et al, 2016) and within this policy, the idea of recovery, and more specifically personal recovery, is central to the proposed model of how services will be delivered and developed (AVFC, 2006; Department of Health, 2020). In recent years, Ireland has also seen a strategic shift in the mode of health service delivery away from hospital-based services and towards a community-based, primary care model. This strategic reconfiguration was outlined in the policy document titled ‘Future Health’ (Department of Health, 2012). In that context, mental health services are also moving towards increased community-based provision where the inclusion and representation of experts by experience at all decision-making levels will be incorporated (AVFC, 2006; HSE, 2014). This shift was expressed in a report from the HSE (2014) which outlined Irish mental health services in the context of the Future Health policy: Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

“

Future Health reaffirms the move from the traditional institutional based model of mental health care towards a patient centred, flexible community based service as set out in Vision for Change. Services are focused on delivering a modern, recovery focused, clinically excellent service built around the needs and wishes of service users, carers and family members and on implementing the reform programme in a way that ensures they are properly integrated with other health and social services” (HSE, 2014, p.15).

The National Framework for Recovery in Mental Health (HSE, 2018, p. 10) also confirms the importance of viewing expertism by experience as a central resource in orienting services in a recovery direction. The articulation of the recovery model as a key tenet of Irish mental health policy aligns with the wider, international policy push for mental health service user participation in mental health care (as outlined in the previous section). Current Irish mental health policy, as articulated in A Vision for Change (AVFC, 2006), drives a citizenship/consumerist agenda via the rubric of a recovery-informed model of care. Personal recovery has been incorporated into recommendations such as in publications from the Mental Health Commission including A Recovery Approach within the Irish Mental Services (Higgins, 2008). There have been studies (Kartalova-O’Doherty & Tedstone Doherty, 2010; Mac Gabhann et al, 2010; Watts, 2012) which document indications of a shift in Irish mental health service provision towards a personal recovery approach. However, Shah et al (2016) stated that services are still a long way from seeing significant changes suggesting that the system needed:

“

Significant development of professional practices or of whole system change in mental health services to provide recovery-orientated services” (Shah et al, 2016, p.122).

Positive developments have taken place at national level including the establishment of Advancing Recovery Ireland (ARI) (HSE, 2020) and the publication of the Partnership for Change report (HSE Mental Health Division, 2016), which made recommendations on the structures and mechanisms for service user, family member and carer engagement in mental health services. Also, in 2018, the Health Service Executive (HSE) published “A National Framework for Recovery in Mental Health” (HSE, 2018). The National Framework document (HSE, 2018) highlights research by Leamy et al (2011) which involved the analysis of 1100 narratives of recovery. In that study, five key processes necessary for an individual’s recovery journey were identified as relevant processes in terms of underpinning the vision of recovery articulated in the National Framework (HSE, 2018). The acronym CHIME was applied by Leamy et al (2011) to the five key processes related to recovery as identified by them in their narrative study. These are as follows:

• Connectedness • Hope

• Identity

• Meaningful Role

• Empowerment (Leamy et al, 2011) 14

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

People who have had an acute episode or have an enduring mental illness can often be isolated from society and the communities they live in due to their diagnosis. Connectedness concerns an individual moving beyond this isolation and reclaiming a social life, a social connection even in the context of ongoing experiences of illness. This connectedness in turn provides a sense of hope for individuals, a process which can helpfully underpin all aspects of a person’s recovery journey. Essentially, it is about an individual developing a new sense of self, a new self-identity (Leamy et al, 2011). It is suggested that having a new sense of self is determined largely by the extent to which one views oneself as possessing a meaningful role in life, with a focus on a person developing their strengths and honing their skills to “have fulfilling and esteem-building activities in life” (HSE, 2018, p.3). Finally, these processes must be driven by empowerment and to achieve empowerment, people must have access to “information, choices and confidence to make informed decisions on one’s own life” (HSE, 2018, p.3). Despite this emphasis on a recovery-informed model of service delivery, the role of recovery-informed, mutual peer support groups is under-researched in Ireland. The analysis reported here, regarding the recovery-relevant benefits that flow to members of the Troy Social Club, offers a rare opportunity to explore the extent to which community-based, peer organisations can contribute to the recovery journey of individual mental health service users in the Irish context.

It is suggested that having a new sense of self is determined largely by viewing oneself as possessing a meaningful role in life, with a focus on a person developing their strengths and honing their skills to “have fulfilling and esteem-building activities in life”

Discussion The literature review reveals that multiple interpretations of recovery are currently in use and how tensions or differences exist between the various interpretations. Despite these theoretical differences, there are unifying characteristics across all of the different conceptualisations of recovery and these are captured in Leamy’s (2011) five key principles of recovery which work to enhance the quality of life of the individual mental health service user. The Troy Social Club committee set out to investigate how membership of the Troy Social Club might support members to maintain their mental wellbeing and progress their recovery. Leamy’s five key processes of recovery offer a useful lens through which to assess the extent to which the Troy Social Club provides a recovery-enhancing experience for its members. Therefore, in terms of the analysis of data collected in the course of this study, Leamy’s recovery processes were used to guide that analysis. The findings derived from the data collected in the course of this study are presented in Chapter Four. In advance of the presentations of those findings, the study design and methodology are set out in Chapter Three.

Chapter Summary

Leamy’s five key processes of recovery offer a useful lens through which to assess the extent to which the Troy Social Club provides a recoveryenhancing experience for it members.

This chapter presents an overview of the recovery model based on an indepth review of the relevant academic and policy literature. Different conceptualisations of recovery are identified. The role of the recovery perspective in Irish mental health policy is traced. Leamy et al’s (2011) five key processes of recovery are highlighted as relevant to the focus of the present study. The next chapter will outline the details of the study of Troy Club members’ views and how the analysis was conducted.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Methodology Introduction................................................................................................17 Methodology Rationale............................................................................17 Timeline.......................................................................................................19 Semi-Structured Interviews.....................................................................20 Material Ethnography...............................................................................21 Research Sample........................................................................................21 Researcher Stance......................................................................................22 Data Analysis..............................................................................................23 Ethical Considerations..............................................................................23 Chapter Summary......................................................................................23

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

This report documents the findings from the study of Troy Social Club members’ views on the benefits of Troy Social Club membership. This chapter outlines the methods used to collect the data on which the findings of this study are based including the collection of information about their views from the Troy Social Club peer members. The chapter outlines the study design that was adopted. Data was collected and analysed using qualitative methods, including individual semi-structured interviewing and material ethnography.

Introduction

Methodology Rationale The study reported here was concerned to investigate how members of the Troy Social Club interpret the benefits they gain from involvement in the Club, with particular reference to their mental health recovery. As such, this study was concerned with producing information on the subjective experience of club membership as articulated by the members themselves. Seale (1998) highlights that exploratory research requires consideration of the theoretical and philosophical choices which need to be made regarding the method(s) of data collection. It is vital that the methods chosen can produce knowledge on the issue under investigation (Cresswell, 2013). Because this study aimed to record and interpret the perceptions, opinions and recollections of club members, a qualitative research design was strongly indicated (Bold, 2012; DeForge & Shaw, 2012; Ritchie & Lewis, 2003). Qualitative methodologies work well in eliciting information on the subjective meanings and individual experiences attached by individuals to events, experiences and social interactions (Denzin & Lincoln, 2000). Subjective meanings and interpretations of experience are inherently difficult to study using traditional, quantitative methods and in studies with this type of focus a qualitative approach is usually regarded as more appropriate. As Butler (2002, p. 2) suggests, qualitative methods provide researchers with routes into the exploration of the many unknowns of lived experiences and help illuminate the viewpoints attaching to such experiences. As this study was centrally concerned to capture the perceptions and opinions of Troy Social Club members regarding the benefits of club membership, an interpretive approach using qualitative methods was indicated as best suited to the methodological foundation of the research design (Allan & Eatough, 2016; Bryman, 2008).

Qualitative research also allows for holistic enquiry where the method of research does not confine the research participants to answering standardised questions but instead invites them to deeper levels of disclosure regarding the bases for their personal views and opinions. Adopting an interpretivist position facilitated both descriptive and reflective data on the key issue to be gathered from the participants in this study. A qualitative approach also facilitates research activity which provides a broad and deep understanding of the topic under consideration (Boix Mansilla, 2010), while at the same time allowing the researcher to critically engage with the knowledge and experience of the research participants (Fletcher, 2016). In summary, for the purposes of this study, the researchers adopted a pragmatic approach to data collection (Danermark et al, 2002) by employing qualitative methods of data collection which could best assist in gathering data capable of revealing how Troy Social Club members perceive the benefits to them of club membership with specific reference to their mental health recovery needs. Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Drawing from the repertoire of methods associated with the qualitative research paradigm, two main data collection methods were incorporated into the research design in order to enable the researchers to achieve in-depth investigation of the views of Troy Social Club members. The adoption of a research design which incorporated two different forms of qualitative data collection was chosen in order to capture, in different ways, the viewpoints of the Troy Social Club members. The methods utilised were firstly, indepth, individual semi-structured interviews and secondly, material ethnography. Both of these research methods, and how they were utilised in this study at that time, are outlined in later sections of this chapter. Through the adoption of a qualitative approach, the research design placed a primary focus on the views of Troy Social Club members as the means by which the perceived benefits of club membership could be investigated.

The present study was concerned to illuminate how Troy Social Club members understand and interpret their membership of the Troy Social Club including reference to how club membership intersects with their journey towards their personal mental health recovery.

Through the adoption of a qualitative approach, the research design placed a primary focus on the views of Troy Social Club members as the means by which the perceived benefits of club membership could be investigated. This research stance was informed by the theory of the qualitative research paradigm as outlined above. It was also influenced by Croft & Beresford’s (1992, p. 27) call for research on mental health issues, such as recovery, to be conducted with reference to the views of mental health service users as legitimate knowledge holders ( see also, Keogh et al, 2014). Research studies incorporating the self-reports of mental health service users have successfully produced reliable knowledge in other research contexts (see for example, Beresford et al, 2010; Kirwan, 2017). The present study, conducted with members of the Troy Social Club, adopted a similar perspective and deliberately set out to privilege the views of the members forged from their experiences of club membership and their reflections on the benefits which flow to them from their membership of the club. This reliance and focus on self-reports is an established stance in exploratory research. Norton (1997, p. 410) explains how self-reporting is concerned with establishing “how people understand their relationship to the world” and how that relationship is “constructed across space and time, and how people understand their possibilities for the future.” The present study was concerned to illuminate how Troy Social Club members understand and interpret their membership of the Troy Social Club including reference to how club membership intersects with their journey towards their personal mental health recovery. Thus, this study, fitting with Norton’s (1997) vision of meaning making as outlined above, aimed to establish how members perceive the relationship between their attendance at the Troy Social Club and their recovery journey and how they interpret the possibilities of that relationship for their futures. The roll-out of the data collection strategies was also conducted with reference to guidance from Wilson & Neville (2009) which recommends that researchers pay attention to issues of partnership, participation, protection and power when engaging with research participants. This further indicated the benefits of a qualitative approach because of its participative and collaborative qualities which also provide the researcher with flexibility to collect data at a pace and in a manner suitable for individual research participants (Liamputtong, 2007).

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Timeline The Troy Social Club Management Committee first made contact with Dr Gloria Kirwan, then based in Trinity College Dublin, during the summer of 2018, seeking assistance with their aim of compiling a report detailing the views of Troy Social Club members on the benefits of club membership and participation. Ethical approval was granted for the study and work began on the approved strategy straight away. Calvin Swords became involved as the second volunteer researcher at this point in time. He was also based in Trinity College Dublin where he was pursuing his doctoral studies on the topic of recovery in mental health service provision. A series of meetings was held between the researchers and key Troy Social Club Committee members and peer members of the club in order to gather background information on the club, to agree the timeline for data collection and to visit the club itself to familiarise the researchers with the club’s location and activities. Two members of the club took on the role of contact liaison persons between the researchers and the wider membership of the club. This proved a very useful communication system and enabled the researchers to plan each stage of the research design in full consultation with the liaison persons and the wider club membership. From late summer 2019 onwards, an intense period of data collection was conducted during which time members of the Troy Social Club were invited to meet with the researchers to become informed on the research study plan. Prior to the commencement of the interviewing stage, the two researchers visited the Troy Social Club on a number of evenings to provide members with opportunities to learn more about how the study would be conducted, and to clarify any questions about the collection, storage or analysis of the collected data. These visits also provided Troy Social Club members with opportunities to meet and speak with the two researchers in an informal context so that they could better decide if they wished to volunteer to be interviewed for the study or not. On these occasions, the researchers distributed the Information Sheet about the study, explained and distributed samples of the Consent Form and spoke to members individually and in groups about the study. They answered questions and queries from the members concerning how the study would be conducted. This assisted the research process by helping club members to decide whether or not they wished to volunteer to take part in an interview when the interview stage commenced. At all times, it was carefully explained that there was no pressure on anyone to volunteer and that members could opt in or out as the study progressed. The study interviews took place on the nights when the Club was in session, either before or during the Club’s usual opening times. Members were told in advance that one or both of the researchers would be present and available to conduct interviews with anyone who wanted to volunteer to take part in a formal interview. At all times, the researchers were concerned to ensure that interviewees volunteered freely and did not experience any peer pressure to participate in the interviews. The interviews were conducted in private. The names of participants are not revealed in this report in order to protect the privacy of participants.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Semi-Structured Interviews Semi-structured individual interviews were used in this study because it is a data collection method through which it was possible to gather the individual viewpoints of Troy Social Club members. This method focused on collecting the viewpoints and opinions of the club members, thus allowing these views to hold a central position in the study. The central purpose of the interviews was to capture the ‘meanings’ that Troy club members attach to their experiences of club membership. Recollections of relevant events were useful if they could be provided but not essential in these interviews as it was the meanings and perspectives of participants that was sought. Studying club members’ perspectives on club membership involved finding appropriate ways to collect their perceptions, recollections, reactions and opinions, or what Costa et al (2012, p. 87) refer to as the “subjectivities” of service user experience, which in the context of this study relate to the opportunities arising from club membership as perceived by members of the Troy Social Club. As such, the meanings attached to club membership were viewed by the researchers as central to understanding how club members perceive the benefits of club membership. Qualitative interviewing in social research also acknowledges the ‘multifaceted lives’ of research participants (Rosie, 1993, p. 144) and helps reveal the interconnectedness (Wengraf et al, 2002) between personal perspectives and personal histories. Thus, semi-structured interviews are ideally suited to learning in detail about how people view or respond to a particular phenomenon, event or experience (Brinkmann, 2013). Adopting this approach allowed the researchers in this study to attain Troy Social Club members’ descriptions of the Club as well as their interpretations of how the club benefits its members in a number of different ways including how it contributes to the recovery journeys of individual members (Bryman, 2008, Saldana, 2011). For this strand of data collection, the interview guide that was used set out key questions which each interviewee would be asked in relation to their views on the benefits of club membership. As the interviews were semi-structured in nature, the questions posed in the interviews were not rigidly fixed allowing for flexibility and expansion beyond the interview topic guide (Bryman, 2008). The interviews were either audio-recorded with permission by the researchers or, where participants did not wish to be recorded, the content of the discussion in the semi-structured interview was noted in written notes compiled during the interviews by the researchers. The interviews yielded a large amount of data which was collated and analysed by the researchers.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Material Ethnography Material ethnography involves exploring perceptions of individuals with reference to objects that represent those perceptions. Drawing on material culture theory, Doel (2019) suggests that material ethnography facilitates the exploration of complex issues through the identification of objects to which an individual attaches meaning in relation to that issue. He captures succinctly the essence of this approach by stating that “things provide clues to a person’s life” (ibid, p. 825). Pratt & Rafaeli (2006) explain how objects as artifacts embody both physical and social meanings, and can reveal aspects of individual and organisational realities. Similarly, Fiol & O’Connor (2006) also suggest that objects carry meaning. Broderick et al (2019) found that using visual representations to convey the experience of individuals provided a concrete image through which insights into the subjective experience of individuals can be achieved. They suggest the tangible nature of data in material ethnography helps avoid “lazy interpretations and explanations” of other people’s realities (ibid, p. 20). The researchers asked the Troy Social Club members to identify objects which represented the benefits they associated with club membership, thus using objects selected by some members as ‘clues’ to how those members thought about being members of the club. Thus, following a strategy adopted by Sherry Turkle (2007), Troy members were asked to identify objects which represented the benefits of club membership and to explain in their own words how these objects evoked this association. Turkle (2007) refers to objects as “things we think with” and in the study reported here participants were asked to think about their club membership with reference to objects that, for them, captured the essence of one or more benefits of membership of the club. The process involved in this aspect of data collection was straightforward. Via the research liaison members, the researchers asked for photographs of objects from club members that represented positive aspects of club membership. The objects were photographed by a club member on one of the club nights and these were forwarded to the researchers accompanied by a brief written explanation about each object and the benefits with which each one was associated. In this way, the objects selected by the members, and the explanations they provided regarding their relationship(s) to those objects, stand as representations of the Troy Social Club members’ experiences of club membership. This data was incorporated into the thematic analysis of the interview data and helped to clarify or confirm themes which were identified in the analysis of the individual interviews.

Research Sample The current members of the Troy Social Club in Dalkey, South County Dublin comprised the total research population for the purposes of this study. In relation to inclusion criteria, participants were required to be current members, which was defined as attending the club on at least one occasion in the previous 12 months. An open invitation was issued to all members of the club and anyone who wished to participate in the interviews was invited to do so. This ensured potential inclusion of all members but not all members opted to participate in the researcher interviews. A total of 13 members took part in the semi-structured interviews and an unknown number contributed to the compilation of the photographs and written explanations of the Troy Social Club artifacts. All of the research participants indicated that they frequently attended the club. Members were well informed in advance about the research study, how it would be conducted and how data would be collected and managed. Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

The researchers were concerned that the participants might choose to tell the researchers opinions which they thought the researchers wanted to hear, a process in research which is referred to as social desirability bias (Durand & Chantler, 2014). However, the researchers were alert to this possibility and adopted strategies to help avoid this phenomenon. These strategies included reassuring participants that their personal views were important, reassuring participants of their confidentiality and anonymity throughout the data collection and reporting processes, and using two different data collection strategies (semi-structured interviews and material ethnography) in order to ascertain the viewpoints of the participants as accurately as possible. The researchers visited the Troy Social Club on several occasions to discuss the research study with its members and to explain how the individual interviews would be conducted with any members who wished to participate. These visits by the researchers acted as information sessions with members of the club to support their understanding of the study, explain how it would be conducted, and what would be involved if any member volunteered to participate in an individual interview. At these information sessions, members of the club were encouraged to ask questions of the researchers either during the group discussions, or on a one-to-one basis. The information sessions took place over a period of weeks, and the researchers visited the Troy Social Club on a number of occasions in order to provide many opportunities for members to clarify any aspect of the proposed research design with them. Consent forms and information sheets were brought to the information evenings and were left at the club for people to review between sessions. At the end of the information sessions schedule, the researchers informed members about when interviews would begin, and explained again that anyone interested in taking part in an interview could complete an invitation form, and place it in the anonymous post box that was left in the Troy Social Club for this sole purpose. The researchers were then able to follow up with individual members who had completed invitation forms to discuss further with them their interest in and potential participation in an individual semi-structured interview. Times were arranged with participants to conduct their individual interview for the study. The researchers arranged to use a room in the venue where the Troy Social Club is located so that the interviews could take place in a private setting. This provided privacy but it also meant that the support of other club members was nearby if this became necessary at any point during the interview. Each interviewee decided if they wanted to be audio-recorded or not and it was made clear that they could change their mind about their involvement in the study at any point up to the writing of the study report. When participants elected not to give permission for an audio recording to be made of their interview then, with permission, the researchers made notes during the interview or immediately afterwards.

Researcher Stance Both researchers have extensive experience working and researching in mental health contexts and they were able to draw on that experience in this study, particularly during the data collection and analysis phases. The researchers were also aware of their own potential biases while gathering the data, such as any felt desire to find results that would cast the club in a positive light. The researchers aimed to counter any such bias through adopting an overt process of reflexivity (Willig, 2013). The researchers had no prior involvement or personal attachment to the club which also supported a more objective research process on their parts. Both researchers were able to discuss and reflect on a regular basis about their personal stances which might impact on the objectivity of the research. 22

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Data Analysis The researchers chose to interpret and analyse the data thematically. This approach helped the researchers to gain an understanding of the participants’ subjective views regarding the benefits they experienced related to club membership (Allan & Eatough, 2016). Thematic analysis assisted the researchers to extract core viewpoints from the data which were eventually formulated into specific findings (Fereday & Muir-Cochrane, 2006). The researchers manually analysed the data and adopted a consensual approach to the analysis (Hill et al, 1997) by cross-checking their findings for agreement or contradictions within the data. In this way, the researchers were alert to any contradictory or divergent viewpoints which were detectable in the collected data. Strong agreement was discovered across the dataset. The findings are presented in detail in the next chapter.

Ethical Considerations Ethics approval for this study was granted by Trinity College Dublin. The Troy Social Club is an independent organisation steered by a membership-led Management Committee. The Troy Social Club Management Committee submitted a letter stating its request for the study and gave permission for the researchers to carry out the research activities. Individual consent from members was secured before each of the interviews took place, and interviews were only conducted with participants who demonstrated full understanding of what the research interview involved and who could express their voluntary agreement to take part. All participants were reminded throughout the process that they could withdraw their consent and retrieve their interview data at any point prior to the compilation of the research report. A number of participants opted not to be audio-recorded in line with the explicit guidelines for the conduct of the interviews and this was fully respected. If permitted by the interviewees, the researchers took notes during the unrecorded interviews.

Chapter Summary This chapter outlined the research design of the study including the rationale for adopting a qualitative approach to data collection and analysis. Attention was paid to ensuring that the club members who volunteered to be interviewed for this study were fully informed on the nature and purpose of the interviews before they took part. They were also assured that they could retract their data from the study at any point up to the compilation of this report. The photographs of objects selected by members as representing aspects of club membership also informed the analysis. The findings of the study are presented in the next chapter.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Findings Introduction................................................................................................25 Findings........................................................................................................25 General Benefits.....................................................................................25 Recovery-Relevant Benefits................................................................29 Troy Social Club: Future Potential.......................................................39 Chapter Summary......................................................................................42

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

The main aim of this study, as explicitly stated in Chapter One of this report, was to establish the views of Troy Social Club members on the benefits of club membership including the extent to which members perceive that the club supports in any way, or if at all, their personal recovery journeys. As outlined in the last chapter, a qualitative methodology was employed which incorporated individual, semi-structured interviews alongside a data collection method described as material ethnography. The data collected using these methods were collated and analysed thematically by the researchers and the key findings from that analysis are presented in this chapter. Before presenting the findings, it is useful to re-state the research questions.

Research Questions:

What benefits do Troy Club members perceive they gain from their membership of the Troy Social Club?

In the views of members, what elements of the Troy Social Club programme assist members in their recovery?

Introduction

To what extent and how can the Club develop its programme to further support its members in their recovery and social connectedness?

The findings are presented in this chapter in sections which address each of these questions sequentially. The chapter concludes with a short Chapter Summary section.

Findings This section presents the findings from the analysis of data collected from the Troy Social Club members who voluntarily opted to take part in the study, either in the individual semi-structured interviews or in compiling the list of objects for the material ethnography exercise. The presentation of the findings is organised and presented in three sections which relate to each of the research questions, listed above, which guided the study.

General Benefits

The main question which this study aimed to address was framed as follows:

What benefits do Troy Club members perceive they gain from their membership of the Troy Social Club?

The participants in the study identified a set of general benefits which they associated with club membership. The main benefits identified by the participants are presented here using three categories, namely, personal benefits, social benefits, and peer group benefits. Many of the identified benefits overlap with the elements of the Troy Social Club programme which participants identified as assisting club members in their recovery. The ways in which club membership assists with recovery in the views of club members are presented in detail later in this chapter.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Personal

General Benefits:

Personal Benefits In terms of personal benefits, the data collected from club members reveals that they associate club membership with a clear set of personal benefits. The issue of isolation was raised by a number of participants who contrasted their previous experiences of isolation and loneliness with their current experience of belonging and feeling part of the Troy Social Club. For example, one member vividly depicted how they had personally experienced isolation associated with their mental illness:

“

[I] withdrew from society, into rooms, paranoid, depressed, reclusive…” (Member7, Interviewee)

When this participant joined the Troy Social Club they found it directly addressed their feelings of isolation. They described the general membership of the club as “people from my own tribe” and notes that it is “good to be with your own tribe” because “those are the people who will understand you the most.” This was echoed by another participant who described their reasons for attending the club as related to how it helps them with their feelings of isolation:

“ “

[The Club] breaks the isolation if your mood is low, cos at home I’m only, my head is only going over and over my problems… coming here can help” (Member11, Interviewee) A cup of tea and a chat, you can’t go wrong!” (Member13, Interviewee)

Many of the study participants identified the weekly club meeting as an activity which they look forward to each week. In this next quote, the club member indicated that without access to the Troy Social Club they would have no social activity to look forward to each week:

“

I wouldn’t have something to look forward to at the end of the week you know” (Member 2, Interviewee)

Another participant suggested that the weekly activities distract members from their own problems and give them a break from their mental health struggles. Some participants associated attendance at the club with personal freedom, a place where they could be themselves. For some participants this sense of freedom included the freedom to socialize with people who are experiencing similar recovery journeys and to give and receive support regarding the various challenges which accompany diagnoses of mental illness:

“ “

… they now have somewhere to go or be able to ring someone, and if they are in a bad way, they ring any of us, and they can talk to us” (Member 6,Interviewee) It gets you out of the house, talking to people, meeting people…” (Member 13, Interviewee).

A recurrent theme was the personal benefit gained from knowing that club members are accepted non-judgmentally by each other, no matter what their mental state or stage of recovery or illness.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

“

General Benefits:

There is no pressure on any club member to engage in the club activities but the activities have evolved in such a way that there is something for everyone to do. The ethnographic data included a photograph of the bingo cards used in the weekly bingo competitions to symbolise the emphasis on fun and feeling comfortable during attendance at the club. The following explanation was provided by one member to accompany the bingo photograph and in it they explain how members can move around the different activities taking place in the club and can match their engagement with the degree to which they wish to get involved in club activities on any given evening:

Personal

“

I can come here, and I can talk to one of my mates you know what I mean, and I can say, I am a bit down today, I am a bit all over the place today… X and Y will say listen, this is a bit heavy for you and I will give you a ring and we can have a chat about it” (Member 4, Interviewee)

So what if you do not like table tennis or pool? Well we also run bingo when members request it. This is a great way to sit and chat to other members and is really good fun. The bingo is great and maybe after you get knocked out of one of the tournaments you still want to do something else or even to relax and do something less demanding – this is where the bingo comes in. We also have other board games like chess and checkers that individual members might like to play” (Club Member – Contributor to Ethnographic Data)

Participants highlighted the sense of support they experience through membership of the club and many recounted examples of contact with each other outside the specific, weekly club night. Some participants recalled being contacted by other members if they did not attend for a number of weeks, or at times when they were experiencing challenging mental health issues or were hospitalised.

“

Most of these people might not em, would miss the social aspect of their week and as I say a lot of them associate with each other outside the Club” (Member 3, Interviewee)

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Social | Peer Group

General Benefits:

Social Benefits In all the study interviews, the members of the Troy Social Club spoke about the social aspect of the club activities, and the enjoyable social outlet which it offers. Many of the participants associated club membership with the development of long-term friendships with peers whom they look forward to meeting each week.

“

Mainly just to meet, meeting new people you know” (Member 1, Interviewee)

“

Well I think it has improved my, like it has kind of got me out of the house, like I mean you know, it has got me mixing with people” (Member 2, Interviewee)

Some participants described their membership of the club as one of only a few, or in some instances the only place, where they met people socially outside activities or programs provided directly by mental health services.

Another participant explained that after a severe relapse and a long period of hospitalisation, she found it difficult to re-engage with society. For this participant, the Troy Social Club was significant in helping them to find a social outlet:

“

I was hospitalised in XYZ – involuntary. I felt isolated and very medicated… when I left hospital.…basically I had nowhere else, where do you go to socialize? I had no interest in anything but this made a huge difference. I enjoy participating, it’s about interacting” (Member 11, Interviewee)

The theme of access to useful resources was developed further in the following quote by another interviewee:

“

[The club] gives a social, comfortable surroundings to sit …it’s socially, conveniently, everybody has a chat and a nice comradery and that’s good. It would be a shame if it wasn’t here because then where would those people go? I enjoy coming here, I enjoy the whole thing … I think if this club wasn’t here all those people where are they going to go? (Member 12, Interviewee).

The club was also identified as a preferred social outlet by some members who indicated that they had alternatives available to them but found the Troy Social Club as an outlet which matched their interests and needs:

“

I can say that its, it’s a good alternative to other social life at the weekend” (Member 3, Interviewee)

Peer Group Benefits

Based on the data collected, it was clear that the existence of the Troy Social Club is regarded by members as a peer-led resource run by people who experience mental health problems. Examples were provided of new members making contact with the club through word of mouth on the recommendation of current or past members and how established members tried to help new members integrate with other members and build their interpersonal skills. Members also expressed pride in the achievement of keeping the club up and running despite the ongoing pressure of ensuring that it has sufficient resources to run the weekly club night and the other activities such as the respite breaks that it provides each year. 28

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

In the views of members, what elements of the Troy Social Club programme assist members in their recovery?

A considerable amount of data relevant to answering this question was generated through the interviews and the material ethnographic exercise. Analysis of the data was informed by the five key processes underpinning recovery as identified by Leamy et al (2011) which are as follows: • Connectedness • Hope • Identity • Meaningful Role • Empowerment The main findings relating to each of these themes are presented below.

Connectedness

Recovery-Relevant Benefits:

The second question addressed in this study concerned the following:

Connectedness

Recovery-Relevant Benefits

At a primary level, participants noted how attendance at the Troy Social Club provided them with contact with others who were going through (or had at some point experienced) similar mental illness issues. This provided members with a social space in which they could simply meet others who understood what they were going through and who shared this understanding based on personal experience.

“

The Troy Social Club was set up for people with mental illness, a place to come and socialise” (Member 5, Interviewee)

“

“Getting to talk to people, getting in with people, the lads make you happy, you make them happy as well. And it is one big happy family” (Member 4, Interviewee)

“

Em where they could kind of be themselves, make friends, feel they could be themselves, and em make, make friends basically, make companions (Member 5, Interviewee)

Examples of social reciprocity were described by participants that provided evidence of the sense of social connectedness experienced by club members through their membership of the Troy Social Club. The quote below indicates that attendance at the weekly club programme provides a social outlet where members can enjoy the company of others, and where they know they are providing support to others as well. One participant describes the members as “one big happy family”, suggesting feelings of belongingness, support-getting and support-giving:

The interview data revealed a perception that the welcoming, non-judgmental atmosphere in the Troy Social Club creates an environment conducive to building friendships. In the quote below, the participant described the depth of relationships which club membership facilitates:

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Connectedness

Recovery-Relevant Benefits:

One long-term member suggested that the socialisation experienced by members helped members to socialise better in other social settings beyond the context of the Troy Social Club. There were indications that membership of the club offered wider social opportunities beyond the specific club night:

“ “

So if I look at it in terms of like, occupying people’s time, engaging them in social skills..emm..having a timetable to come here every week” (Member 3, Interviewee) It has a long history, positive history as well. Some people think it only happens on a Friday night but it doesn’t really, because they are celebrating their birthdays during the week, meeting, eating, meeting each other or going to the cinema all that kind of stuff you know” (Member 5, Interviewee)

The data revealed how club membership can assist members to engage socially with others, gradually feeling more comfortable taking part in social interactions through club activities. The club offers members access to social interaction without anyone being assigned labels or designated as well or unwell:

“

… a lot of them they have been coming for years. If someone comes into the room here now, they wouldn’t know the difference between someone who has a mental illness and somebody that doesn’t” (Member 5, Interviewee)

The sense of connectedness was illustrated by one participant using the following metaphor:

“

This is my foot in the ground. It helps me to keep in touch with my basic health… here there is no pressure” (Member 8, Interviewee)

A series of photographs were taken by members of cups of tea and the refreshments on offer on club nights. The following explanation provided by a club member captures the social processes with which the refreshments are associated (emphases added by researchers)

“

When the members arrive at the club the very first thing that they do when they come in the front door is sign in and order what they want from A and B [two club members] who staff the teas and coffees. They can choose between tea, coffee, cordial soft drinks or water. I think it is more than that though. When anyone comes in they are welcomed by the members and volunteers long before they take the short walk over to sign and order what they would like. I feel this gives the members a real sense of belonging on a Friday night. The members also choose some snacks that are laid out as you see in the photo” (Club Member – Contributor to Ethnographic Data)

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Recovery-Relevant Benefits:

“

As you can see that around all the areas of competitions, there are tables and chairs. This is where members sit and chat and drink the tea and the coffee. This is just as important as anything else at the club. It is important because everyone sits down and talks. The conversation is always flowing while the members wait to take a pool shot or for their name to be called to play table tennis. It is also a great way for members to catch up with everyone and see what they got up to that week. This helps with new friendships and if you know you have a friend, who goes to the club, it can be very encouraging for that friend to come along and participate with you” (Club Member – Contributor to Ethnographic Data)

Connectedness

For similar reasons, photographs of the tables and chairs where members sit together in the club were submitted as symbols of the social connectedness that members experience through attendance at the club nights. The following abstract from a description of the chairs captures the high level of importance attached by members to the opportunity provided by the club for them to socialise with others:

Along with the social connectedness experienced by members of the club, evidence that participants believe the club aids their recovery journey is further supported by examples regarding the instillation of feelings of hope, which were noted in the interviews with participants in relation to club membership.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Hope

Recovery-Relevant Benefits:

Hope Participants identified the sense of hope gained by members through participation in the club activities. Through participation in club activities with other club members, in an environment which is focused on connectedness, the data suggests that members gain increased feelings of hope for their individual trajectories.

“ “

Since I joined the Dalkey Club it brought the best out of me” (Member 4, Interviewee) You get to know what people do – what work they do and you get a general feeling what is possible for onself” (Member 7, Interviewee)

The feelings of hopefulness described by participants included an increased sense of engagement in life, such as having something to look forward to each week: This sense of hope was expressed as “feeling good” by one participant, an internal sense of improved wellbeing:

“

Feeling good, good inside and stuff, all those different aspects and I think this is one of those aspects I think” (Member 3, Interviewee)

“

So they have a whole new, what, what we are providing for them is a launch for a new life, social outlet that they can have” (Member 6, Interviewee)

“

I find it great, it’s a place you get lost from all your week’s, you know, troubles and everything else” (Member 1, Interviewee)

Club membership was also positioned in the following quote as providing more longterm, general hope for a better future. This participant, who has been a member of the club for many years, describes joining the Troy Social Club as “a launch for a new life” and explains that new members can quickly feel the benefits of being a club member:

In the following quote, the sense of wellbeing gained through club membership was described as the benefit of being able to leave one’s worries to one side during time spent in the club:

The opportunity to meet others who have experienced mental illness and to learn from them was identified by the following participant as important to them:

“

It is helpful to meet others with mental health problems because they are like-minded and they can help each other…. Isolation is really bad and it comes along with mental health problems. You are not isolated if you are a member of a club like this. I have friends in this club and we went on holidays together organised by the club.” (Member 7, Interviewee).

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

In the interviews, insights from participants in the present study revealed how membership of the Troy Social Club helps change the negative self-narratives of members and help them better understand and sometimes recalibrate their progress on the road to recovery. In the following quote, one participant distinguished their positive sense of self to other people suffering mental health problems whom they often encounter during their week (unrelated to the Troy Social Club setting):

“

Benefits:

The detrimental effect on self-identity which flows from the experience of mental illness has been evidenced by a number of studies (Estroff, 1989; Wisdom et al, 2008). Yanos, Roe & Lysaker (2010) also highlight the difficulties which can arise for individuals in trying to shed an ‘illness identity’.

Identity

it [Troy Social Club] makes you, it makes you a whole person, you know, some of my friends would be very introverted” (Member 1, Interviewee)

The following quote highlights the benefits of a positive sense of self which flow from being in a non-judgmental context where one is not defined by one’s symptoms:

“

I think the reason why the Club is so successful is because we are service users and they [other members] don’t feel intimidated by us. And they know they can be themselves, and they know that they are in an environment that is, that is friendly to them, and that they are accepted in the environment, they don’t prove anything to anybody or anyone, they know the people there don’t have agendas, they know the people are like-minded people so they enjoy themselves and have a good time” (Member 6, Interviewee)

Another participant suggested that “Here you get to fit in” (Member 7, Interviewee) and this feeling of being accepted as a person and not defined by one’s symptoms was echoed in other interviews also. Yet another participant explained the feeling of acceptance they found in the club by stating:

“

“I didn’t feel I had to pretend.. this is now part of my support system.. I can sit on my own if down, I have a mood related disorder … no-one here holds it against me”

I didn’t feel I had to pretend.. this is now part of my support system.. I can sit on my own if down, I have a mood related disorder … no-one here holds it against me” (Member 8, Interviewee).

The club environment, as described in the participant interviews, comprises a shared sense of identity, and access to a social context in which individual members can reconnect with a positive sense of self. Connectedness, hope and peer support were captured in the following quotes as elements in supporting the individual’s journey towards recovery:

“ “

It’s important, friends, the relationships you know, ehh, it makes you a more balanced person you know? …Being part of the club, is part of recovery, because, ehh, because if you are having an off day, em, the other members of the club will help you out like you know” (Member 2, Interviewee) I feel more comfortable here, I feel more at home here, why I come here. It’s nice after a bad week to know this is here… the club has an easy atmosphere, no competitiveness” (Member 11, Interviewee)

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Meaningful Role

Recovery-Relevant Benefits:

Meaningful Role Having a meaningful role involves people building on their strengths and coping skills. Firstly, the study participants discussed how club membership supports people in developing their coping skills and their confidence to continue on their journey towards wellness:

“

[The] Troy Social Club helped me in that role in finding, a bit of stability, a bit of confidence to do, to do what I do. And it has progressed over the years my, my mental health in a positive way” (Member 5, Interviewee)

Another member explained that the weekly meeting of the club gives them a sense of purpose:

“

[The club] gives me something to look forward to, I’ve made great friends here, it’s like a family. It means a lot to me…” (Members 11, Interviewee)

“

Well, I actually value my time on my own now…that quiet time, or whatever you want to call it is really important to me now” (Member 1, Interviewee)

“

I wouldn’t have been able to, for a better word, cope with myself” (Member 1, Interviewee)

One of the study participants described how club membership has supported their capacity to manage “alone time” in between club meetings and has changed how they perceive being alone, no longer feeling generally isolated:

Being on their own was something this participant explained they would not have coped well with prior to their involvement in the Troy Social Club:

… [I] converse with people of different talents you know, which is what the Club does… because X learnt about business from me, and I learnt about creativity from him”

Furthermore, the study participants explained how club membership has supported members to build on their strengths and confidence and to move forward on their journey towards a better quality of life and a better sense of mental wellness:

“ “

The Club is a lifeline for some people” (Member 7, Interviewee) … the Club is just a means to an end. The end is wellness, happiness, get a job” (Member 6, Interviewee)

The participants discussed the self-worth and esteem building environment that they enjoy in the Troy Social Club and which they attribute to the structure of club membership and the positive relationships they can build with other members:

“ “ 34

… [I] converse with people of different talents you know, which is what the Club does…because X learnt about business from me, and I learnt about creativity from him” (Member 1, Interviewee) I mean me and myself and I have come a long way myself in the last few years. I am a lot more functional now…” (Member 3, Interviewee) Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

“

They have made friends; their mental health is good. They might have joined some choir or go to the pictures, they make friends, they do their own thing outside of here but, this is where it all kind of started for them” (Member 5, Interviewee)

In the following quote, one of the participants described membership of the Troy Social Club as a type of catalyst for people who were trying to create a new sense of self, and to re-enter society after a period of illness such as an acute episode of mental ill-health:

“

They are kind of raw out of hospital and they are kind of finding their paths and they make friends…they have gone on to, to live a reasonably good life” (Member 5, Interviewee)

One of the members of the Club emphasised the prevalence of hospitalisation for some people who suffer with chronic and severe mental health problems. Referring to the national policy document, A Vision for Change (2006), this interviewee referenced the high rates recorded in Ireland of readmission to acute settings and they emphasised the useful role of social outlets such as the Troy Social Club for people who have been through this type of treatment experience:

“

Recovery-Relevant Benefits:

One of the participants outlined how they have witnessed some members being able to develop their strengths and skills through their club membership, which has led to fulfilling and meaningful developments in their lives beyond the activities of the Troy Social Club:

Meaningful Role

“

…and forget about the world, I shut the world out. Like this place has really helped, I feel fit enough to get a job” (Member 4, Interviewee)

In a Vision for Change it was stated that over 70% of people who have mental illness will have readmittance into hospital in their lifetime….. There is 30% that go into, they have their episode, they come out, they have jobs, they have a life outside, they have a social life. Once they have their jobs, they settle back down in their jobs and they settle down into that job that they are happy….70% of them, a lot of them don’t have jobs. So they don’t have a say, purpose in life? You find somebody a purpose in life, you give them everything. If you take away their purpose? They are left like a shell. That goes for everybody, that goes for the Pope himself, everybody!” (Member 6, Interviewee)

The role played by the Troy Social Club in helping members identify a purpose and meaning in their lives was a recurring theme across many of the participants’ interviews. Accessing a supportive environment, such as the Troy Social Club, is also highlighted by some participants as the first step towards gaining a sense of purpose and meaning.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Empowerment

Recovery-Relevant Benefits:

Empowerment Mental illness brings many challenges, one of which concerns the loss that some people experience regarding their sense of personal agency. Out of a desire to protect the person suffering with mental illness, close family and friends sometimes become concerned for the safety and well-being of the mentally ill individual and can act in ways they believe serve to protect that individual from risk. This can then lead to negotiation at many levels regarding many issues as the individual strives to re-connect with life following an acute episode (Watts, 2017). This process of negotiation was illustrated succinctly by one of the study participants who described their efforts to re-build a social life in the aftermath of a period of acute mental illness. They found their family very supportive but also very protective which the participant summed up as:

“

My parents were anti me joining anything” (Member 7, Interviewee)

“

We leave our problems behind – at the door. We also help each other and if you are worried about things we listen to each other and give support” (Member 7, Interviewee)

This participant explained that they prevailed in their efforts to find and connect with suitable outlets. Eventually, through information from other mental health service users, this participant joined the Troy Social Club which they found to be a place where members help each other by listening and offering support:

Motivation was described by participants in this study as a key philosophy underpinning the aims of the Troy Social Club and the way it operates:

“ “ “

The motivation thing with mental illness, it is hard to get kicking and get going. Whereas, if you have something to go to on a Friday night, they might just talk to the person next to them” (Member 5, Interviewee) …communication skills ehh…being active, motivation, feeling good, feeling good inside” (Member 3, Interviewee) Well it’s like, it’s very hard to motivate a person with a mental illness right. It seems to be a key, a key thing here, they try to motivate each person to participate and get involved” (Member 1, Interviewee)

Explaining the importance of keeping club members involved and motivated to take part in club activities in order to ensure that people continue to enjoy coming to the club, one participant distinguished the participation they experienced in the Troy Social Club compared to other group programmes and services that they had been previously involved in:

“ 36

…if you start a Club and you say…there is a cup of coffee and there is a slice of cake, after a while, after 3 or 4 weeks they say well, there is nothing to talk about, I’m not going back there” (Member 6, Interviewee)

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Recovery-Relevant Benefits:

“

The table tennis is run … every Friday night. This runs in conjunction with the pool tournament. Table tennis is more physical and requires a great deal of concentration…. If the members do not play pool, they play table tennis and some play both. Everyone has his or her own ability level from Beginner to Advanced players. Anyone can learn to play and everyone is always welcome to come and have a game. This is important to the members because it gives them something physical to do as in some games the pace is very high. The competition runs in much the same way as the pool does. In both competitions, it gives members something to look forward to each Friday” (Club Member – Contributor to Ethnographic Data)

Empowerment

The table tennis activity was chosen by one member as a symbol of their motivation and empowerment gained through club activities:

This contributor went on to reveal how members gain a sense of ownership and control of the club through the decisions which surround the choice of activities that take place on club nights. They explained this as follows:

“

As a social club that is what we try to do – give the members a place to come on a Friday. Give them something to do that they want to do. Ask them ‘what do you want to do next?’ This applies to everything we do at the club” (Club Member – Contributor to Ethnographic Data)

Another participant directly connected their involvement with the weekly table tennis competition and their decision to join another sports club:

“

Through the table tennis here I plucked up the nerve to join {identifies a different club] and I am still with them” (Member 13, Interviewee)

The shared experience of mental illness across the membership, and the supportive group environment which participants associated with the Troy Social Club, creates an accepting and non-judgemental atmosphere where members can begin to feel comfortable engaging with others and taking part in club activities:

“

We are service users, and they don’t, they don’t feel intimidated by us. And they, they know they can be themselves…they are accepted…they don’t have to prove anything” (Member 6, Interviewee)

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Empowerment

Recovery-Relevant Benefits:

“

Well other Clubs have a thing called judgemental…Nobody is laughing at anyone here. Nobody is making fun of anybody, and that is what I love about this place” (Member 4, Interviewee)

Participants in some of the interviews outlined how members get involved in different aspects of running the Troy Social Club, including bringing people together and organising the activities such as weekly activities and also occasional bigger activities such as outings:

“ “

I love to play to play the snooker and the pool like you know” (Member 2, Interviewee) . hey seem to get engrossed, interested and get motivated in playing T the table tennis and the pool and stuff” (Member 5, Interviewee)

In the following quote, one of the participants identified how coming to the Troy Social Club and getting involved in activities with other members provides more than participation in a game of pool or table tennis:

“

… an environment that is, that is friendly …we run it in such a way that is non-threatening” (Member 6, Interviewee)

Participants recounted how members become empowered to build on the relationships they make with other club members. Over 300 members have taken part in club activities and respite breaks in the past 10 years and in the following quote, one participant explains how the club can facilitate progress towards reconnection and re-engagement with life:

“ 38

Over 300 people come to our Club in the last 10 years and a lot of them, a lot of them move on to other things…they have a life of their own, they have got their life back (Member 6, Interviewee)

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Troy Social Club: Future Potential In addition to the perceived general and recovery-related benefits of the Troy Social Club, this study was also concerned with gathering the views of club members on the future of the club and its potential going forward in time. The following question captures the focus of this aspect of the study:

To what extent and how could the Club develop its programme to further support its members in their recovery and social connectedness?

In the interviews, participants articulated a vision for the club’s future. This vision included finding ways to demonstrate the benefits of club membership, to bolster recruitment and also to encourage the establishment of similar clubs across the country which could cater for the wider community of people who have or have had experiences of mental illness. There was strong support for preserving the ethos of the Troy Social Club as a peer-led and participative community resource.

Demonstrating the Benefits of the Troy Social Club In the interviews, many members expressed their desire to see wider recognition of the benefits which have flowed to them through membership of the Troy Social Club. It was repeatedly stated that there was insufficient recognition granted to the significant gains they felt and experienced from being part of the Troy Social Club membership network:

“

What I would like to see happen to the Club is that it would get the recognition for what is happening here and what has been going on… that the report is done, findings are brought out (Member 6, Interviewee)

The study captured the practical ways in which the Troy Social Club is perceived by members to benefit the lives of its members, including in the following quote:

“

A lot of these, a lot of these people would have nowhere to go at the weekends, services are gone, so what would they do? Where would they be? Their lives, their social lives, they would have no social lives” (Member 10, Interview)

Recruitment Several of the participants spoke about the potential which exists for making more people aware of the existence of the Troy Social Club and continuing to build the membership so that more people could reap the benefits of being part of the club membership community:

“ “

Well to show that there is a community here like you know…we are always looking for more members…there are people with mental health issues that are falling through the cracks, and, it’s, I mean, they, they should know about it a place like this” (Member 2, Interviewee) Spread the word more...that’s how mobile phones make their money, through ads, through T.V, why can’t Dalkey Club do that? You don’t have to be in a certain area to join the Dalkey Club? (Member 4, Interviewee)

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Replication of the Troy Social Club Model The interviews confirmed the high regard in which the participants viewed the benefits which flow to them and others from club membership. Many expressed feeling lucky that they had joined the club and indicated that similar clubs were needed throughout Ireland:

“ “ “ “

There should be more centres across Dublin and the country that cater for people with mental health issues… these should be based on clubs already in operation…the Troy Club is for everyone” (Member 7, Interviewee). Visually, the whole thing, I visualise the whole thing, one of these in every town, every town in Ireland, one of these Clubs with the attendance, what is happening here to happen there, that would be my vision” (Member 6, Interviewee) What I feel I would like to see is that social Clubs can be replicated from what we do here” (Member 5, Interviewee) I would like to see other Clubs do the same thing. I would em, what I would like to see happen eventually, contribution to that. All of them, us like a little acorn for a big tree” (Member 1, Interviewee)

Recognition of the benefits for members, as well as building awareness in Ireland of the benefits of this type of club, were described as key wishes held by members of the club. There was a clear message from the data that the participants believe there is a need for more examples of this type of peer-led participation and support model to be available so as to reach more people and support them on their recovery journey. However, participants were also acutely conscious of the effort involved in keeping the Troy Social Club operating at its current level and expressed a clear wish to see the club’s activities receive more recognition and support from relevant external agencies.

Preserving the Ethos of the Troy Social Club There was a strong determination expressed in the interviews with participants that this club would continue and a commitment from all interviewees to work together to keep it in operation in its current configuration. There was a clear desire in the interviews that the current ethos of the Troy Social Club would be preserved going forward. In particular, there was consensus that the club should continue to be run for peer service users, who have experienced mental health difficulties (currently or in the past). In fact, the membership structure, comprising service users of mental health services, was identified by participants as the key reason for the club’s success:

“ 40

I think the why the Club is so successful is because we are service users” (Member 6, Interviewee)

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

“ “ “

The people involved in running it, we have passion, we have passion for our fellow service users” (Member 5, Interviewee) When I say different, I mean, like you know, we all understand each other” (Member 4, Interviewee)

“

.................................................................................... and other members are very aware of ehh, the way people are and their needs and what they need to, and I don’t think that needs to be a professional, in fact I believe the opposite that it is better because they themselves have these difficulties” (Member 3, Interviewee)

I think it is important that it is led by people with mental illness because they are at the coalface first-hand, you know? They are experiencing the difficulties day to day, you know?” (Member 2, Interviewee)

The peer-based membership structure, whereby many members are people who have experienced mental health difficulties, was highlighted by participants as a key feature that distinguishes the Troy Social Club from other services that some members attend. The study participants did not dismiss the role and importance of mental health professionals and the services they provide but described how the Troy Social Club is distinctive in meeting their recovery needs. For example, the opportunity to socialise with peers and learn from each other was highlighted repeatedly in the data. One of the participants in the study used colour blindness metaphorically to distinguish the difference in understanding of mental illness held by peers as compared to professionals, meaning that peers can understand more clearly what their fellow peers are experiencing.

“

You see, the professional, the professionals, they, they know all the theory, but they can’t feel what we feel, they can’t feel what another service user is feeling. It’s like, it’s like ehh, someone, it’s like a jigsaw puzzle, and some people know where all the pieces are, and they can put it all together. You get a professional, they, they can’t put it together, they can’t see the same. Take a prime example of it, colour blindness right, I can’t do jigsaw puzzles because I’m colour blind. But, on the other hand, if … that colour-blind person was a professional, and you had, I was a service user, I could see all the colours, because I know what the jigsaw puzzle is all about” (Member 6, Interviewee)

The importance for the club of adequate financial backing was raised by a number of the study participants. Funding of the Troy Social Club was a topic which participants raised as necessary to ensure the stability of the club and to provide it with the necessary financial capacity to develop further.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Additional Resources The importance of resource stability for the Troy Social Club was associated by participants with the ability of the club to benefit its members:

“

It’s the back-up and support behind you that can really put the momentum of a Club eh, of making it stronger you know? That creates a great energy and ehh, that adds, adds to the whole ethos, the whole ethos of the Club” (Member 10, Interviewee)

“

Open for longer, for example, in the afternoon cos nothing like this in the afternoon locally” (Member 7, Interviewee)

“

I. think it could be improved if we had the finances to do what we really wanted to with the Club” (Member 6, Interviewee)

Some participants expressed a wish for the club to be open more often during the week:

With the provision of additional resources participants expressed the belief that the Troy Social Club could enjoy a more stable future.

“ Em, as value for money there I go again. Apparently, if you are in X [mental health facility] for a week it will cost the taxpayer €8,000 per week. What do you call it, the whole running of our Club a year is €6,000. So you can see the value for the taxpayer. Everyone is a winner, service users are a winner, the taxpayer is a winner, everybody is” (Member 5, Interviewee)

One participant described the value for money that the service provides to its members:

“

Em, as value for money there I go again. Apparently, if you are in X [mental health facility] for a week it will cost the taxpayer €8,000 per week. What do you call it, the whole running of our Club a year is €6,000. So you can see the value for the taxpayer. Everyone is a winner, service users are a winner, the taxpayer is a winner, everybody is” (Member 5, Interviewee)

This participant described the low costs involved in running the club, but also the importance of securing the baseline funding to keep the club in operation and the need for additional resources if the club were to develop further.

Chapter Summary This chapter outlined the main findings identified from the data analysis of this study. The next chapter discusses the findings and draws a set of conclusions which brings this report to a close.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Troy Club’s Social Artefacts

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Discussion and Conclusions Introduction................................................................................................45 Discussion....................................................................................................45 General Benefits.....................................................................................45 Recovery-Relevant Benefits................................................................47 Future Potential of the Troy Social Club...........................................49 Conclusions.................................................................................................52 Chapter Summary......................................................................................53

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

This chapter considers the main findings as set out in Chapter Four and, with reference to the literature review in Chapter Three, it discusses the general benefits and specific recovery-relevant benefits of club membership as identified by members of the Troy Social Club who participated in the study. This chapter also discusses the club members’ views on the future potential of the club. A set of conclusions are presented derived with reference to the discussion of the findings.

Introduction

Discussion As stated in previous chapters, the study of the Troy Social Club members’ views on the benefits of club membership was carried out with reference to an overall question supported by two related questions. These were as follows:

What benefits do Troy Club members perceive they gain from their membership of the Troy Social Club?

In the views of members, what elements of the Troy Social Club programme assist members in their recovery?

To what extent and how can the Club develop its programme to further support its members in their recovery and social connectedness?

The findings presented in Chapter Four were organised under three main headings, namely:

General Benefits;

Recovery-Relevant Benefits

Future Potential of the Troy Social Club.

Although, the findings were organised into three main sections, it is clear that there are many overlapping themes across the three categories of findings. In this chapter, these three main organising categories are adopted again to structure the discussion but findings from all sections of the study are integrated into this discussion. In the conclusions, the main issues that emerge from the study are set out.

General Benefits All of the Troy Social Club members who participated in this study were affirmative and unambiguous in describing the Troy Social Club as an important feature of their lives and a valued component of their social network. The enthusiasm for the club as a social meeting place and source of personal support was also evidenced by the consistently high rate of attendance that was directly visible to the two researchers on the many occasions when they visited the club nights. Some participants recounted examples of the personal support they have received from peer members whom they met through their membership and attendance at the club. These examples underscored the sense of group solidarity (Egolf & Chester 2013; Tuckman, 1965) associated with club membership which was conveyed repeatedly in the interviews by many participants. It was clear that all participants who took part in the interviews enjoyed the sense of comradeship which they derived through their membership of the club.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Mental illness is often associated with experiences of stigma (Beresford, Nettle & Perring, 2010; Corrigan & Penn, 1997), othering (Hughes, 2002), social exclusion (Boardman, 2011) isolation or loneliness, the latter particularly among people living alone with enduring mental illness (Salokangas, 1997). Ritsher & Phelan (2004) identified the negative impact of internalised stigma and feelings of alienation among people experiencing mental illness and how difficult it can be for people to break out of the cycle of stigma and alienation which encircles their diagnosis and illness. The detrimental effect of self-stigma on self-esteem has been established by studies such as that by Karakas, Okanli & Yilmaz (2016). As Beresford, Nettle & Perring (2010, p. 33) point out, “stigma and oppression experienced by mental health service users/survivors can become internalised, having an additionally damaging effect on their self-esteem and sense of self and possibly perpetuating their distress.” However, Sheridan et al (2014) established that social isolation and loneliness could be counteracted among people experiencing enduring mental illness if they engaged in increased social activity. It was encouraging, therefore, to find that many participants in this study reported experiencing increased feelings of social connectedness and less isolation on foot of their involvement in the Troy Social Club. It was not possible to administer pre-membership test measures as part of this study, and, therefore, it is not clear if membership leads to increased social interaction or vice versa. From the qualitative data that was collected, it was clear, however, that participants felt advantaged by their membership of the Troy Social Club and that they perceived enhanced social connectedness flowing directly from their club membership and attendance. In particular, participants indicated that part of the attraction for them of being a member of the Troy Social Club was that it is a peerbased social space, an aspect of the club which they were proud of and regarded as essential to its success. Participants repeatedly highlighted the sense of social connectedness, which they associated with being part of the Troy Social Club network of members. Some participants noted the enjoyment they experienced from taking part in the club activities and respite breaks, while others emphasised the social interactions and fun that they looked forward to on club nights. Many participants spoke of the altruistic gestures they had experienced from other club members such as personal encouragement and support received during challenging times related to their mental illness. Indeed, examples were also provided by participants where they explained that helping others in the club enhanced their own personal sense of wellbeing and fulfilment. In further support of these general findings it is useful to point out that many of the participants reported in their interviews that they have remained longterm members because they believe it is beneficial for them. The study participants provided many positive statements in which they connected their club membership with enhanced social engagement and reduced isolation. In their statements, the club was portrayed as a safe, encouraging and inclusive group environment for people experiencing mental illness where they could connect with others in a positive social space whilst either giving or receving encouragement to and from their peers. These viewpoints convey the Troy Social Club as a supportive and relationally positive social context. There were no negative viewpoints expressed by participants regarding their attendance at the club and no indication of viewpoints which contradicted the positive views expressed regarding the benefits of club membership. As will be discussed later in this chapter, there was a desire for greater external recognition of the benefits derived by members from attendance and connection with the club, but again this confirmed the extent to which the participants viewed the club as beneficial. 46

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Thus, the study succeeds in revealing why the Troy Social Club is valued by its membership, not only in terms of the personal benefits they each feel they gain from their connection to the club but also because they see it as an asset for the community of people who suffer with mental illness (the wider peer community) and who might at some point in the future wish to join.

Recovery-Relevant Benefits In the literature, personal recovery is a journey taken by an individual who has experienced a period of mental illness. It is a journey which is individualised, unique and the person is positioned in the recovery paradigm as the expert (Anthony, 1993; Gaffey et al, 2016; Pilgrim, 2008). From this perspective, recovery is a personalised and individualised journey. However, the literature review also highlights how recovery includes a social dimension through which the individual restores their sense of social identity, their social connectedness and their sense of groundedness or control in their lives (Tew, 2013; Tew et al, 2012). The analysis of the data from this study was conducted with close reference to Leamy et al’s (2011) five key processes essential to a person’s recovery journey. These include connectedness, hope, identity, meaningful role and empowerment. These recovery processes are highlighted as fundamental to positive recovery outcomes in a person’s life and recovery journey (HSE, 2018). It was considered useful, therefore, in addressing the research questions posed in relation to this study, to analyse the dataset with reference to these five key processes. The main findings are set out in Chapter Four in which it is clear that the participants in the study identified all five key processes in how they perceived the benefits to them of club membership. Each key process is considered in turn below.

Connectedness Connectedness is about reclaiming a social foothold in the world and reducing feelings of isolation which often accompany a diagnosis or experience of mental illness (Leamy et al, 2011). In this study, participants explained how the Troy Social Club provided them with a route into social connectivity. In other words, in the club, members can meet new people, mix with peers, develop friendships, receive and reciprocate interpersonal advice and support. The concept of “one big happy family” was used as an analogy by one participant in this study to describe the Troy Social Club and others explained to the researchers that the club helps them to develop and practise social skills thereby enhancing their confidence when mixing with others in the wider world. The club, the researchers were told, achieved this supportive social space by fostering normative features including non-judgmental and reciprocal communication styles, a strong sense of collective identity (membership of the Troy Social Club), and by involving peer members in the decisions made in the club regarding club activities, responsibilities in the club, respite break destinations and so on. As identified in the literature, social recovery is fundamental for an individual’s overall recovery prognosis. It is not simply concerned with being able to interact with others in a specific social setting, such as the club, but concerns being able to move beyond this type of localised context to actively engage socially in the individual’s wider social sphere (Ramon, 2018). Tew (2013), referring to the concept of recovery capital, highlights the importance for people in recovery from mental illness to regain a sense of personal capability in social contexts. He suggests that access to opportunities for community involvement, such as social and recreational-type outlets, help foster or rekindle a sense of belongingness and engagement in social life. The Troy Social Club provides an environment where members can experience social connectedness in a supportive context which then helps members to replicate this experience in Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

other social contexts. It is clear from the data collected in this study that members regard the Troy Social Club as a social outlet where they can find opportunities for community-based social engagement in abundance and that members are perceiving the opportunities provided by the club as beneficial to them in their recovery journeys.

Hope Participants in this study described the strides and progress that they as members have made since joining the Troy Social Club. Participation in the club’s activities was reported as affording members a positive status and self-identity. Participants highlighted how being a member of the club brings the best out in the members, they feel good in themselves and helpful towards each other. Many participants noted that they look forward to the open club night every week and there was particularly high endorsement of the enjoyment gained from the club’s respite breaks. The benefit of something to look forward to is noted in the literature regarding personal recovery (Higgins & McGowan, 2014; HSE, 2018; Leamy et al, 2011; Watts, 2012), and it is clear from the analysis of the data that the Troy Social Club provides members with access to a popular and accessible outlet where they look forward to a range of social activities. Ramon (2018), in particular, emphasises the importance of hope as part of the social recovery journey. In the analysis of the data for this study, it appeared that hope was interpreted by the participants as having something meaningful for them to look forward to and a feeling that going forward they had the support of the other club members, even if they suffered a relapse in relation to their mental illness.

Identity Recovery for an individual is about building confidence, developing a positive outlook on life, and an invigorated sense of self (Anthony, 1993; Dalgarno & Oates, 2018; Leamy, 2011; Onken et al, 2002; Perkins & Slade, 2012). Participants in this study attributed positive gains in their self-identity arising from their membership of the Troy Social Club. By attending the club and supporting its activities, participants viewed themselves as contributing to a community organisation which is filling an important need among their wider peer group. None of the participants reported any sense of stigma attaching to club membership, in fact, quite the opposite was conveyed. Many participants recounted having heard from other people about the club before they joined and being very excited to join and keen to get involved. The community rootedness of the Troy Social Club, its reputation as a fun and supportive group, and the pride felt by its members, creates a set of conditions conducive to fostering among individual members a positive self-identity and in this way the club is providing a useful platform on which members can move forward in their individual recovery journeys.

Meaningful Role In the recovery literature, emphasis is placed on helping individuals identify what a meaningful life is for them (Chester et al, 2016; Higgins & McGowan, 2014; Ramon, 2018). Participants in the study spoke about the purpose and focus the club gives them in their lives, including how it supports them to develop their coping skills and focus on their strengths as individuals. From the data, it was clear to the researchers that all members believed they had an important role to play. Some members clearly carry a central, organising role in terms of organising activities and generally keeping the club up and running. Some members are tasked with or agree to take on specific functions, such as organising and serving the refreshments on club nights. Two members acted as the liaison members with the researchers in relation to this study. All members see their role in supporting others as a significant contribution to the club’s success, and in that regard, all members play an important role in ensuring 48

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the club provides a positive environment for all its members. As an example of how busy being a club member can be, one of the participants in the study spoke about how they now appreciate their alone time, and how they can cope with it (actually enjoy it) due to the role of the Club in giving them meaning and purpose in their life. Essentially, participants described, drawing on a range of examples, how club membership builds their confidence, and enhances their sense of self-esteem and worth. The findings indicate that the club provides an environment where members feel involved in all apsects of the club, also providing them with a social context in which they experience a positive sense of self-identity, as well as a sense of solidarity and connectedness with other members and a role in ensuring that the club is a positive experience for all its members.

Empowerment For an individual to progress their personal recovery journey, it is helpful if they can feel personally empowered to work towards identified goals (Chester et al, 2016; Higgins & McGowan 2014; HSE, 2018; Leamy et al, 2011; Pilgrim & McCranie, 2013). The Troy Social Club provides members both with a purpose and a sense of achievement by keeping the club up and running. While some members take on additional responsibilities for aspects of the club’s programme of activities, there is a shared sense of achievement that recognises the contribution all members make in maintaining the ethos and activities of the club. It is not possible to identify with precision how the sense of pride in the club, articulated by the study participants, translates or transfers into any general sense of empowerment for individual members. However, it is possible to state that the club members articulated their belief that they were contributing to the success of the club through their own actions. From the findings, it is clear that the Troy Social Club offers opportunities through which elements associated with mental health recovery can be fostered and developed. In particular, the strength of group cohesiveness which underpins the running of the club also fosters a positive social atmosphere where members feel supported and respected and empowered to get involved in the club’s activities.

Future Potential of the Troy Social Club The analysis of the data confirmed high levels of satisfaction among its member with the Troy Social Club. Within the data, there is a clear call for the present ethos, structure and programme of the club to continue without any significant change in how the club is organised, run or managed. A set of interlocking features of the club was identified which members believe contributes to the club’s success. Some concerns were raised about the sourcing of resources needed to secure the future of the club. These issues taken together represent the views on the future potential of the club. They are discussed here in relation to the importance of preserving the club’s peer ethos because of its essential contribution to the club’s ongoing success, the desire to secure increased resource stability for the club and the future vision for the club.

Troy Social Club Ethos Participants in this study stressed the importance of preserving the Troy Social Club as a peer club. Many of the members who participated in interviews identified the club’s success as connected to the fact that it is run by and for mental health service users. The shared identity among members, participants suggested, engendered a sense of togetherness and shared lived experiences.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

The mutual aid potential of peer to peer contact is gaining increased attention in the research literature (see for example, Bellamy, Schmutte & Davidson, 2017; Davidson et al, 1999; Naslund et al, 2016). The participants in this study were unanimous in stating that the Troy Social Club provided them with access to peer support which was difficult for them to access elsewhere. Their desire for access to this type of peer-led resource, as expressed by participants in this study, echoed the call found in the wider literature for increased attention to service user views on what is helpful to them (Croft & Beresford, 1995; Davies, Gray & Webb, 2014; McPhail, 2008; Rose et al, 2016; Simpson & House, 2003; Tait & Lester, 2012; Thornicroft & Tansella, 2005; Watts, 2014; Wilson & Daly, 2007). This study adds to the amplification of such viewpoints. It is important to acknowledge that in positioning this service-user-led organisation as a recovery-relevant resource for mental health service users, this study is radically departing from the traditional construction of mental health care which has primarily emphasised the provision of specialist medically-led care when people become mentally unwell. This report does not dispute the value of specialist health care but it reports that the participants in this study also perceived the peer-based social environment found in the Troy Social Club as a recovery-relevant resource. In general, the conceptualisation of service users as experts by experience (Kirwan, 2013, 2014), as well as increased exploration of the assistance which experts by experience can provide to each other (Mead, Hilton & Curtis, 2001; Sledge et al, 2011; Solomon, 2004), has prompted recognition of the usefulness of peer-led or peer-informed resources. It has also prompted policy commitments to increasing the level and forms of service user participation in mental health service planning and delivery (A Vision for Change, 2006; Department of Health, 2020). Slade, Adams & O’Hagan (2012) have suggested that research needs to look beyond traditional service structures to identify the range of possibilities for service user participation, although Johnston (2014) suggests that more could be done to recognise the value of service user perspectives in the Irish context. In the present instance, it is clear that the service users who attend the Troy Social Club regard it as a highly valuable recovery-relevant resource which aids their ability to cope with their illness and progress their personal recovery journeys. Therefore, it is not in the intention of the club but on the basis of its reported efficacy that the evidence emerges regarding the club’s potential to support the recovery journeys of its peer members.

Club Resources In terms of the club, it appears that members view the main resource as the members themselves. In its Strategic Plan (Troy, 2019), the Troy Social Club lists its main resources to also include its current access to a large meeting room in a community building in the centre of a Dublin suburb, although this is generally only available to the club for one night per week. However, this venue is accessible to those on public transport and indeed, some participants in the study reported travelling some distance in order to access the club. The Strategic Plan (Troy, 2019) also lists as club resources some funding it receives from the HSE, as well as small private donations and small-scale fundraising activities. It also has a clearly articulated governance structure including a Club Constitution. Furthermore, the club has a growing online presence. It manages a dedicated Facebook page (www.facebook.com/troymha) which includes a members’ blog space and also it operates a dedicated website (www.troymha.com). In the club’s strategy statement (Troy, 2019), the main strengths of the club are identified as the club members and the level of control which they exercise regarding how the club operates.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

It also portrays the club as a safe place for people with mental illness to “re-socialise” after a period of ill-health and explains how the club aims to act as a “stepping stone” towards the integration of members into the wider community. Furthermore, the club’s Strategic Plan (Troy, 2019) also notes that the club provides support to the carers and friends of people with mental illness and it explicitly notes that this wider group are also welcome to attend the club at any time. Based on the information gathered from participants, alongside the researchers’ own observations, all of the above strengths were identifiable and a picture emerged of a club that is providing important personal support to members whilst also running efficiently in terms of smooth organisation and a range of activities on a low budget. This is occurring in the context of an increasing membership. As was evident in the semi-structured interviews and the ethnographic data collected by the researchers, the tea and biscuit refreshments, the chairs and tables as well as the activities symbolise for members the social connections they enjoy through membership of the club. Thus, the conversations shared over the cups of tea are the context through which members experience the social dimension of the club and were highlighted as valuable to them. Although, the provision of refreshments is relatively low cost, it is nonetheless an ongoing responsibility which can be challenging in the context of sparse resources. There is also a strong interest among the members for respite outings and the costs associated with such events require extra effort by a small number of members who take on the task of organising such activities. Participants in the study expressed a wish for resource guarantees. Some participants also highlighted how even a small amount of additional funding could provide the means for additional useful developments in the club and less worry for those who take on the burden of responsibility for the club’s financial stability.

Future Vision The study uncovered a deeply felt sense of solidarity to the Troy Social Club on the part of its members. Many times, participants voiced their hope that the club will continue to operate into the future. There is clearly a strong affinity to the club among its current members and a growing demand for access to the club from potential new members. The hope was also repeatedly expressed by participants that the value of the club to its members would be eventually understood and acknowledged by relevant agencies, and that some additional support in terms of funding might then become available. The participants expressed the belief that people across the country who are experiencing mental illness would benefit from access to similar clubs. At a national level in Ireland, there is a focus on making services more recovery-orientated (HSE, 2018), and the findings of this study strongly indicate that members of the Troy Social Club view it as recovery-relevant for them. For those concerned with the roll-out of recovery-relevant services and outlets in other parts of Ireland, the Troy Social Club’s model offers one possible structure worthy of consideration.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Conclusions The study reported here presents the views of Troy Social Club members regarding the benefits they enjoy related to their membership of the club, both in terms of general benefits and recovery-relevant benefits. Furthermore, the research sought to identify the views of club members on the future potential of the club. As outlined in earlier chapters, the researchers utilised qualitative methods, including semi-structured interviews and material ethnography, to gather data. Thematic analysis was used to interpret and review the findings. The findings of the study, as set out in Chapter Four and discussed in Chapter Five, indicate that members can identify a comprehensive range of general as well as recovery-relevant benefits which flow to them on foot of their membership of the Troy Social Club. This section draws a set of conclusions which arise in light of the findings from this study. These are presented here as the conclusions the researchers derive from their analysis of the study’s data. The conclusions are as follows:

1. 2. 3. 4. 5.

The Troy Social Club offers its members a social outlet which they enjoy, find generally beneficial and also helpful in terms of their personal recovery goals. The ethos of the Troy Social Club is one of inclusivity, non-judgmentalism and respect for the inherent dignity of all members. In this club, members are not defined by their mental illness diagnosis, but instead each one is regarded as an important and valued individual. Leamy et al’s (2011) five key processes of recovery are present in the club and accessible to club members. The study revealed that the Troy Social Club provides a safe social space for members who have experienced mental illness where they can experience connectedness, hope, improved self-identity, a meaningful role and a sense of empowerment. The study participants reported high levels of satisfaction with the club as it currently operates. The club has adopted a Strategic Plan (Troy, 2019) which aims to consolidate the club as it presently operates and also to allow it to grow in tandem with the increased interest from potential new members. The provision of additional resources could enable the club to better accommodate new members whilst remaining vibrant and responsive to the needs of current members. The Troy Social Club achieves what it sets out to achieve. In this light, the club offers a peer-focused, community-based social outlet popular with its members. The Troy Social Club model is one which could be replicated in other localities and which club members believe would be attractive to people across Ireland who have personal experience of mental illness.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

The conclusions outlined above emphasise the high satisfaction levels among club members regarding the general and recovery-relevant benefits they believe they acquire through membership of the Troy Social Club. The conclusions indicate that significant potential exists to grow the current club and also to replicate the club model in other localities. However, there is a note of caution in relation to expansion and an appeal that external agencies will not require structural or ethos-related changes in exchange for additional resource investment as such imposed conditions could be detrimental to the benefits currently delivered by the Troy Social Club to its members.

Chapter Summary This chapter completes this report. The discussion of the findings presented in this chapter leads to a short set of conclusions which highlight the general and recoveryrelevant benefits which flow to members through their membership of the Troy Social Club. The conclusions also emphasise the potential for the Club to grow and suggest that the Troy Social Club is a model worthy of investment. However, the conclusions also caution against any developments which would impose changes to the club’s ethos or current efficacy in delivering the identified benefits to members. The club has flourished through the collective decision-making approach adopted by club members and this essential feature is its most valuable asset.

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

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Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

This report was commissioned by the Troy Mental Health Association Social Club. Publication Date: December 2021 © Gloria Kirwan & Calvin Swords

Stronger Together: The Troy Social Club Model of Peer-Led Participation and Mental Health Support

Articles inside

References References

Conclusions

Chapter Summary

Future Potential of the Troy Social Club

Recovery-Relevant Benefits

Chapter Summary

Troy Social Club: Future Potential

Timeline

Contextualising Recovery

Researcher Stance

Recovery in the Irish Context

Troy Social Club Strategic Plan 2019-2021

Conceptualising Recovery

Semi-Structured Interviews

Rationale