Negotiating support from relationships and resources: a longitudinal study examining the role of personal support networks in the management of severe and enduring mental health problems

Background Personal communities or personal support networks comprise a variety of social ties considered important to individuals in their everyday lives. This set of active and significant ties influence the capacity to manage mental health problems because of the potential to access social support. However, little is known in the context of people's everyday management of mental health about how relationships with people, places, objects and activities are navigated and negotiated. This study aimed to explore the nature and negotiation of support from personal communities in the everyday management of severe and enduring mental health problems. Methods A longitudinal qualitative study undertaken in the UK incorporating 79 interviews with 29 participants based on personal network mapping. 29 users of mental health services with a diagnosis of severe and enduring mental illness were interviewed at three time points. Data was analysed using an inductive thematic approach underpinned by the Network Episode Model. Results The presence and maintenance of interpersonal trust was a fundamental condition of the relational work required to develop, undertake and sustain relationships with others. Whilst relationships with spouses, family members and friends were generally viewed positively, the work required to engage human others was contingent, vicarious and overlain with felt and enacted stigma. Developing relationships with others was hindered by a lack of confidence fuelled by the experience of mental illness and a fear of rejection or failure. By contrast, weaker ties and inanimate objects and places offered and provided a sense of reliability and security. Strategies employed by participants in order to garner sufficient support for condition management in the light of these particular challenges are illuminated by the discussion of who and what is relevant and valued in personal support networks. Conclusions Access to valued activities, hobbies and things should be considered alongside human relationships in providing a means of ongoing support and resource for the everyday management of life for those experiencing severe and enduring mental health problems.