Preparing for a physical activity intervention in a secure psychiatric hospital: reflexive insights on entering the field

The medical model for treating severe mental illness has been critiqued for its insensitivity to the subjective and contextual facets of patients' illness and recovery experiences. For many, mental health service efforts are a function of the social and institutional contexts in which they occur. Understanding this therapeutic context is therefore critical to planning effective care strategies. In this confessional tale, the first author reflects on one-year (>300 h) within a medium secure psychiatric hospital - a process carried out to inform the future design of a physical activity intervention. Drawing upon reflexive journal entries, conversations across the research team, and personal introspection, three broad methodological insights are offered; 1) becoming a reflexive researcher, 2) negotiating 'the self' in a mental health context, and 3) cultural means to logistical ends. Researcher reflexivity is a challenging and effortful process that can lead to unforeseen insights into the research setting. Practicing reflexivity supported the first author towards an awareness of her own stigmatised attitudes to mental illness and how they might affect the research process. Immersive fieldwork is time-consuming and presents a raft of methodological difficulties, but it supports deep and nuanced insights unavailable through other methods. When seeking to effectively tailor intervention strategies to the unique needs of a given healthcare setting, this added depth and nuance is valuable. Health intervention work that draws on immersive qualitative methods, rather than tokenistic forms of 'patient public involvement', is better equipped to deliver strategies that are not only efficacious but also effective.