Final Essay – Aaron James Lee – A1644607

MENTAL HEALTH LITERACY: AN INTERPRETIVE PHENOMENOLOGICAL

ANALYSIS RESEARCH PROPOSAL

Qualitative Research Methods in Social Sciences SOCI 3014

Aaron Lee

University of Adelaide

17th June 2022

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Final Essay – Aaron James Lee – A1644607

Mental Health Literacy: An Interpretive Phenomenological Analysis Research Proposal

Mental Health Literacy (MHL) is referred to in scientific literature as a level of

educated understanding of mental health disorders (Ma, Anderson & Burn, 2022), and is one

of the largest factors that can influence adolescents to seek out treatment (Radez et al., 2021).

Radez et al., further indicate that Mental Health Stigma (MHS) is also a large factor that

inhibits children, possibly leading to poor MHL. Current literature claims to address this

stigma through family-based treatment (Brooks et al., 2022), with recent research efforts

primarily aimed at improving MHL and MHS in children. Despite this progress,

normalisation of mental health (and therapies) involving families does not specifically target

stigma in older generations. Here the issue of stigma remains – even within older generations

who receive mental health assistance (Temple et al., 2021). Therefore, the stigma generated

has ties that can be intergenerational - a form of tribal stigma - which can create a cycle of

MHS passed down from generation to generation (Barnwell, 2019). In an effort to bridge the

research gap between MHL, MHS, and intergenerational stigma, this essay proposes a

research project that will explore the lived experiences of individuals who live with a mental

health condition, family history of mental health, and the support they received from parental

figures, or from people of previous generations. The proposed research project will utilise the

methodological framework of Interpretive Phenomenological Analysis (IPA) and employ in-

depth interviews to answer the following research question: How does mental health stigma

influence intergenerational mental health literacy?

Literature review

The intergenerational effects of mental health have garnered much attention in

research literature, exploring ideas ranging from treatments into family-based interventions as

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a methodology to heal the mental health disparity between generations, to analyses of the

consequences of neglected mental health. As indicated by Van Doesum et al., (2019), the

need for family-based mental health practices is critical to avoid detriment to children whose

parents are mentally ill. This research specifically highlighted that children had a higher

propensity to become mentally ill themselves, with effects reaching long into their adult lives.

In addition, research examining the mental health of adolescence in general has found that

prevalence rates for mental health illnesses are rising (Tully et al., 2019). Consequently, a

large amount of research has sought to improve possible mental health interventions for

children, mainly by increasing their MHL levels (Brooks et al., 2022; Ma, Anderson & Burn,

2022; Tully et al., 2019). As indicated by Radez et al., (2021), MHL levels were a prevailing

factor that led to younger children not seeking out mental health assistance. Thus, it is

understandable why current findings are emphasising the need for increased education, and

why these programs focus primarily on children. However, poor MHL levels being recorded

internationally indicate that this phenomenon is caused by other common factors (Ma,

Anderson & Burn, 2022). The findings from Radez et al., (2021) suggest that poor MHL

result from MHS which is either learned from one’s family/culture; however, this can also

emerge as a form of self-stigma, in which mental health is seen as embarrassing. Thus, it can

be observed that families have the means to assist children in their mental health recovery by

engaging with therapy (Foster et al., 2018). Alternatively, families can contribute negatively

to a child’s mental health by engaging in behaviour which promotes mental anguish, and

further leading to violence or suicide (Campo et al., 2020).

The research findings highlight family involvement and adolescent MHL as

reoccurring themes linked to addressing adolescent mental health. The lasting effects of

mental health on children discussed by Campo et al., (2020) coincides with the findings

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presented by Van Doesum (2019) in relation to mental anguish and suicidal tendencies. Yet,

the exact effects may vary from the loss of the child’s life, to the child continuing the cycle of

intergenerational mental health issues to their own children. These effects indicate a

reccurring state of mental illness that travels across generations; a point that is somewhat

acknowledged by Tully et al., (2019) and Brooks et al., (2022), though absent in work by

Radez et al., (2021), and considered outside the scope of Foster et al., (2018) and Ma,

Anderson and Burn (2022). Clearly, the nature of child mental health illness presents a

challenging dilemma for society and researchers. Each generation’s MHL depends on the

MHL of the former generation, yet lower levels of MHL will lead people to neglect their own

mental health, their ability to support others, and their children in the future; thus creating a

new generation with poor MHL who will perpetuate the issue further. Therefore, while the

direction of family-based care may (when fully supported) slow the progression of this cycle

in individuals, this method does not address a solution for the wider populace, and can only

act as a short-term solution to the intergenerational transfer of mental illness.

The MHS carried over from generations acts as a block to seeking help and improving

one’s own MHL. Understanding ways to challenge these held beliefs can offer greater

improvements beyond merely addressing MHL alone. As indicated by Hurley et al., (2020),

factors influencing young people to seek mental health support can range from parental

perceptions of the treatment being appropriate based on religious, cultural or ethnic reasons.

Additionally, Hurley et al., also separately addresses stigma, with findings showing mothers

may still display stigmatising attitudes despite possessing higher levels of MHL. These

findings indicate that the process of labelling stigma falls under the umbrella of possessing

attitudes against mental health. This stigma can also arise from held views of alternative

treatment, which are as important as stigma; these views can inhibit the younger generation

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from seeking help, despite the presence of programs seeking to improve MHL. Parents’

stigmatisation of mental health is compounded when they are also mentally unwell

(Goodyear et al., 2018). The facilities available to handle such complex situations may not

possess the resources to ensure a positive outcome. Furthermore, as indicated by Temple et

al., (2020), health care systems also can hold stigma to treat those from older generations,

leading to prolonged waiting times and distress.

Considering the above research on MHS, it is clear that stigma significantly

influences society in regards to the progression of widespread mental health issues. These

issues are also embedded in cultures, with the definition of stigma mentioned by Hurley et al.,

(2020), highlighting the influence of cultural, ethnic and religious beliefs. These points give a

better representation of what MHS is, though was not thought of in a similar way by

Goodyear et al., (2018) or Temple et al., (2020). Conversely, when challenged with the

question of how to overcome MHS, Goodyear et al., (2018) refer to a general definition that

stigma is complex when additional factors are involved, and do not present tangible solutions.

This general definition does not move the conversation forward, with the above research

showing MHL as a means to combat stigma. The stigma that Hurley et al., (2020) presented

is highly resistant in that even those who are informed of mental health practices may ignore

this information due to their preconceived beliefs. Nevertheless, the body of literature on

MHL and MHS is robust and shows an active discussion towards varying aspects of either

issues. The additional concern raised from intergenerational findings and how this influences

children shows that there is a gap in the literature when providing possible responses to

combat mental illness from influencing future generations. This is a topic which merits

further exploration.

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Position Statement

I would like to acknowledge my own position as someone who suffers from mental

health issues, as someone who belongs to a family with a mental health history. As indicated

by Johnson, Adkins, and Chauvin (2020), addressing one’s own position prior to a proposed

study is needed to clarify any biases that may influence the study, and to signal any ethical

issues this could create. The main bias that can be seen from my own position is how I am

strongly affected by the subject matter being researched; yet, this bias serves as a source of

motivation for exploring the issue, and does not negatively affect my performance or my

analysis of findings. I recognise that my position can be used to sympathise with the intended

sample of participants, yet the nature of questions in this research is strictly about the

experience of others and thus should not create any issues. Nevertheless, my position in

combination with being a researcher in the interview process may affect the participants. I

have thus included countermeasures in the ethics section to address these concerns.

Methodology

The methodology selected for this study will utilise interpretative phenomenological

analysis (IPA) as its methodological framework. IPA stems from the theory of

phenomenology, which has origins stemming from the early 2000s, and is distinct in the

methodology used to understand experience when compared to hermeneutics and

transcendental approaches (Miller et al., 2018). Furthermore, Miller et al., (2018) indicate

that IPA extends beyond the other traditional approaches through its commitment to

ideography (particular focus, rather than general focus). This informs its epistemological

framework. As such, IPA is centred around the lived experience of an individual with a

particular quality; in this case, the experience of those with a mental health disorder. This

phenomenological approach finds justification in the need for further research depicting the

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lived experience of growing up mentally ill and/or with mentally ill parents, and the effects

MHL can have on MHS. When participants are acknowledged as people - separated from

their identities and given a voice - the researcher may best capture these narratives as ways

to interpret how MHL can be utilised to combat MHS through additional support programs,

development of programs, and further directions for research (Patrick et al., 2019).

Furthermore, IPA’s alignment with the hermeneutics approach supports the appropriateness

of this methodology with those having suffered from mental illness themselves, and/or with a

mentally ill parental figure (Nizza et al., 2021). Finally, in contrast to nomothetic approaches

which apply analysis at the group level (Nizza et al., 2021), IPA’s idiographic analysis retains

the details on an individual level. This retention encourages the exploration of detailed

accounts which build a picture of themes and reoccurring motifs that are not intended for

generalisation; rather they function as material to make sense of intersecting themes. Thus,

the IPA framework provides a means for exploring the detailed lives of those with mental

illness or mentally ill parents in order to make sense of their experience, and the contextual

interpretation of the MHL and MHS.

Methods

Sampling

Considering IPA’s ideographic emphasis and the need for the desired representation of both

mental ill children and parents, this project will use a stratified sampling method (Foster et

al., 2018) with ten Australian participants recruited through flyers and emails to mental health

practitioners. This method of recruitment was utilised by Patrick et al., (2010) in relation to

the experience of mentally ill parents with children in Australia, and endeavours to utilise

three factor criteria for selection of participants. Firstly, the participant or parental figures

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must have a mental disorder. Secondly, participants must be above 18 years old (this will

constitute a new generation). Finally, participants must be residing in Australia. This is the

process of recruitment that allowed Patrick et al., (2019) to have a diverse sample in their

desired demographic; thus, the same method ought to yield participants who are familiar with

discourse, and further demonstrate degrees of introspection in regards to their recounted

experience.

In line with the considerations which Knox and Burkard (2014) present prior to research, the

medium of interview, frequency, and relation to cost need to be stipulated thoroughly. This

research will utilise face-to-face interviews as well as a pre-interview screening which will be

used to assess the suitability of participants who will be subjected to multiple interviews. The

use of multiple interviews is suggested to uncover the relevant contextual information (Knox

& Burkard, 2014). The time added between will also allow participants to reflect on what

they have said and further clarify statements. This autonomy is given to participants in order

to reassert their sense of control ensure their full participation when addressing challenging

subjects.

Data Collection

Following IPA’s phenomenological underpinnings and preference for detailed accounts, this

study will utilise multiple semi-structured, face-to-face interviews as its data collection

method (Moser & Korstjens, 2017; Knox & Burkard, 2014). There will be three interviews

for each participant, and these interviews are intended to gain an understanding of the lived

experience and attitudes surrounding the Mental illness through a phenomenological

perspective (Peters, 2010). The intent is to encourage exploration into a participant’s lived

experience, and to ensure questions aren’t asked entirely for the purpose of any specific

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response (Moser & Korstjens, 2017). The use of semi-structured interviews allows the

researcher to maintain a focus for the interview, but grant the interviewee the autonomy to

discuss things at a pace they can comfortably move through (Knox & Burkard, 2014). For the

interviews, I will develop an approximate interview guide (Moser & Korstjens, 2017) that

will feature a series of guiding questions based on the findings within the MHL and MHS

literature. Additionally, the previously mentioned intergenerational effects of mental illness

will be discussed to determine how relatable, relevant, and applicable the participants’ family

history are for these findings. The interviews will be conducted face-to-face in a semi-public

setting with audio recorded, while being transcribed verbatim for analysis (Moser &

Korstjens, 2017). These interviews give participants a voice to share their lived experience of

mental illness in detail.

Data Analysis

Data analysis through the lens of the phenomenological methodology is attempting to make

sense of the gathered material to grasp possible meaning (Knox & Burkard 2014). However,

this subjective interpretation means that there is no correct way for meaning to be created

(Miller et al., 2018); thus, there is risk of being affected by my own judgements, attitudes,

and feelings towards the material. In order to mitigate such affects, a strict model of analysis

aligning with the IPA’s idiographic nature will serve as a guide when examining each case

individually for themes and recurring patterns. This will be undertaken before applying the

same process broadly across the whole study. I will follow the method of analysis outlined by

Miller et al., (2018), as it explicitly explains the use of a first and second order analysis that

coincides with IPA methodological framework. This framework functions with the intention

of first analysing the data as a pure descriptive means, and secondly finding and attaching

meaning to the information. This process will allow me to reflect on the material produced

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and how it relates with already established findings of MHL and MHS, while ensuring

appropriate tracing to individuals.

Ethics

Contemporary approaches to ethics in social research pertain to a sense of good and respect

to the human rights of others. This recognition of ethics of little concern in previous

generations; as such, this led to poor treatment of people that served as a basis for early

scientific study (Orb, Eisenhauer, & Wynaden, 2001). Consequently, studies have now

adopted measures that ensure the absolute protection of human rights along with ethical

principles that function to promote autonomy, justice and benevolence (Ibid, 2001).

However, this use of ethics is not be mistaken for a barrier to research, as it is a safety

measure which ensures that the participant is safe from the consequences of research such as

the type of research investigated, how the knowledge is produced, and how findings are

published (Kostovicova & Knott, 2020).Thus, it can be determined that research carries risk

to the participant, and must have a series of safeguards to ensure that ethical principles are

followed and communicated effectively. Prior to the commencement of this study, an ethics

application will be lodged to ensure all considerations are adequate in handling ethical

concerns, as well as garner improvements for the protection of myself and the participants.

Autonomy

In recognition of participants’ autonomy when recalling past experiences of mental health

issues, a large amount of ethical considerations are put into place to ensure that any emotional

damage can be mitigated and addition support services will be available. Firstly, the initial

pre-screening ensures that the emotional stress of recounting events will be manageable for

the participant. Although participants may be able to acknowledge that they are willing, in the

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likelihood of distress arising, participants will need to be made aware of their ability to cease

the interview at any stage or withdraw from the study entirely. The informed consent of the

participant is acknowledged and made aware to participants at the commencement of every

interview. If distress is latent, a support email will be sent outlining that participants can

reach out to voice any concerns. My role in this study is strictly established as that of a

researcher, and I will also inform the participant that I cannot be involved in emotional

management processes.

Justice

To ensure the participants’ data and identity are protected, the study will be strictly referring

to the participants and subject in the publication of any findings produced. Furthermore, there

will be engagement with participants at each stage of research to determine if they would like

to continue the study; this will continue even after the last interview. The intention of

maintaining engagement is not only to bring peace of mind to those involved, but to

accurately capture the essence of what has been communicated and to avoid

misrepresentation of their portrayed experience. As indicated by Shaw et al., (2019), working

with those who suffer from mental health issues are considered vulnerable and it is crucial

that their contribution is fully acknowledged as their own work. This respect of information

coincides with the notion that these people’s voice will represent the broader society, so their

message must be clearly articulated and accurate.

Benevolence

The findings of this study are intended to enhance the current means of mental health

understanding and material that is used to formulate effective treatment. Participants will be

made ware of this fact, and can choose to receive a copy of the produced findings.

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Conclusion

The proposed research study aims to address how younger generations can effectively utilise

MHL to combat MHS in older generations. Using an open definition of ‘mental disorder’, the

term is more inclusive to allow varying mental illnesses to be incorporated in the study. The

intention of the study is to represent the lived experience of mentally disordered people, the

MHS they faced, and how older generations within their family demonstrated support. The

research design is built around the methodology of phenomenology (specifically through the

use of interpretative phenomenological analysis), and the research methods of in-depth

interviews will be employed to understand the experience of a small sample of those

suffering from a mental disorder. A HREC review will be submitted prior to commencing

this research, and as much effort will be made to minimize the potential risks to myself and

participants while working ethically. In conducting research with those with a mental health

disorder, we can begin to acknowledge and highlight the impact that Mental Health Literacy

has on relationships with parents, older generations, and future generations to come.

Words: 3, 198

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