Improving Transitional Care for Individuals with Severe Mental Illness: The Role of Narrative Repair

Traditional healthcare narratives have set the stage for the care of the population with Severe Mental Illness (P-SMI). Thus far, two prevailing health strategies anchor services for mental illnesses, acute psychiatric care, and mental health, psychosocial rehabilitation. Between these, care transitions mediate PSMI’s needs and their movements from the hospital to the community and home. However, as individuals with Severe Mental Illness (i-SMI’s) leave the hospital, time is short with little opportunity to make known authentic narratives born out of self-evidence. After transitional care, maintenance treatment re-centers these individuals back into a playbook with operatives of pathology and disability and inconsistencies with the narratives on recovery and rehabilitation.

This project sought to hear i-SMI’s stories and propose how their experience can be used to create a new “counter” story of transition that empowers these individuals through a better understanding of their “space”: conceptualized here, as all that surrounds them and is dynamic and responsive to their interactions and needs. Underpinning this inquiry is a post-modernist conversation that converges on the critical perspectives in the theory of architecture, philosophy of mind, cognitive science, and the aesthetic practice of psychiatric nursing in the context of transitional care. A qualitative paradigm of narrative repair guides an ethical appraisal, “deprivation of opportunity,” and “infiltrated consciousness,” regarding relational power dynamics that are at work in healthcare master narratives.

Narrative findings of this study reveal that identity and agency come together in a personal space of safety born out of a core sense of self, belonging, and control. Space emerges within the self-narrative as physical sensibilities in the constructs of agency and safety, and as with emotional responses, metaphor and meaning can repair personal transitions.

The counterstory derived from the narrative findings reveals: Equitable relational dynamics attune social space, the physical environment, and meaning, as a response to the dismissiveness and overcontrolling health professional power. Thus, the journey toward narrative repair from the perspective of i-SMI’s uncovers a deeper counternarrative, Ecosystem of Space: the manifestation of a personal architecture for healing, making a systematic organic-space-experience for the core sense of self to transition and flourish.