An exploration of social participation for young adults following a first psychotic episode

Individuals with mental illness continue to be among the most excluded in society. Adolescents and young adults with psychotic disorders often fare worse than their peers in areas such as education and the adoption of adult social and occupational roles. Although various factors have been identified that influence this exclusion and impairment, studies have predominantly focused on stigma with insufficient attention paid to other societal factors influencing participation (e.g., socioeconomic status, normative age expectations, and social institutions). In addition, there is a notable gap in the literature studying participation beyond that of employment for individuals with first episode psychosis (FEP). Numerous studies have shown that the ability to participate and interact with others is vital to recovery for people with mental illness. Indeed, participation and social interaction promote the development of social networks to support the recovery process, encourage engagement in meaningful activity, and foster community integration. A thorough understanding of how social participation shifts for individuals following their first psychotic break is needed to develop interventions targeting social integration and participation. The objective of this collaborative ethnography was to explore participation in social life for young adults following their first psychotic episode. To meet this objective, the study adopted two specific aims: 1) explore the sociocultural mechanisms that facilitate or hinder the experience of social participation for young adults following FEP; and 2) explore perceived opportunities for participation for young adults following FEP. The transactional perspective, in conjunction with the life course model and theories of action, were used as guiding theoretical frameworks for this study. Semi-structured interviews, participant observations, and discourse elicitation were used for data collection. Seven factors were revealed that impacted consultants' social participation: 1) social norms and expectations; 2) a sense of responsibility to others; 3) consultants' occupational histories and prior routines, including their relationships prior to the illness; 4) change in the physical and social environment; 5) the types of participation available; 6) the need to manage the illness; and 7) consultants' self-perception and the associated perception of occupational possibilities. These factors transacted in a complex way to impact consultants' experiences of belonging and their life trajectories following FEP. Consultants reported experiencing a space of liminality, wherein they struggled with new identities and negotiated new life trajectories. Participation in occupation facilitated movement through the liminal space and promoted belonging after FEP. The study findings offer new insights into theories of belonging, including how belonging is impacted in varying spaces of belonging. Implications for occupational science and occupational therapy are discussed, including recommendations for continued research related to belonging and the use of occupation as a conduit for identity work and movement through liminal spaces.