Literacy matters in mental health : mapping the ruling relations that influence the work of mental health recovery through a lens of literacy
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[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT AUTHOR'S REQUEST.] This 14-month long institutional ethnography seeks to understand how the work of recovery from serious mental illnesses is impacted by both limited literacy and the ruling relations found within a state-run long-term forensic mental health institution. It included 22 adults receiving treatment in the state's maximum and intermediate forensic mental heath facility for serious and persistent mental illnesses. All of the participants had been involuntarily committed to the hospital by either the courts or their families or guardians. Using methods that aligned with institutional ethnography, this study was conducted in four phases. These phases included observations, interviews, collecting artifacts, assessing clients' literacy skills, analyzing the text given to clients, and data analysis. Findings indicate that a complex set of ruling relations and level of literacy skills directly influence clients' recovery work. As a result, those clients who lacked literacy skills of an average middle school student were often unable to independently access many of the treatment tools that required them to read or respond to text. However, when clients could read well enough to understand and respond in writing to treatment texts, they not only had more access to treatment tools, but also had a greater sense of agency, more choice regarding their treatment, and were able to negotiate with their treatment teams. The ruling relations governing treatment often inhibited treatment efficacy and efficiency. This study is one of a handful of studies in the United States that directly explores how limited literacy skills impact treatment efficacy; as such, it has many implications. It adds knowledge to the dearth of literature on the topic of literacy and mental health, and it makes clear the disparities between the intentions of scripted mental health treatment programs and the actualities of the clients' work of recovery, especially when they have limited literacy skills.
Access is limited to the campus of the University of Missouri-Columbia.