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Understanding a complex intervention: Person-centred ethnography in early psychosis

Background: Mental health interventions are increasingly “complex” as it is recognized that a holistic, integrated or “biopsychosocial” approach is required to provide adequate treatment and support. While randomized controlled trial (RCT) studies are applied to assess clinical outcome, the actual workings and experiential effectiveness of this type of intervention are poorly understood and documented. Aims: To discuss the value of a social science perspective of interpretive understanding (verstehen) and existential phenomenology to study sociocultural processes in a complex intervention, in particular when taking an ethnographic approach. Methods: A person-centred ethnographic study of a Danish early intervention in psychosis service involved two years participant observation and repeated interviews with 15 clients. Results: The study detailed therapeutic encounters in the intervention, supplemented by clients' reflections and insights generated through dialogue. Following first episode psychosis clients experienced an existential crisis, and the intervention offered therapeutic engagement, support and systems of explanation that provided meaning and life direction through the recovery models of “episodic psychosis” and “chronic schizophrenia”. Conclusions: The person-centred ethnographic approach provides rich insights into the sociocultural and personally experienced workings of a complex mental health intervention, which allow a critical understanding of therapeutic processes and how they may be improved.