Partnership in action: Understanding mental health through Participatory Action Research

Stephanie Cantrill and Helen Fernandes

06 Jul, 2017

This blog is based upon a presentation made by Stephanie Cantrill and Helen Fernandes of TEAR Australia at the Research for Development Impact Conference, 13-14 June 2017.

Community development principles are integral to the work of TEAR Australia. Where communities are empowered and have ownership over what’s happening, progress can be more sustainable, more contextualised and more genuine. As an approach to development, community development values inclusion, participation, lifelong learning and equitable access.

When TEAR embarked on a journey to undertake some mental health research, it was natural to let those same principles guide our approach to research. This meant the research needed to be collaborative, involve participation and inclusion, and give a voice to the little-heard voices in the community.

Enter Participatory Action Research. More specifically, enter Photovoice as the medium for this research. What we wanted to do was explore barriers and pathways to inclusion for people experiencing psychosocial disability (a term that captures the limitations to social and community access experienced by people with mental health issues beyond the actual diagnosed illness). Photovoice allowed us to hear the voices of those most affected by giving cameras to people with psychosocial disability. It provided a means for the sharing of stories and perspectives that might otherwise go unheard.

Of course, this research was not as simple as just putting cameras in people’s hands and letting the stories play out. We took a partnership approach that involved a vast range of players – academic colleagues, a mental health reference group, TEAR staff, TEAR partner organisations in India and Nepal, communities, and the people with psychosocial disability themselves. Given the diverse partners involved, the process did not always progress smoothly nor as planned. Nevertheless, it roughly followed the stages below, allowing for flexibility and adaptation as needed. 

Using Participatory Action Research provided opportunities for on-the-ground struggles to be surfaced and discussed, allowing partners to co-create solutions. For example, some staff have reported having fresh insights into how factors broader than access to medication has impacted on the lives of people with psychosocial disability, thus strengthening their support of community groups.

Looking at our research through the lens of Cargo and Mercer’s core elements for participatory research has helped us to evaluate how well we did this (spoiler alert – looks like we did okay, actually). Let’s discuss that below:

First, there’s capacity building. When it came to research, there was a lot of our own capacity to build first – the TEAR staff involved (one paid and one volunteer) are not, strictly speaking, academic types. With support from the staff at the Nossal Institute for Global Health, we were able to go through the processes of ethics applications (three different processes!), academic writing and so on. We then created and provided training materials for local partners in the use of Photovoice as a research method (before we started, the partners told us they didn’t want a bar of any “boring research” – and we listened), and supported the partners through the process. Partners are already talking about how some of the outcomes could be used in their programs.

The next essential domain for participatory research is empowerment. What we’re hoping is that it’s not only the partner organisations that are empowered through this process – but certainly that’s something we’re seeing, as described above. In addition, we hope there’s empowerment of people living with psychosocial disability, plus their families and communities, through this research. Giving people a voice, and letting them identify not only challenges but also pathways to change, can lead to good things.

Another essential element of participatory research is ownership. From the start, ownership has certainly been the aim. We wanted the partners to be fully on board, and so we selected the particular method of research in collaboration with them. We wanted the loudest stories to be the ones told by those most affected by psychosocial disability – choosing Photovoice because it “puts people in charge of how they represent themselves and how they depict their situation (Booth & Booth 2003).” Recommendations for action arising from this research are likely to be locally-based (but hopefully with some implications for other settings), and we intend to support the partners as they play this out in their own contexts.

Next up is accountability. Our primary means of maintaining accountability was a conscious and continuous effort to keep all parties updated throughout the process. To maintain a shared understanding of what was involved, we spent a lot of time communicating and making information more accessible. We conducted a practice review with partner organisations in order to explore what was already working (and not working) in regards to their work in India, Nepal and Afghanistan. We also collaborated on the research frameworks, contextualising where needed.

Finally, of course there needs to be sustainability. An advantage that we had here was that the researchers were members of the local communities, with a thorough understanding of the language and cultural context. Therefore, participants could be understood in a non-threatening context that allowed them, along with their families and communities, to not only identify problems but also discuss solutions and community-led actions for change. Also, the process of establishing partnerships for this research has created important linkages between organisations – linkages that can provide opportunities for future sharing of ideas.

Importantly, we at TEAR have learned a lot through these research partnerships – learning from our partners in the process, and from the process itself. The mix of experience, expertise and local knowledge has been an incredible asset to this research, but it has required flexibility among all players in order to allow for differing priorities or ideas. This, naturally, has led to the process requiring more time than previously anticipated. That being said, we are excited to be seeing tangible results from our research already emerging, and we plan to disseminate the research findings through direct feedback to communities involved, through photographic exhibitions here in Australia, and through workshops to partners and the wider sector. Most importantly, this research aims to give voice to those most directly impacted by psychosocial disability, and we hope that their voices can be heard and lead to the breakdown of barriers and greater inclusion.

TEAR Australia is grateful for the work of its key project partners: the Nossal Institute for Global Health; Centre for Mental Health and Counselling (Nepal); Emmanuel Hospital Association (India); and TEAR’s Partner in Afghanistan (unnamed for security reasons). TEAR Australia acknowledges the financial support of the Department of Foreign Affairs and Trade in making this research possible. 

  • Stephanie Cantrill and Helen Fernandes
    Stephanie Cantrill and Helen Fernandes

    Stephanie Cantrill and Helen Fernandes, Tear Australia 

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