title: Understanding mental health: the use of narratives by those that have experienced State care
Creators: name: Power, Luke
Publisher: name: The University of Edinburgh
Year: 2025
Subjects: subject: Scottish care system
subject: mental health
subject: care leavers
subject: purpose
subject: affirming relationships

description: INTRODUCTION: People who have experienced State care as children tend to have worse outcomes than their non-care counterparts across a range of domains including education, health and employment. Although, it is important to note that these trends fail to account for those who have positive trajectories. Differences in mental health outcomes between care and non-care experienced populations have been particularly emphasised. Within studies examining the mental health of this population, there has been limited use of narrative based approaches in understanding their trajectories. The value in utilising such an approach is that it permits one to understand the subjective nature of meaning creation in the context of an individual’s biography. Thus, there is a need to understand (1) what narratives people who have been in care use to understand their mental health in the context of their biographies? and (2) what, according to people that have been in care, are the key factors that impacted their mental health, both positively and negatively? METHODS: Third sector organisations and Edinburgh City Council were engaged to support with recruitment. Eight participants were interviewed on 2-3 occasions each, which led to collection of 25 hours of data. The interview technique employed was an adjusted version of the Biographical Narrative Interview Method (BNIM). In the primary session participants were asked to draw a timeline of their life and were then asked a single question aimed at inducing narrative (SQUIN). Follow up sessions were used to unpack key themes. Two analytical strategies were utilised: BNIM and thematic. The first was used to assess the narratives employed by participants and the second aimed to examine what additional experiences – outside of their narrative construction – impacted their mental health. FINDINGS: There are two interrelated sections within this thesis. The first section of this pertains to the importance of relationships (inter-personal, institutional and cultural) to care experienced people’s mental health, both in producing positive and negative feelings. Honneth’s three-pronged theory of recognition was utilised to assess the narratives of participants. The three narratives that emerged in relation to these three dimensions were ‘the need for unconditional love’; ‘choice, agency and dehumanisation’; and finally, ‘finding a purpose and meaning in the world’. The second section focused on those additional factors that interviewees considered to be critical to their mental health. There were 4 themes that emerged: parental mental health; transitioning into homelessness; poverty prior to, during and after care; and neurodivergence and learning disabilities. Given these findings a re-examination of the applicability of Honneth’s framework is presented through an engagement with Fraser’s critique. It is posited that while Honneth’s framework is useful, it fails to account for the objectives needs of this population. In addition, while Fraser’s approach overcomes Honneth’s failings, it too has its limitations. Consequently, this thesis advocated for the use of an adjusted, Fraser-style, perspectival dualism model whereby recognition is not limited to its cultural or institutional forms but also acknowledged the importance intersubjective recognition- that which occurs between individuals. CONCLUSION: The development of a model which furthers the insights made by Fraser provides a method by which to explicate the mental health of those that have been in care. This specifically relates to understanding their intersubjective and objective needs, or what might be termed their relational and material needs. While distinct, these factors are closely intertwined and thus cannot be addressed independently of each other. If Scotland is to be “the best place for children to grow up”, as outlined in the Scottish Governments Promise, it must address these issues by meeting the targets they have set. If it does not, it will fail to fulfil its obligation to those that have experienced care in Scotland and those that, unfortunately, will in the future.