Exploring participation in a recovery focused-filmmaking group for younger adults receiving mental health care Open Access

A qualitative research design was used to explore the experiences of younger adults participating in a filmmaking group. This approach enabled the participants, who attend a mental health service, share their perspectives and opinions of taking part in the recovery-focused group. Ethical approval was received through a local Ethics Committee (Health Service Executive Dublin North City, REC Reference: 12 / 2019).

Sampling was done purposively, whereby all participants of the filmmaking group were given an information leaflet and consent form to invite them to the research study. Inclusion criteria were individuals who attended for the duration of the project. Individuals who were actively psychotic or acutely unwell were excluded from the research. It was made clear that participation in the research was not a requirement and their decision would not influence their involvement in this or future groups. There were opportunities to clarify any information before agreeing to participate.

Data was collected through in-depth semi-structured interviews carried out by the lead researcher, who also co-facilitated the group. All interviews were carried out remotely via telephone or video call due to the government restrictions in place at the time because of the COVID-19 pandemic. An interview schedule was developed to guide the interviews (see  Appendix 2). The interviews were recorded using an audio device and varied in duration from 18 to 56 min.

The recorded interviews were transcribed by the lead researcher, which enabled familiarisation with the data. Guided by Braun and Clarke’s (2013) thematic analysis approach, both authors read and re-read the material to facilitate a full immersion and familiarisation with the data. Each author independently coded each interview relevant to the research questions. Together they reviewed and compared the codes to identify patterns. Themes were discussed and agreed upon through a process of discussion and returning to the interviews to ensure the themes captured the views of the participants.

Throughout the process, the lead researcher was cognisant of establishing trustworthiness as defined by Lincoln and Guba (1985) and this included prolonged engagement with the project and the research process. The preliminary results were discussed with the participants in an informal manner. Each step of the process has been recorded and an audit trail is evident. Both authors debriefed and reflected on the process, using the memoing technique.

The group consisted of five younger adults (23–30 years old) with a range of mental health diagnoses including anxiety, bipolar disorder and schizophrenia. Four participants identified as male and used pronouns he/him and one participant identified as transgender and used pronouns they/them. All five participants who attended for the duration of the group agreed to be part of the study.

Two main themes, with four sub-themes were identified (see Figure 1) and are explored in the following section.

Recovery-focused filmmaking was recognised by the five participants as a way to learn and develop practical skills, as well as provide a medium for personal growth. They described a supportive environment which provided opportunities to build self-confidence and self-esteem and noted how the relaxed atmosphere supported the learning of filmmaking skills.

The group afforded the participants the opportunity to develop practical skills involved with the filmmaking process. They were able to immerse themselves in the process, particularly using the stop motion animation approach. This involved learning about, and exploring, the techniques involved. Some of the participants had previously tried photography and video making (e.g. using a smart phone) and the group provided the opportunity to re-engage with their creativity in a structured way: “Yeah, absolutely, (being creative) with people, instead of obviously on my own and with some guidance, and a reason and a timeline” (Rowan).

For most, the group was their first opportunity exploring their creativity through film. As Shane noted:

Learning new skills was highlighted by participants as a motivational reason to attend the group from week to week as Nathan said “I looked forward to each week, just to see if I was going to learn something new”. The group opened individuals up to experience new and stimulating ideas that were novel to them. Jay’s curiosity was whetted as he said “I became more interested in the ways movies are made […] I started thinking about those things”. The practical nature of the group provided participants with tangible opportunities to build skills through the “doing” of the filmmaking process.

In addition to practical skills, other skills, sometimes referred to as “soft” skills, including social, team working and confidence, were developed by participants. In the group, they took on different roles, e.g. writer and set designer, which engendered a sense of meaning and purpose and developed team working skills. Jay reflected how he “learned about friendship and an effective and efficient way of managing team work and team processes”. As Dave recalled “I’d say, I got more used to the group experience”.

A key part of this was the open communication between individuals. Initially group members were reserved, however over time individuals interacted through working collaboratively and sharing recovery experiences. There was a shared empathy, as Jay explained “there was good understanding, we provided good care for each other when working”. Working as part of a team, Shane felt helped with “understanding other people opinions […] what they take on board, what they feel”.

The project provided an occupation-based and task-focused supportive environment. Having a focus on filmmaking, rather than a discussion group, enabled participants to participate more easily and reduce anxiety through doing. “I think it was ok, cos it was mostly hands on stuff, making things [.] It probably helped with not overthinking, having something to focus on” (Dave).

An increase in confidence in creative abilities was noted “Yeah, like I definitely got more confident, and like about my abilities to be creative” (Jay). Group members recognised how participation mirrored “real world” educational and work environments. “Oh yes definitely it gave me good exposure into the environment of work, it promoted the working standards and ways to manage and work. Work as a team” (Jay).

After the group finished, Rowan, continued to build skills and enrolled on a third-level film degree programme. They directly attribute their success in applying for the programme to their participation in the filmmaking group. They used some of their work from the group for their application and credited the filmmaking group with “100 percent (it helped) with confidence [.] I can do something if I focus” (Rowan).

Participants described a shared connection both through the filmmaking process, as well as their common recovery experiences.

Working week to week on a shared goal and screening the three short films fostered a sense of purpose and connection. Creating the short films as end products had an impact, Jay shared that “the work, the type of work I was doing in the group, gave me more passion and interest in coming to the group and completing it”. The films and their screening provided a tangible end product that instilled a sense of accomplishment; Nathan noted that a highlight was “when the work was finished, when it was edited together”. Rowan proudly reflected “I actually completed something […] seeing it all come together in the end and putting the music to it the little video […] was a really good feeling”.

There was a sense of having shared common experiences: “Slight differences, but similar. We were all similar age […] the common thing was we all had good communication between us” (Jay). Nathan noted shared interests such as football and going to the cinema as a common bond in the group. The shared bond of having experienced mental health conditions was noticeable: “Being around people in similar boats, we’re all going through something, we’re not all pretending to be perfect” (Rowan). In this way, the group was a safe space to explore personal recovery in a collaborative manner. “It probably would have seemed like more of a challenge if people weren’t in the same boat”. (Dave)

During the project, participants were invited to explore the CHIME elements of personal recovery and encouraged to share their experiences within the group:

Some participants highlighted the link between meaningful occupation and recovery, “I believe we should not be idle all the time, we have to be working […] Recovery would be being social and active” (Jay):

Participants noted that it added to their weekly routine and in turn increased their activity levels: “It broke up the week more, before that I was just going to work, and not much else” (Dave). It provided expectation in the week as Shane noted:

The positive link between creativity to mental health was recognised. As Rowan reflected “at the time I was really struggling, I’d lost creativity from my life and that was the thing that was making my anxiety worse, not having a creative outlet”. Some participants saw the group as a motivating factor to further their participation in creative activities after the group, Nathan planned on using his own stills camera more: “Just thinking about going out with the camera”.

An aspect of recovery is taking positive risks. The group afforded opportunities for participants to take risks in a safe space as Dave noted “It’s like expanding your comfort zone, recovering your old comfort zone”. There was a sense that through challenging themselves in a safe environment, individuals were provided with opportunities for self-growth and developing or regaining a sense of self. As Rowan noted, “what I have said to friends is I’ve been going to this filmmaking therapy group, combining the two”.

Being part of a filmmaking group provided the participants with the medium to create and develop skills and knowledge. This enabled collaborative working, peer support and opportunities for self-expression. The invested ownership of having a screening as the end product was a motivating factor. In addition, the project supported individuals to understand their personal recovery through the storytelling process. And illustrating how creative occupations can be an important factor in recovery and a catalyst for personal growth (Slattery et al., 2020; Hurst et al., 2022).

These findings align with other filmmaking studies, for example: development of social connectedness, new insights into mental illness and confidence (Boyd, 2010) as well as its value to explore creativity, enhance skills development and inspire future work in media (Gagliano et al., 2023). The group fostered a sense of possibility and hope which is integral to recovery (Llewellyn-Beardsley et al., 2019). The concept of “esprit de cour” (noted by participant, Murphy and Fox, 2024) aligns with the theme of the “same boat” and highlights the importance of team working and connectedness. It supports Hurst et al. (2022) idea that the CHIME model can be updated to C-CHIME to include creativity, highlighting its importance in recovery.

This study was distinct in the combination of facilitators, who brought their own skillset and knowledge to the process. Although the lead researcher has a background in film, it was deemed necessary to co-facilitate the group with an experienced filmmaking tutor to provide the technical expertise required; this input was highly valued by participants. Whilst the tutor took the lead with demonstrating the technical aspects, the occupational therapist guided the process using an occupation-based approach (Fisher, 2013; Christiansen and Haertl, 2023), which was person-centred and activities were graded to match participants’ abilities. The occupational therapist was in tune with their needs, e.g. being cognisant if they needed a break or time out of the room they were working in. The occupational therapist guided the recovery discussions and was mindful of creating the relaxed and supportive environment and drawing on individuals’ strengths. Therapeutic use of self was a focus of the approach, to provide an optimal experience for participants. Throughout, the therapist adapted the approach as guided by the intentional relationship model (Taylor, 2020), particularly using the modes of collaborating and encouraging. The combination of occupational therapy and filmmaking facilitators was complimentary and created a synergy of creativity and learning.

It has been highlighted that younger people often have limited engagement with interventions and there can be gaps in service provision that do not match the interests of this population (Creamer et al., 2020). Prior to the group, some participants had limited participation in meaningful occupations and had experienced disruption to age appropriate roles (including student or worker) due to mental ill health. The group provided the opportunity to build confidence to re-engage with such roles. The use of animation has been highlighted to increase motivation in younger people who had limited engagement previously (Mason, 2009).

Several participants identified that they would be interested in taking part in similar projects in the future. Due to COVID-19 restrictions, it was not possible to run subsequent groups directly after, however plans are in place to run a similar group in the future. Co-facilitation of the filmmaking tutor and occupational therapist, which was integral to the group, places demands on funding and staffing, and this may be seen as a disadvantage in comparison to more traditional interventions. There is also potential for increased involvement of service users through co-production (where service users are more directly involved with planning and facilitating the group) as outlined by Bird et al. (2021).The PhotoVoice method as used in occupational therapy (Birken and Bryant, 2019) could also be used for future research.

Due to the duration of the group, it was not possible to explore other styles of filmmaking, outside of stop motion animation. Participants expressed an interest in other areas of filmmaking and these will be taken into account for future groups. There is scope to work with partner organisations, e.g. community-based arts organisations through Réalta (the national resource organisation for arts and health in Ireland) and to establish links with third-level media courses to access facilities, equipment and expertise.

Research limitations include the small sample size recruited from one service. The study was carried out during the COVID-19 pandemic and therefore there were some restrictions on the data collection process. The interviews took place via telephone or video call, which potentially impacted on the process. The lead researcher was also the co-facilitator of the project and therefore had to be mindful of bracketing of existing knowledge. This was done through self-reflection, being self-aware and in the data analysis discussions that took place. Although efforts were made to ensure the dual role of the occupational therapist did not influence participants in the research process, it must be acknowledged that it may have impacted on the data collection process.

This is the first known research study solely focused on filmmaking and animation from an occupational therapy perspective and highlights the benefits of co-facilitating groups with professionals from outside the health-care domain. It illustrates the potential of creative occupations for developing not only skills but also fostering a shared sense of purpose and meaning, in a safe environment that affords opportunities for self-expression and collaborative exploration. Creative occupational participation can be a catalyst for recovery. This study points to the benefits of filmmaking for younger adults attending mental health services, however future projects could focus on different age groups. This research indicates that there is a role for filmmaking in occupational therapy but future research would be beneficial to build the evidence base.

• Exploring how creative groups can be more sustainable.

• Investigating how innovative interventions can be integrated into occupational therapy practice.

• Incorporating participatory research methodology.

The authors would like to thank the managers and staff involved for their support of the project, Colm Mullen (filmmaking tutor) for his role in the group and most importantly the participants.

• What interested you about the group? Do you watch films? Go to cinema? Had you ever made any films or done photography before the group? Was the group what you expected?

• How did you get to the group each week? What was it like to work with others? What skills do you feel you developed during the group? What motivated you to come to the group week to week? Did you do any creative activities outside of the group when it was taking place or since?

• How do you describe recovery? Did you have things in common with others – what sort of things? What was it like to work on the project with others who have been through similar experiences? What did you notice about yourself, your confidence?

• Did you discover anything new about yourself?

• What was the best bit about it? What would you change if we were doing it again? What would you tell a friend about the group? Did it change your routine/week? - In what way?

• Would you like to be involved in similar projects in the future?

• How did you find working the two facilitators?

Source: Authors’ own work