Dont Get a Pet Until Your Ready Peer Reviewed

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• Published: 09 December 2016

Ontological security and connectivity provided by pets: a study in the self-direction of the everyday lives of people diagnosed with a long-term mental health status

• Kelly Rushton^ane,
• Sandra Walker^two,
• Karina Lovell¹ &
• Anne Rogersⁱⁱ

BMC Psychiatry volume 16, Article number:409 (2016) Cite this article

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Abstruse

Background

Despite evidence that connecting people to relevant wellbeing-related resource brings therapeutic benefit, there is express understanding, in the context of mental wellness recovery, of the potential value and contribution of pet ownership to personal support networks for self-management. This written report aimed to explore the role of pets in the support and management activities in the personal networks of people with long-term mental health issues.

Methods

Semi-structured interviews centred on 'ego' network mapping were conducted in two locations (in the North West and in the S of England) with 54 participants with a diagnosis of a long-term mental wellness trouble. Interviews explored the day-to-24-hour interval experience of living with a mental illness, informed by the notion of illness work undertaken by social network members inside personal networks. Narratives were elicited that explored the relationship, value, utility and pregnant of pets in the context of the provision of social support and management provided by other network members. Interviews were recorded, then transcribed verbatim before existence analysed using a framework analysis.

Results

The majority of pets were placed in the central, about valued circle of back up within the network diagrams. Pets were implicated in relational piece of work through the provision of secure and intimate relationships not available elsewhere. Pets constituted a valuable source of illness piece of work in managing feelings through lark from symptoms and upsetting experiences, and provided a form of encouragement for activity. Pets were of enhanced salience where relationships with other network members were express or difficult. Despite these benefits, pets were unanimously neither considered nor incorporated into individual mental health care plans.

Conclusions

Drawing on a conceptual framework built on Corbin and Strauss'due south notion of affliction 'piece of work' and notions of a personal workforce of support undertaken within whole networks of individuals, this study contributes to our understanding of the role of pets in the daily management of long-term mental health problems. Pets should be considered a main rather than a marginal source of back up in the management of long-term mental health bug, and this has implications for the planning and commitment of mental health services.

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Background

The ability to manage and to be engaged with everyday life is a primal business organization of people with a long-term status, which too applies to people experiencing mental health problems. Losing previous connectivity and perceived social status with people, losing valued activities and experiencing feelings of loneliness and isolation have been well documented as ongoing concerns [ane, two]. Related to these concerns is a sense of ontological security, which refers to a sense of order and continuity derived from a person's capacity to give meaning to their lives and to maintain a positive view of the self, world and future [iii]. The latter is considered to require positive and stable emotions and the avoidance of chaos and anxiety [three]. In relation to mental health, ontological security is threatened by the breakdown of, and difficulties in, maintaining relationships with friends and family [4], challenges in maintaining routine and daily living activities [5], and feelings of existence judged and stigmatised [6, 7].

Having a support network in identify provides options for the management of living everyday life with a mental health problem. In this respect, emphasis is often placed on family unit, friends, and social interaction with other people [viii–10]. Even so, the role of pets is probable to accept been nether-acknowledged, with indications in research that some people consider their pets as being as important as family members, and their value in terms of companionship, love and back up is widely best-selling [11]. Analysis of an individual's support network suggests a unique contribution from pets that extends beyond the support and connections provided by familial, friendship and weak necktie connections. Weak ties are characterised by relatively brief interactions with acquaintances and strangers but represent important sources of support and are attributed with the power to heighten the reach and cohesion of other social relations [i, ten].

Confirmatory show of the multifaceted relationships that exist betwixt people with wellness problems and their pets emanates from the analysis of narrative accounts which illuminate the presence of, or talk about pets, as producing differing reactions from those of other household members [12]. There has also been recognition of the more distal benefits that accrue from pet ownership, including the benefits to and from the broader community and through the building and receipt of social capital [13]. Social capital refers to the social, economic and cultural resources on which individuals depict in responding to long-term health weather condition. These stand for resource that form an integral part of people's social networks, which are impacted upon by wider determinants of health [14]. Grade-related cultural resources interact with economic and social upper-case letter in the structuring of people's wellness chances, choices, and the unequal distribution of health outcomes [15].

In terms of mental health, the value of the broader role of animals is demonstrated in Animal Assisted Therapy (AAT), which has been found to be effective in psychiatric inpatient populations [xvi] and residential care settings [17]. All the same, despite AAT gaining popularity in contempo years, and therapy animals condign increasingly familiar sights in care homes, hospices and infirmary wards, pets are not considered in care planning processes undertaken for managing mental wellness on an on-going footing. This may in function be due to a gap in evidence or in evidence failing to inform or reach practitioners and policy makers responsible for intendance planning arrangements. Whilst the benefits of formalised AAT for conditions such as dementia [18, nineteen], cancer [20, 21] and childhood developmental disorders [22, 23] are gaining recognition, there is currently a lack of testify exploring the contribution of pets in the broader context of support networks and the part they may play in recovery-orientated activities and the management of mental health.

Studies have examined the benefits of owning and caring for pets demonstrating reduction in stress [24], improved quality of life [25, 26], improved concrete health [27–29], increased social interaction [thirty] and reduced loneliness [ii, 31].

The current study aimed to develop an understanding of the meaning and roles credited to pet ownership and engagement by those with a diagnosis of mental disease within the wider context of recovery activities and the role of other members of individuals' personal communities. Previous research has demonstrated the utility of pets for mediating social connections linked to the mobilisation of resources for those with long-term physical weather condition [32]. Hither nosotros extend the focus of this previous analysis to the function of pets for mental illness, which is currently equivocal and underexplored.

Methods

This paper reports on the findings from qualitative interviews focussed on 'ego' network mapping to elicit an understanding of personal back up derived from social network members conducted in two locations; Manchester and Southampton. The nature of support provided by social network members and the wider community in the management and everyday feel of living with a mental illness was explored.

The methods have been informed by the consolidated criteria for reporting qualitative studies (COREQ) guidelines [33]. The design and analysis of the study used a conceptual framework which built on Corbin and Strauss's notion of illness work [34] and notions of a personal workforce of back up undertaken inside whole networks of individuals with chronic illness (Table i). This approach allows for a close inspection of what tasks are undertaken to manage affliction, who does them, how and where these activities are undertaken and also identifies whatever potential issues associated with this 'piece of work' [34].

Table 1 The illness piece of work framework

Full size tabular array

The definitions of the categories of piece of work included in this study can be found in Tabular array ii and were combined as follows: practical, emotional and biographical piece of work. The notion of affliction piece of work was preferred to alternative theories of social support as it provides a useful lens through which to understand the resources, networks and relationships associated with the management of severe mental disease and allows participants to self-identify a wide range of contributors relevant to their unique circumstances [1, 10, 32].

Table ii Definitions of types of work used within the paper

Full size table

Recruitment

Participants were recruited from one) a randomised controlled trial exploring service user and carer involvement in mental wellness care planning (EQUIP, Manchester) and 2) a sample of people using a Recovery Higher (Southampton). Participants were recruited via invitation messages and flyers advert the study. Those who were interested in taking part contacted the enquiry squad directly to discuss the study in more depth and then bundled a user-friendly fourth dimension, date and location for interview. Informed, written consent was obtained prior to the interview. Purposive sampling was used to select participants to allow for diversity in terms of age and gender. Recruitment stopped upon agreement amongst the study squad that theme saturation had occurred and there was consensus that no new themes were arising from the data.

The sample

Participants were considered eligible for inclusion in the study if they were anile 18 or higher up, were under the care of customs-based mental health services (or had been discharged inside 6 months) and had received a diagnosis from a health professional of a severe mental illness (e.k. Schizophrenia or Bipolar disorder).

20-nine participants were recruited to the study in Manchester (12 of whom identified a pet in their social network) and 25 participants were recruited from Southampton (13 of whom identified a pet in their network). See Tabular array three for more detail on study participants.

Table 3 Participant characteristics (those with pets due north = 25)

Full size tabular array

Data collection

Face-to-face, semi-structured network interviews were carried out between March 2015 and February 2016 past either HB or SW at participants' homes or an agreed local community facility. Participants were asked to map personal networks using a diagram, which consisted of iii concentric circles [35]. Interviewers started the interview past asking the question 'Who or what practise you remember is almost important to you in managing your mental health?'. Participants could place nominated network members in either the central circle considered most important, the middle circumvolve, considered important only not as important as the central circle or the outer circle, considered important but not as of import as the 2 more than central circles. Identified network members included friends, family members, health professionals, pets, hobbies, places, activities and objects. At that place was no maximum number of network members imposed on participants and they were complimentary to listing as few or as many as they considered relevant to their unique situation.

The interviews lasted between xx and ninety min and explored the role and key attributes of individual network members to mental health management based on the aforementioned categories of work (see Appendix one for an interview schedule). This way, detailed information was collected about the contributions each network member made to the unlike types of work associated with mental wellness direction. Interviews were digitally audio-recorded, transcribed verbatim, anonymised and allocated to a member of the study team (HB, KR, SW alternatively) for assay.

HB and KR are health service researchers, SW is a Lecturer in Mental Health, KL is a Professor in Mental Health and AR is a Professor of Health Systems Implementation. As such, researchers had no therapeutic relationship with participants. The conceptual starting point of our study is i informed by a capabilities approach which recognises that the social context and engagement with valued people, places and activities are frequently hidden from view but are probable to be equally important to the management of long-term conditions as traditional therapeutic or cocky-direction support approaches [36].

Information analysis

Transcripts were read a number of times to ensure familiarisation. Excel software was used to aid analysis along with a paper trail detailing framework development independent in a word document for transparency purposes.

A framework analysis was undertaken with individual members of the report team coding data relating to work-related codes (practical, emotional and biographical work, run across Tables one and 2 [34]) implicated in narratives about the role of pets. Each author (HB, KR and SW) coded transcripts independently and a subset of transcripts were independently analysed by AR, with whatsoever coding discrepancies discussed amidst the team to heighten rigour and trustworthiness of data. Researchers met regularly to discuss on-going analysis and to talk over, explore and confirm emergent codes and to remove duplicated codes.

Network diagrams were analysed descriptively to identify the size of network, whether a pet was in the network, along with the relative position of the pet within the network. The study took an individual network approach to understand how the participant managed their condition and the types of support they utilised across the network including the comparative contribution of pets. The main themes that emerged from the coding were the placement of pets and associated attributional meaning within personal communities; the nature and residual of emotional, affliction and biographical work; and the hidden piece of work of pets.

Results

Network placement and attributional significant of pets

Of the 25 participants who identified a pet inside the personal communities associated with the management of mental health and everyday life, the bulk (threescore %, n = 15) placed their pet in the central nearly important circle. A farther 20 % (n = five) placed their pet in the 2d circle and 12 % (north = iii) placed their pet in the third circle. The remaining eight % (northward = 2) whilst identifying a pet within their social network did not place them in 1 of the three concentric circles. Effigy ane details the network diagram completed by ID ii. This male participant had a relatively small network (due north = vi) in which his pet birds were placed in the key, near important circle. The only human being members of his network were his Community Psychiatric Nurse (CPN) and back up worker whom he saw infrequently, highlighting the importance of his pets for the management of his mental health.

Fig. 1

Example Network Diagram (ID two)

Full size prototype

Examples of animals cited as relevant to the management of mental health included family pets, working animals and more than peripheral links to animals in the wider community in places such as urban farms and animal rescue centres. The prominence and salience of animals within an individual's personal community network varied. Some individuals had networks dominated past pets, coined 'pet centric' networks, which provided a range of direct and indirect benefits, whilst others had one animal positioned in a adequately peripheral position within the network (Appendix 2). Information technology was ofttimes the case that where relationships with family and friends were seen to be good, animal-human being relationships were perceived to exist of secondary importance. Nonetheless, the majority of people reported either having difficult relationships with other network members including friends and family or had little or limited other network support in add-on to their pets. For these people, the relationships with companion animals took on discrete and definite functions within networks, which were unlike to the norms associated with man-to-homo relationships. These appeared to centre on the receipt of ontological security not available from elsewhere, as well as concrete proximity and consistency when compared to the other relationships.

So with my pets I suppose although my Mum and Dad are very significant figures they've also got their own lives and lots of other things going on then I'm only 1 aspect of that life and I feel that the pets I suppose they depend on me and also I have daily contact with them and they too requite me a sense of wellbeing which I don't go from any [one else] because near of these interactions with my Mum, Dad, [friend], are all by telephone rather than concrete contact and that's the big divergence is the empathetic physical presence. (ID 21, 10 birds, showtime circle)

Relational work and commutation

Relational work has been used to draw the tasks that are required to develop and sustain interpersonal relationships [37]. A core theme that arose from the data during narratives was the attributional meaning of relationships with pets. Some invested energy in a atypical focus on a preferred pet. For those without close friends and family, the intensive and positive identification associated with their pets made for intense, intimate relationships 'the relationship with my cat was the only thing that stayed constant' (ID 7, one true cat, 2nd circumvolve). Individuals often saw their pet most frequently and for some, they were their just source of support. In this style, pets featured highly in the network hierarchy and were linked to dependency and substitutability of other, often absent network members providing or replacing ontological security from other sources.

Well I just love animals, I just actually do love animals. I haven't got a partner then I take something around me otherwise I'd go totally bonkers. That'due south the near important matter to me is my animals (ID 13, range of pets, beginning circle).

Participants described the diverse, nuanced means that pets connected them to others in, and beyond, their personal networks or to the wider social environment. Participants described new relationships with network members or community organisations as a result of pet ownership, likewise every bit enhanced ones with existing network members.

That surprised me, you know, the amount of people that stop and talk to him, and that, yeah, it thank you me up with him. I haven't got much in my life, only he's quite proficient, yes (ID 9, 1 dog, outset circumvolve).

For participants in this written report, the connection an private felt with their pet was seemingly of relatively more salience when compared to studies of other long-term weather condition [32]. Linked to ontological security, participants spoke in depth nearly the connectedness they felt with their pet, which was ofttimes not replicated in their relationships with friends and family, either considering they had no human network members or existing relationships were difficult.

If I didn't have my pets I remember I would exist on my own…You lot know what I mean, so it'southward…it's nice to come home and, you know, listen to the birds singing and that, you lot know (ID 2, 2 birds, first circumvolve).

I felt in a sense that my cat was my familiar in that he understood or was an extension of my thoughts (ID vii, i cat, second circle).

These limited or difficult connections with others were often perceived to have come well-nigh from what participants referred to every bit a 'gulf in understanding' between themselves and the other humans in their network. Participants felt that in order to have a beneficial relationship with friends and family unit, in that location needed to be a shared understanding of their mental health condition, which was problematic to obtain without direct experience and in the absence of similar value judgements or thwarted expectations. Pets, on the other paw were credited with either having an understanding of their owners' mental wellness problems without the need for this to exist communicated, or as beingness a network member with whom they could have an adequate relationship without this pre-requisite level of understanding.

I think it's hard really when yous oasis't had mental affliction to know what the bodily experience is for someone who has had the experience. There's like a chasm, deep chasm between united states - a growing canyon. They're on one side of it and nosotros're on the other side of it. We're sending smoke signals to each other to attempt and understand each other merely we don't ever - we don't always empathise each other I don't call back. (ID 1, one cat, beginning circle).

One of import component of the relationship with pets was a sense of indelible trust between individuals and their companion animal, which enhanced the value of pets when compared with humans. Often, participants described fractured relationships with friends and family that had occurred due to past behaviour on their function attributed to mental affliction, which had caused existing relationships to strain or to suspension down. Participants also worried virtually upsetting the humans in their networks. Information technology was considered that pets, on the other manus, were not bailiwick to these sensitivities and thus possessed the capacity to form more enduring and secure relationships. People talked almost pets still being in that location however they were treated and compared this straight to relationships with friends and family unit. In this manner, pets served to provide a unique form of validation through unconditional support, which was often not forthcoming from other network relationships.

Er, there'southward a lot less things to worry virtually. I mean you can't…you can't like be like if he was naughty or anything like that you'd tell him off and that was it and at that place'd be no hard feelings. That there's non, yous don't get the nastiness (ID eleven, ane dog, third circle).

Alternatively, participants provided examples of friends and family not having been a helpful or useful source of back up in difficult times, which meant they were reluctant to trust or to rely on them to provide this in the hereafter. Additionally, participants alluded to a full general distrust of people attributable to a sense of vulnerability fastened to mental illness. These concerns became heightened during times of acute mental health crises.

Yes, they can give you loving, pets can and you can trust pets not to steal off you (ID vi, i republic of guinea hog, first circle).

Often, participants expressed the view of wanting to avoid the world when acutely unwell, whilst at the aforementioned fourth dimension acknowledging that this was sometimes a directly barrier to recovery. Pets provided participants with a mechanism for engagement with the social world through having to intendance for their animals no thing how they felt. This sense of purpose was considered key to a sense of wellbeing and recovery and demarcated the support provided past pets from that given by other network members, which was often considered provisional on moment-to-moment changes in a person's mental wellness status (e.g. only seeing friends when feeling well enough).

Yous know, so in terms of mental wellness, when you just want to sink into a pit and just sort of retreat from the unabridged world, they strength me, the cats forcefulness me to sort of nonetheless be involved with the globe (ID 5, 2 cats, start circumvolve).

Balancing of emotional, illness and biographical pet work

Negative piece of work and burden

In a small number of instances, negative aspects to pet ownership surfaced. These 'deviant' cases included narratives related to the burden of looking later on pets, pets as a source of anxiety and the acknowledged or predictable distress when loved companion animals died. Additionally, whilst pets were identified as a valuable source of support in times of crisis, one participant talked about her pets blocking the achievement of aspirational goals associated with recovery, such equally travel. For ane participant, since condign unwell her pets had lost all their beneficial elements.

Yep the simply thing is my future plans revolve around saving up equally much money as possible and travelling for as many years as possible which means dogs and cats that I've got I won't be able to go on so (ID 14, 2 dogs and 2 cats, outset circle).

Emotional and affliction work

When participants talked about the work that their pets did to support them in managing their mental wellness on a mean solar day-to-day ground, narratives virtually affliction and emotional work were conflated at times. Unsurprisingly, pets were rarely implicated in everyday practical piece of work (such as house work) but were considered important in relation to affliction-related practical piece of work and emotional work.

Given the consistency of presence and a shut concrete proximity, pets constituted an instantaneous source of calming, therapeutic do good for their owners. Pets were a source of concrete contact and comfort and a manner for individuals to aqueduct their own emotional free energy often non available elsewhere.

Aye, y'all get condolement from them, because they lick you lot and all that, and they knead you with their claws and purr at you and all that, so yes, they're lovely (ID 8, 2 cats, start circle).

The network benefits associated with pets could be direct or experienced indirectly via pets owned by other people, simply whose benefits were transmitted. Pets owned by others in the network could provide solace and support that some participants could not source themselves within their own network. There was also a sense that animals were imbued with intuition for when their owners were feeling unwell to which they behaved accordingly.

When I'grand feeling really low they are wonderful because they won't leave my side for two days. I volition get upwardly and I will permit them out to the toilet and I will feed them merely I am straight dorsum in bed and I won't even get myself any food or h2o and so they'll but come straight back up and but stay with me until I'm ready to come out of it. They are used to information technology I suppose (ID fourteen, 2 dogs and 2 cats, first circle).

One element of the intimate human relationship with pets was their input equally a source of applied affliction work, notably in relation to distraction and disruption from negative feelings, emotions and untoward symptoms. This finding indicates a therapeutic role beyond that constitute previously for other long-term conditions. For example, pets could distract their owners from positive symptoms of schizophrenia such equally hearing voices, from suicidal ideation or from a general sense of feeling alone.

Just if I'm here and I'k having…having bug with voices and that, erm, it does help me in the sense, you know, I'm non thinking about the voices, I'm just thinking of when I hear the birds singing (ID 2, 2 birds, first circle).

Pets often introduced a source of humour into hard situations and were ofttimes the only thing that could lift participants' spirits.

She, sort of, does random stuff, like climbs on the bars and… stuff [express mirth] and things [which distract me] and it's quite funny watching her what she does because she's not like a normal hamster (ID 3, 1 hamster, 2nd circumvolve).

Given this attributed role of distraction and disruption, pets were particularly benign in crisis situations. In comparison with other relationships within their network, pets were considered as an omnipotent and constant presence then people could rely on this source of distraction and unconditional back up.

I hateful I could ever go out, take him out of his, er, hutch, give him a stroke or something [if I needed to] (ID 3, one hamster, second circle).

Biographical work

Pets were reported to exist important in relation to biographical work given their aid in managing the stigma associated with the diagnosis and experience of mental illness and by providing ontological security. They also provided self-validation both through their relationship with their owner but likewise because of a perception that they mediated how other people viewed them.

Pets were identified equally having a part in providing routine for their owners. For some, pets encouraged exercise and for others their pets were the only reason they got out of bed in the morning time. Through the rituals of feeding, practice, training and caring for their pet a sense of consistent daily routine became embedded in their lives, which participants felt was vital for their wellbeing.

And I just endeavor and make sure that I walk him, and that, in the mornings….just sometimes I tin't be bothered to do that, merely then I think….I..I remember about, you know, that it's not off-white if he doesn't go (ID 11, 1 dog, third circumvolve).

Participants reported experiencing high levels of felt and enacted stigma related to their diagnosis - even from friends and family unit. Pets were relevant to an individual's construction of self and played a unique role in the reduction and management of stigma. For instance, pets were seen to accept people for who they were without sentence or resentment. This form of 'unconditional beloved' was an important chemical element of the human-pet dyad, which became increasingly valuable given the vagaries of living with a mental illness.

And everybody that finds out that you've got a mental health problem they will think you're, you know, off your head and you're not (ID ii, 2 birds, start circle).

Participants described how pets (in comparison to human being relationships) understood boundaries and knew intuitively when to leave them alone. At that place was a perception that pets did not hold past behaviours against them and accepted them for who they were. Friends and family unit members still, oftentimes every bit a consequence of past behaviours including suicide attempts, overstepped boundaries and made intrusions into their lives that were often not welcomed by the participants included in this written report.

They [pets] don't look at the scars on your arms, or they don't question things, and they don't question where you've been (ID 12, 1 dog, first circle).

Participants reported feeling negatively experienced force per unit area from friends and family unit members. This included a perception that friends and family unit could ask too much of them and pressurise them to recover when they did not feel able to. Having friends and family members rely on them or to ask them for assistance could be challenging for participants, especially when they were feeling acutely unwell. Complicated dynamics between people in their network could too be stressful to cope with. Relationships with pets were altogether a more simple affair, and they asked very little of each other.

Well, you know, apart from being fed, they don't make many demands (ID 10, 2 cats, first circle).

Others discussed similarities with their pets in relation to their mental health condition (e.chiliad. budgie also having Post-Traumatic Stress Disorder (PTSD)), which may point that this identification could exist used past participants equally a style of managing their own conditions. At the very least, this identification meant that participants did not experience alone in their experiences. Pets were passive recipients of these characteristics, which were projected freely on to them by individuals in a way that appeared to fulfil a specific need to do so.

I dearest budgies and every budgie I've had I've always managed to go it into a position where it will sit on my shoulder and at the moment I'thousand just training this one because I'chiliad sure he's got PTSD from living with [friend's] nan because she used to just chuck things at him in the cage so that'south why the home said nosotros had to get rid of the bird considering she wasn't leaving the room and consequently we took the bird and she'southward getting better in the home she's in. I await subsequently that bird every day, I wake him up, I sit with him and in the evening I'll sit for a adept hour playing with him on his cage or in his cage. (ID 15, Budgie and goldfish, 2d circumvolve).

Reciprocity embedded in relationships with pets demarcated such relationships from human being ones, which were oft not considered reciprocal.

When he comes and sits up beside you on a dark, information technology's different, yous know, information technology'southward only, like, he needs me as much as I need him, sort of matter. (ID nine, i dog, get-go circle).

The hidden work of pets

Successfully caring for a pet could provide a source of validation. Pet owners talked near the pride associated with having a pet that was seen to exist well loved and cared for. Given the high levels of unemployment and isolation within the sample, participants had express other opportunities to develop this course of validation. One participant's dearest of animals had led her to the local city farm where she volunteered, which impacted on her confidence. Often, the physical connexion with pets was enhanced through mastery such as teaching an brute tricks. Through these relationships with their pets, participants could nowadays themselves to others in a more positive light.

I hateful it's merely a squeamish feeling to accept somebody around that you tin can 50, like, take care of (ID 3, 1 hamster, second circle).

Despite this perceived value attributed to illness work, pets were unanimously neither incorporated into participants' discussions with wellness service providers nor into mental health care planning. Our data indicates that the work undertaken past pets has little salience to those in positions of power in relation to determination making and service provision inside health services. Nearly participants, however, could see the benefit of incorporating pets into these discussions through the development of an holistic agreement of the individual and the production of more relevant and useful care plans.

Kind of, knowing about your cats and your friends and your family would feed into them knowing you and understanding you a bit meliorate, and…Which would, in turn, feed into how useful the care plan could be. (ID 5, 2 cats, commencement circle).

Give-and-take

To our knowledge, this is the kickoff qualitative study empirically exploring the function of pets in the social networks of people managing a long-term mental health problem. Using a social network approach incorporating illness work concepts, nosotros identified the attributional pregnant attached to pets past those diagnosed with mental health weather condition as well equally the implicated part of pets in different types of illness piece of work.

Pets contributed, over time, to individuals developing routines that provided emotional and social support. This was fix against a backdrop of pets also providing the ability to gain a sense of control inherent to caring for a pet, which was absent in relationships with other network members. This seemed to enable a sense of security and routine to be adult in relationships with pets, which reinforced stable cognitions from the cosmos of certainty that they could turn to and rely on pets in times of need. With reference to how Giddens [iii] used the term, pets provided ontological security through generating a sense of gild and continuity to individual experiences and through this close connection provided a sense of significant to people'due south lives. Pets also served as passive recipients of projected characteristics. For example, one participant discussed how her pet also had PTSD, which meant she did not experience lonely in her condition and could relate to some other network member with whom she perceived to share experiences. In this sense, the piece of work of pets in personal communities provided participants with a seemingly deep and secure relationship, often non available elsewhere within the network or wider community. This became increasingly of import given the often uncertain illness trajectory associated with severe mental illness including recovery and periods of crisis.

In terms of the illness work associated with managing mental health, our findings signal to the value of pets in disease practical work. This included distraction and disruption from distressing symptoms, such equally hearing voices, suicidal thoughts, rumination and facilitating routine and exercise for those who cared for them. Furthermore, pets were implicated in biographical work through their directly impact on managing the stigma associated with mental illness. Pets provided a class of credence for their owners and participants considered that by undertaking the tasks associated with being a responsible pet owner, this positively impacted on how others viewed them. These aspects of affliction piece of work provide an extension to previous findings nigh the role of pets for concrete illness management [32] and mental wellness (i.e. a reduction in stress [24] reduced loneliness, [ii, 31] and the receipt of social capital letter [13]). The findings also dissimilarity with previous research that demonstrates the negative impact of pet ownership [38] and of losing a family unit pet [39].

It is not the intention of this paper to bespeak that pets play a more important function for i type of health business than another, rather that there are nuanced differences in the ways in which people with labels of mental and physical conditions may come to view recovery [40] and the impact that a diagnosis may accept on a sense of cocky [xl, 41]. On the confront of things, it appears that the participants raised similar themes as those with physical wellness weather condition [32]. However, in relation to the salience of themes with specific regard to mental wellness, there were clear differences. Participants in this study had more difficult and contentious relationships with others and experienced greater levels of stigma than those included in studies of chronic physical weather. This increased the perceived importance of their pets, reflecting the added salience of being labelled with a mental health problem as having a greater impact on ane'south sense of 'self' than concrete illnesses, since the surveillance of moral responsibleness may be felt more intensely, and levels of isolation and stigma are likely to be greater [40, 41].

Service implications–the hidden piece of work of pets

The network mapping undertaken every bit part of this study illuminated the part of pets as a hidden resource for mental health management and supports the idea of a 'lifestyle' arroyo to the management of mental wellness problems and prevention [42]. The latter involves the incorporation of holistic principles to heighten physical and mental wellbeing, including ecology, behavioural and psychological principles [43] and this study identifies pets every bit a subconscious asset that could be deployed in this regard. All the same, the value and utility of pets as office of an agile indicate of give-and-take and resource for people remains invisible within mental wellness service provision and in the negotiation of individual intendance plans. A lack of consideration for private caring responsibilities for pets also represented a source of worry for some of the participants included in this report when they considered the chance of them existence in a crisis in the future (e.g. business concern for the care of their pet should they become hospitalised). This suggests the demand to consider including pets in the care planning process so that service users feel confident that their pets are cared for and returned to them should they not be able to care for them for a period.

Further implications for health services are the inclusion of pets as a topic of word, to facilitate healthcare discussions. Previous inquiry suggests that service users feel distanced from healthcare and uninvolved in discussions almost services [44, 45]. Taking more creative approaches to intendance planning discussions, including the use of pets, may be 1 way of addressing this considering of the value, pregnant and engagement that individuals accept with their companion animals. The study also highlighted the timeliness of incorporating pets into discussions with those in services – particularly about managing mental health over time, with pets considered especially useful at times of crisis but potentially restrictive when aspirational goals associated with recovery were considered.

Strengths and limitations

Primal strengths of the paper were the utilisation of an established theoretical framework (Corbin and Strauss's Illness Work) and the comparison with non-pet owning participants. Adopting a qualitative, social network arroyo provided rich information with which the theoretical 'illness work' framework [31] was used to let participants to describe the unique and distinct role of pets within their personal communities compared with other network members. The authors considered that theme saturation was achieved with the information collected, and participants were sampled to ensure a variety of attitudes were encapsulated into the study. Participants were recruited from inside two locations in the United kingdom, included only those cared for withing the community and did not recruit whatever participants from Black, Asian and minority ethinc communities. It therefore may not be possible to fully transfer findings in terms of typicality to other ethnic groups or other service populations.

Conclusions

Cartoon on an approach incorporating notions of illness work and a personal workforce of support, this study contributes to the understanding of the role of pets in the management of mental wellness. This was achieved through the identification of the unique office and value of pets in relationships and work associated with managing mental health over time. The implications of this report propose that pets should be considered a main, rather than a marginal source of back up, in the management of long-term mental wellness issues and could be considered equally extending more traditional Collaborative Care Models for managing mental health [46]. These insights provide the mental health community with possible areas to target intervention and potential means in which to improve involve service users in service provision through the word of valued experiences.

Abbreviations

AAT:

Animate being Assisted Therapy

CLAHRC:

Collaboration for Leadership in Applied Wellness Research and Intendance

CPN:

Customs Psychiatric Nurse

COREQ:

Consolidated Criteria for Reporting Qualitative Research

EQUIP:

Enhancing the Quality of User Involved Care Planning in Mental Health Services

NIHR:

National Plant for Health Inquiry

United kingdom of great britain and northern ireland:

United Kingdom

PTSD:

Post-Traumatic Stress Disorder

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Acknowledgements

The research team acknowledges the back up of the National Institute of Health Research Clinical Research Network (NIHR CRN). The authors wish to thank all participants who took part in interviews for this research and Elinor Hopkin for proof reading the commodity.

Funding

This is a summary of independent research funded by the National Institute for Health Research (NIHR)'s Plan Grants for Applied Research Programme (Grant Reference Number RP-PG-1210-12007) and the National Institute for Wellness Research Collaboration for Leadership in Applied Health Enquiry and Intendance (NIHR CLAHRC) Wessex and Solent NHS Trust. The views expressed are those of the author(south) and not necessarily those of the NHS, the NIHR or the Department of Health.

Availability of information and materials

The dataset(s) generated during the current study are not publically available due to ethical restrictions but are available from the corresponding author on reasonable request.

Authors' contributions

The Manuscript was written by authors HB and KR, with editorial comments past SW, KL and AR. Data was collected past HB and SW, analysed by HB, KR and SW, and verified by AR. All authors confirmed approval for submission of the piece of work.

Competing interests

The authors declare that they have no competing interests.

Consent for publication

All participants provided consent for the recording and publishing of anonymised data.

Ideals approving and consent to participate

Upstanding approving was obtained from the National Enquiry Ethics Committee North W–Lancaster [xiv/NW/0297] and University of Southampton Ethics and Inquiry Governance Office [9380]. All participants provided written informed consent to participate in this written report.

Author information

Affiliations

1. Division of Nursing, Midwifery and Social Piece of work, Faculty of Biology, Medicine and Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, Britain

   Helen Brooks, Kelly Rushton & Karina Lovell

2. NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK

   Sandra Walker & Anne Rogers

Respective author

Correspondence to Helen Brooks.

Appendix 1

Prompt questions for interviews: List of the prompt questions utilised during the interviews with participants.

Prompt questions for interviews

1. 1.

   How do your people/pets assist you lot manage your condition day to mean solar day?

2. two.

   What exercise people/pets exercise to help you cope with your disease?

3. 3.

   Where or to whom do you become to find out more nigh your disease?

4. 4.

   Is there anything else that you find useful to help you cope with your disease?

5. 5.

   When you need communication about, or help with, your diet, who do you get to?

6. 6.

   When you need advice well-nigh, or aid with, practice, who do you get to?

7. 7.

   Where would you go, or who would you lot go to, for advice or help with relieving stress?

8. 8.

   When you need advice about, or help with, medications, who would you lot plough to?

9. 9.

   a) Living with a long-term status oft means that you need to practice things more than slowly, have on boosted tasks and other people may demand to make compromises that are skilful for your health. Who in your diagram does these things?

   b) Delight describe in detail what you lot would do on a typical twenty-four hour period starting from getting up in the morn.

   Please include tasks and activities that are not related to managing your condition, such equally cooking, cleaning, making repairs, etc. Tin can you tell us how different people/pets on your diagram are involved with different activities?

10. 10.

    Who do you turn to when you are worried near your illness?

11. 11.

    a) Looking at your diagram, who practice y'all think you would like to exist more involved in helping you lot with your illness than they are at present?

    b) What and who helps or hinders your care (related to nutrition/exercise/medication)? Can y'all call up of examples?

12. 12.

    Who or what (e.g. people/pets) in your diagram gives y'all emotional support and encouragement? Can you think of examples?

13. thirteen.

    Who in your diagram would pace in/stand for you when you practice non feel well enough to stand up for yourself?

14. fourteen.

    Who among the people or pets in your diagram practice you help? How?

Appendix 2

Information for each participant's social network including the number of pets, full network size and position of pet within the network.

Table 4 Data on study participants

Full size tabular array

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Brooks, H., Rushton, Yard., Walker, S. et al. Ontological security and connectivity provided by pets: a study in the self-management of the everyday lives of people diagnosed with a long-term mental health condition. BMC Psychiatry 16, 409 (2016). https://doi.org/10.1186/s12888-016-1111-3

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• Received: 28 May 2016

• Accepted: 03 November 2016

• Published: 09 December 2016

• DOI : https://doi.org/x.1186/s12888-016-1111-iii

Keywords

• Mental health
• Social network mapping
• Pets
• Qualitative research
• United Kingdom

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