Risk Expanded. A Qualitative Study of Youth and Mental Health Research

The Saving and Empowering Young Lives in Europe (SEYLE) health promotion study sought to evaluate the outcomes of different preventive programs through a randomized controlled trial (RCT) in ten European Union countries. The twofold aims were to improve adolescent health by means of a decrease in risk-taking and suicidal behaviors and to collect epidemiological data on risk behaviors and psychiatric symptoms. The Youth Aware of Mental health (YAM) program reduced the number of suicide attempts and severe suicidal ideation with approximately 50% and was hence the most successful of the intervention programs. In addition to the RCT, two qualitative studies were performed with YAM youth and instructors respectively. In 32 semi-structured interviews with YAM participants in Estonia, Italy, Romania and Spain, mental health topics including risk and their experience of YAM was discussed. Drawing on both qualitative and quantitative methods to better understand the everyday practices of youth, risk is here investigated as an experience rather than behavior. The main focus of inquiry is how the research questions posed define and limit our findings. Mental health research carries a lot of expectation about youth, often placing the youth of today in relation to future moments, behaviors and health outcomes, more or less positive ones. In youth mental health research, risk behaviors are considered a major public health concern. Risk and youth are primarily studied through the lens of behaviors and attitudes within a developmental framework. Attached to risk are various correlations and future outcomes such as that of psychopathology. Risks are everywhere. They take the form of threat, disease, accident, war, climate, finance, relationships and affect us in different ways. In everyday life, risk is experienced quite differently than in terms of statistical links between risk factors and mental health outcomes. Risk decisions do not occur in isolation, but are performed in the context of the many shared and perhaps contradictory norms and practices that surround that particular individual. Cultural beliefs, habits, power relations, social acceptability, scientific knowledge, personal experience and more, all influence risk perception and management. Defining risk is steeped in value, for individuals and the scientific community alike and classifications change over time. Risk cannot be considered as primarily negative or with only negative outcomes, instead, risk can be neutral, or even positive. The relationships between behaviors and mental health outcomes are more complex than is frequently suggested. Much of the risk studied in mental health research takes as point of departure that of objective risks and dangers, yet what is considered a hazard in one historical or cultural context may not be identified as such elsewhere. In the YAM program, by putting the participating youth in focus beyond the paradigm of risky/protective behaviors, a more fluid approach to their everyday lives and mental health topics takes center stage. Here mental health promotion is not connected to morality or deciding exactly which activities are healthy and positive. Based on empathy building and finding solutions as a group, the YAM youth reflect and analyze their actions through play and discussion. In this dissertation a call is made for a more reflexive research practice, maintaining a critical approach to the meaning of categories and methods in all steps of the research process. Specifically, collaborations with youth in study design and analysis, cultural adaptation of assessment tools and mental health promotion programs, the use of different research methods to explore similar topics and a more nuanced and less normative stance on risk will hopefully lead to research results reflecting the complexities of everyday life.