Turning on “the Photographer Mind”: Experiences of Mental Health Service Users in a Tutor-Led Photography Group in an Irish Context

Abstract

A photography group was established in one Irish mental health service during the Covid 19 pandemic to impact isolation, wellbeing, and recovery. This research explored the experience, benefits and challenges of group-based photography. Qualitative interviews were conducted with four participants and analyzed using Reflexive Thematic Analysis. Four themes were identified: a progression from beginner to amateur photographers; looking at the world with a photographer’s eye; working together as a photography team; and recognition of the interaction between occupation and wellbeing. The research indicates that photography can provide an immersive occupational experience and develop skills for people experiencing mental health challenges.

Keywords:

• Photography
• occupational therapy
• community mental health
• social transformation

Background

To photograph is to hold one’s breath, when all faculties converge to capture fleeting reality. It’s at that precise moment that mastering an image becomes a great physical and intellectual joy.

Henri Cartier-Bresson (as cited in Nikolova, 2008).

Coming from the Greek phrase “writing with light,” photography has fascinated humans since its development around 1839. Taking and displaying photographs has personal, political, commercial, journalistic, scientific, research and social purposes and meanings (Davenport, 1999) and this art form was used for therapeutic purposes since its earliest days, particularly in mental health settings (Saita & Tramontano, 2018). Photography can help people find hope in difficult circumstances and develop post-traumatic growth—the reconstruction of self and the meaning of traumatic events that is a vital part of reestablishing wellbeing following trauma (Tedeschi & Calhoun, 1995). A systematic review identified several important therapeutic mechanisms of photography including empowerment, critical reflection, meaning-making, narrative reconstruction, enhanced therapeutic relationships, peer support, creative expression and a sense of achievement (Buchan, 2020).

Clinicians take a number of approaches when using photography to help people with mental health challenges. While there can be some overlap, Saita and Tramontano (2018) distinguish three key approaches as Photo Therapy, Therapeutic Photography and Photo Art Therapy. Both Photo Therapy and Photo Art Therapy emphasize the photographic image that is taken (by the service user or others) and the symbolic/personal meanings of that image. Photographs are used to facilitate deeper self-expression and self-understanding (Halkola, 2013) in talk-based therapies and the counselor or art therapist facilitates deep discussion about the personal relevance of the image to the individual (Saita & Tramontano, 2018). In contrast, Therapeutic Photography does not involve formal psychotherapy, but includes “photo-based activities that are self-initiated and conducted by the individual (or as part of an organized group or project)” (Saita & Tramontano, 2018, p. 2). Fewer studies have examined this therapeutic use of photography—where the emphasis is on experiencing and learning the skill of photography, without the images subsequently used for therapeutic or research conversations.

Occupational therapists have a long history of using skill-building and activity-focused interventions, particularly in mental health settings. Participation in hands-on activities like woodwork or crafts during mental health treatment was described by participants as leading to strong feelings of competence, achievement and satisfaction. The actual “doing” of an activity is vital for self-efficacy—a realistic sense of what one is able to do; “I’d never done anything like it before. I didn’t know what I was capable of….after I made one [plant trough], I was confident enough to do it on my own” (Mee et al., 2004, p. 228). Occupational therapists used photography as a therapeutic activity since the mid-20^th Century. Boucher (1951) describes photography being used in a TB Sanatorium as “a recreational hobby, means of rehabilitation and vocation” and discusses the value to patients in reading about the subject, developing skills and potentially developing a “remunerative hobby” (p. 31). The act of taking photographs itself has therapeutic potential. It often involves being outside, has a physical movement element, requires concentration on the environment, using the camera or phone, choosing between images, editing them and sharing them with others (Brewster & Cox, 2019).

The Covid-19 pandemic and resulting lockdowns (2020 and 2021 in Ireland) caused significant disruption to all people (Burke et al., 2020), but the impact on those with severe mental illness (SMI) or with emerging mental health issues were of particular concern (Hofer et al., 2022). During lockdown periods in Ireland most mental health services transitioned to online/telehealth service delivery, home visits by staff or family were canceled and opportunities to meet others in day hospitals or day centers were negligible (Kelleher et al., 2021). Added to this was the general societal shutdown of shops, pubs, cafes, churches and the opportunity to visit family or friends. The disruption to support and therapy services was severe (Kelleher et al., 2021) for mental health staff and service users. For example, the WHO estimates that psychotherapy and psychosocial intervention delivery fell by 40% across Europe from March-October 2020 (Sánchez-Guarnido et al., 2021).

While psychological supports may have successfully moved online, the in-person, activity-focused work of occupational therapists was more difficult to completely deliver digitally (Culleton, 2021). The percentage of patients with SMI receiving face-to-face occupational therapy dropped from 47% prior to Covid-19 to only 8.1% in lockdown in one study, leaving many vulnerable individuals without activity, rehabilitation or diversion at a stressful and isolating time (Sánchez-Guarnido et al., 2021). Loneliness was a significant factor that increased depression, particularly for those with schizophrenia and SMI (Lee et al., 2022). As a result, many occupational therapists used imaginative ways to continue to deliver in-person, activity-focused therapy at this time, as one Irish therapist noted, “we [occupational therapists] are in a good position with our skills and knowledge of adapting and analyzing activity and using the environment as a resource” (Culleton, 2021). Therapists and service users welcomed outdoor social interventions, as they could be adapted safely within public health guidelines (Culleton, 2021). Kamalakannan and Chakraborty (2020) described the role of occupational therapy during the COVID-19 pandemic eloquently as “unlocking locked-up occupations.”

The current study was completed in a community mental health service in a mainly rural part of Ireland. Like in other community mental health services in Ireland, face-to-face groups and service-provider visits were canceled with the outbreak of Covid-19 (Lyne et al., 2020). While a small number of studies have explored short-term photography interventions during the pandemic, they did not include face-to-face social interaction (e.g., Read et al., 2022). In contrast, the current study explored;

1. the experience of participating in an in-person photography/film group in the context of Covid-19 from the perspective of individuals attending a mental health service

2. the potential benefits of participation in terms of well-being, recovery and social connectedness

3. the perceived challenges to engagement

4. future learning opportunities for photography/film groups within mental health services.

Methods

This study is a retrospective exploration of an existing photography/film group which was organized by the senior occupational therapist (CM) and the community mental health team. For background on this group, five service users with SMI were invited, in line with government Covid-19 guidance on social gatherings in July 2020 in Ireland. The outdoor group took place for 90–120 minutes once a week, initially taking an informal approach—participants used their own smart devices to take photographs in a local park. The group facilitator (CM) took a shared and participatory decision-making approach to group development over time. Following group discussion, one participant invited a family member with photography experience to provide tuition to the group for three sessions. Eight weeks later, in partnership with group members and the local resource center, CM applied for and was successful in getting Arts Office funding from the local County Council. A paid photography/film tutor worked with the group in blocks for a total of nine months until May 2022. Participants used DSLR cameras and film-making equipment owned by the tutor to take photographs in the locality and to film and produce a documentary about local history.

In 2021, it was decided to gather participants’ perspectives on this group, and the HSE Dublin North East Research Ethics Committee granted ethical approval for a retrospective study. A qualitative descriptive approach (Sandelowski, 2000) was taken in this research, enabling researchers to gather and analyze rich personal descriptions of individuals’ experiences in the photography/film group. The research team included the Senior Occupational Therapist (CM) and an occupational therapy researcher (JF) who was not otherwise involved in intervention delivery. All participants attending the photography group in March 2022 were invited to take part in this study. Each person received a detailed information leaflet about the study by CM and were advised that their decision to participate would not impact on their engagement in the photography group. Four people consented to participate in the study and provided written informed consent.

A photo-elicitation approach was used in conjunction with interviews to capture additional detail regarding the experience of participating in the group and to prompt memories of participation (Glaw et al., 2017). Photovoice methods have been used in a small number of Occupational Therapy studies, however, this involves participants actively capturing photographs to reflect their experiences (Lal et al., 2012). In this study, photo-elicitation was used as a retrospective method to explore the experiences and prompt participant discussion.

CM and a patient representative co-developed a semi-structured interview schedule based on the research aims. JF completed photo-elicitation interviews with the participants in April 2022. The interviewer had no other input in the photography intervention or in the clinical care the participants and had not met the participants prior to the interviews. To give opportunity for self-expression, autonomy and choice, participants were encouraged (before the interview) to identify 5–6 photographs they had taken themselves, were pleased with and that represented something about their participation in this photography group. As with other decision-making in this group, these photographs were selected in a group meeting. This was particularly important where photographs were the joint work of several people. Participants gave written consent for the images to be used and reproduced for this study and publication. Images were printed in color and numbered to be identifiable during data analysis. Encouraging reflection on photographs during qualitative interviews can yield a more reflexive and profound level of reflection than interviews alone (Harrington & Lindy, 1999), perhaps because photographs “stir deeper elements of human consciousness than words do” (Erdner & Magnusson, 2010, p. 146). For people with SMI particularly, images can encourage reflection on memories or experiences that might not be reachable by language alone (Enzman Hagedom, 1996).

Interviews were audio-recorded with the participants’ consent and transcribed verbatim as soon as possible after completion by CM. The first step of data analysis took place during the interview, when the interviewer and interviewee engaged in an over and back dialogue about the photographs, co-constructing some meaning and interpretation of the photographs (Skott, (2004) as cited in Erdner & Magnusson, 2010, p. 147). Each photograph was described by a number in the audio recording and then included in the transcripts.

The authors followed the seven stages of reflexive thematic analysis (Braun & Clarke, 2013) and conducted data analysis collaboratively. They read and familiarized themselves with the transcripts, recording interesting and relevant points. Both authors worked their way through the interviews and photographs and independently coded data relevant to the research questions. They reviewed the codes and related quotes and identified patterns in the codes. Analysis was data-driven (Braun & Clarke, 2013) to ensure that participants’ perspectives were the focus of data analysis. However, both researchers were influenced by their occupational therapy lens and some of the names of themes and subthemes. Shared digital documents were used to organize and manage potential themes. An example of the coding process and theme development is set out in Table 1. The researchers revisited, reviewed and updated the coded data throughout the process of analysis and write-up to ensure that the themes accurately reflected the content of the interviews.

Table 1. Example of coding process and theme development.

Participant quotes	Subtheme	Theme
“Your eye is always looking out to compose something, to see something nobody else notices” (P4) “A reflection of the light from the window…on the floor. It looks kind of like a jail window…it was interesting to use the shadows and light to see something different than it actually was” (P3) “I think it’s great in (the cathedral). The light is great” (P2) “You’re kind of looking at the world differently. Now you’re looking out and you’re thinking, oh—this angle would be good to take a photo” (P3)	The photographer’s eye	Looking at the world with a photographer’s eye

Results

Four themes and related sub-themes were developed relating to the experience of participating in the photography group (Table 2). Each theme is described in detail with quotations from participants in the following sections. The participants (three men and one woman) were individuals with SMI aged between 40 and 60 years. No other demographic details are presented to protect the anonymity of participants. In this study, as in occupational therapy, the term “occupation” refers to “the everyday activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life. Occupations include things people need to, want to and are expected to do” (World Federation of Occupational Therapists, 2010, online). Photographs are presented throughout the results to complement the participants’ verbal accounts.

Table 2. Themes and subthemes.

Theme	Subtheme
From beginner to amateur photographer	Prior occupational experiences
	Developing mastery and competence
	Tutor as respected guide
	Pride in the creation of art
Looking at the world with a photographer’s eye	Nature and landscape
	Sense of place
	The photographer’s eye
	Photo as thought provoking
Becoming a photography team	Social reasons for going to the group
	The importance of a goal
	Teamwork
	Future occupational possibilities
Interaction between occupation and wellbeing	Participation in the photography group drives/is embedded in routines and busyness
	Interaction between health and activity

Theme 1: From beginner to amateur photographer

Participants had unique occupational histories and experiences that influenced their motivation and desire to join the group. Although some had done photography in the past, all participants were essentially beginners. Both participants 3 and 4 described an artistic and creative self-identity and enjoyed creating art through various media. The photography group provided an outlet to express their artistic identities during the Covid-19 pandemic and motivated them to engage in other creative occupations.

I have always been into arts, drama and dancing. I do like a bit of photography. And….growing up with my Dad who was into photography kind of got me into it (P3)

I do write. I have written a novel. It is edited and I am going to go back to work on that very soon. So, that’s one of the reasons I started writing for this (project) anyway (P4)

Initially, participants met informally in a local park to practice photography. They developed and mastered new photography skills through regular engagement and practice. Mastery took time (“It takes a while to get used to taking photos with the cameras” (P1)), practice and a process of “trial and error” (P4). Participants described a process of developing competence, from basic camera operation skills (“To zoom in. To make sure it’s not blurry, the photograph when I'm taking it.” (P1)) right up to technical effects like adjusting shutter speed, indoor portraiture and light photography:

All this now, all this light effect was great there, it’s amazing how it works. I never knew you could do stuff like that. (P2)

For participant 4, there was a strong sense of achievement in his competency and mastery of both the technical photography skills and the theory behind photography (Figure 1).

Figure 1. Extreme close-up of flower.

I love that I can now look at a picture and go, not only I like it, and not be absolutely be sure why, but now I can break it down and say…well, that’s the bokeh. That’s the way it sits out and it’s a really good picture. That one as well too, the colour, and the cropping of it makes it absolute centre stage. And this one with the lovely rain all over it. (P4)

The group had the help of one family member with photography experience in the early sessions; “I think it was…my Dad’s help. He had written out lesson plans for us” (P3). Subsequently, the employed photography tutor was respected as an expert and his role was significant in guiding the participants from beginner to amateur photographers. The participants emphasized how the tutor assisted in their learning by gently encouraging them, making suggestions to improve their photographs and encouraging them to use new techniques; “he helped me to move and get the trees to frame it” (P3).

The tutor’s role and relationship with the participants changed as their levels of mastery and competence developed;

But, recently, now I have learned so much, I found myself up talking to him and asking questions and….I'm not just dependent on what the tutor is saying or doesn’t say. If I don’t know, I can just look it up on Pinterest which I find fantastic. (P4)

Engaging in photography became more than just taking a picture for some group members. It was viewed as “trying to” (P3) create art and the scene or shot was “composed” (P4) for interesting visual effects. Participants described engaging in light photography “to use the shadows and light to ….see something different than it actually was” (P3) and created scenes including a disco, a fireplace scene and the loch ness monster (Figure 2).

Figure 2. Fireplace.

You get lights to surround them. A battery light and different colours. You just showed the outline of the person, you know. In the darkness. (P1)

Participants expressed pride in both the images themselves and in their new skills; “Learning how to do, to master the skills that I always wanted to be able to do. I didn’t think I would get so into it” (P4). These images themselves were proudly discussed and participants described wanting to “show them off” (P2) in a planned photography exhibition.

I am going be my own mover and shaker as I text my brother last night. (P4)

Theme 2: Looking at the world with a photographer’s eye

Many of the participants’ photographs focused on nature and landscapes and this was an important reason why photography was meaningful to the participants. They felt connected to the Irish natural landscape and their photographs included local scenery (lakes and trees) and wildlife (birds and fish). Being outside in the “fresh air” (P2) was important and participants spoke about being fully engaged in the natural environment—looking for photo opportunities (Figure 3);

Figure 3. Tulip.

Outside the building here there is all…. the flowers coming up there for spring. We stopped for us to take photographs of primroses and then there was photos of bluebells and then this tulip. (P3).

Photographs were used to show the local area and its’ history both from a personal and community perspective. Participants highlighted connections with a former nursing home, churches, schools, lakes, viewing points and an orphanage in their photographs, and this made their images more meaningful (Figure 4).

Figure 4. Lakeside image.

I never thought I would be doing light pictures in the cathedral there. My brother got married there 11 years ago. It’s a very awe inspiring building but it’s cold to my taste, you know. The convent is far nicer with the windows, the stained glass windows (P4).

Yeah, well years ago I used to fish in it…. I used to swim in that actually, when I was young (P2).

Participants were attracted to certain photographs for a range of personal reasons, with images provoking thought and reflection. Some participants were attracted to the beauty of the photographic subject, such as P1 who chose to photograph primroses, as “it was a nice photo to take” while P2 wanted to capture how “peaceful” the water was in his image. In contrast, P4 enjoyed reflecting on the technical aspects of his photographs and felt the photography techniques add to the quality of the image (Figure 5).

Figure 5. Woman in cathedral image.

I like this one here with the woman in it. She’s a little bit blurred and it adds something to it rather than just having…it’s a contrast. It’s good…And the lines coming in seems to make it better as well. It’s kind of, mm what is going on here? You know, is it a ghost? Is it a spiritual experience? And I don’t think she notices this amazing thing behind her and stuff’. (P4)

Photography also provided a different lens for participants to view the world around them, noting new and interesting perspectives. Some images provided creative inspiration and even became part of a larger storyline or movie (Figure 6).

Figure 6. Road in woods image.

…immediately my mind went into horror movie mode! I imagine someone running through the trees, you know….With this photo, it’s obviously the woods, but it’s kind of the idea that you would look at it and you would say “well where is this road going?” You kind of want to follow it and see what is past it. (P3).

Theme 3: Becoming a photography team

The participants were initially motivated to join the photography group for social reasons. There were few opportunities for socializing during the Covid-19 lockdown period and the group was an opportunity for “mixing with people” and “doing things together as a group” (P2). It was an opportunity to reconnect with existing acquaintances or friends, to combat isolation and meet new people.

Personally, I live alone and I had just moved up to [town] before (Covid-19) all happened so I didn’t really know anyone apart from the people at the day hospital. (P3)

The group members needed to work as a team with the photography tutor to create painting with light photographs and a documentary film. The participants worked well together, helping each other out and “encouraging” (P3) each other:

One of the good things then, we all took different roles each week. And then we would help each other. So, if I was doing the sound one week, the person that did the sound the week before would be helping me. It wasn’t just the tutor saying right, you do this, you do that. We were all working together and helping each other (P3).

The images and documentary could not have been created without “a team effort” which “builds team spirit, espirit de coeur’ (P4). This team effort created unique and interesting photos that were the source of great pride:

There’s a great one there. Different colours there. Then a fella there, <name > would come up and wave another light. Make a flash, you know. It’s amazing there to see the fire there, you would think it was lit (P2). (Image 2)

The group developed into a “democratic” (P4) team where members took on a variety of roles, including leadership roles, but ultimately, shared decision-making took place; “We just discussed it as a group. We decided on different things, you know” (P1). The participants felt confident enough to share ideas and recognized that their ideas and suggestions were valued by others;

It was very nice. You felt very comfortable to be able to come forward and say I think this. You know, in some classes you would be afraid to speak up. We were all very comfortable with each other. The ideas that people were coming up with were great. (P3)

One participant chose to take on a leadership role within the group, acting as a “representative of the patients with the lobbying for the funding” (P4).

Participants identified the importance of having a goal or focus to facilitate the progression of the group. Although they recognized the value of the informal beginnings, it was clear that having goals such as an exhibition were very beneficial to both the development and direction of the group;

Another good thing from the start was to be looking towards goals and even local exhibitions in the local library or something just to give, a kind of “okay, we need to get this done this week and this done next week.” Instead of just floating around with phones, you know. (P3)

Looking to the future, participants noted opportunities and potential for their group to develop and even expand. Two people identified the need for funding to facilitate this future development. P4 had the financial means to buy his own camera, but most group members did not and were dependent on the tutor to supply cameras each week. This influenced how self-directed these evolving photographers could be. Reflecting his emerging leadership role, P4 described how the group was seeking funding from a community organization to purchase “a number of cameras that can be rented out and have printing facilities and post process like photoshop or what’s the other one, lightroom” (P4). This would ensure that the group were “not as dependent on external sources or external circumstances” (P4) and allow the group to engage in photography even when the tutor was not available.

Theme 4: Interaction between occupation and wellbeing

It was clear that all participants experienced fun and enjoyment through engaging in photography and this had a positive impact on wellbeing. Participants used words such as “fun” (P1 and P3), “great” (P2) and “love to learn” (P4) to describe their experiences of the group, with one highlighting how he would “look forward to meeting up with them and taking photographs” (P1). The group provided motivation and a sense of purpose that had a positive impact on wellbeing;

It was just getting out and not sitting……at home all the time. Getting out into the fresh air and then having people to talk…it’s something to do. To occupy the mind you know. For that 2 hours you were thinking about…your photographer mind was on. (P3)

It’s simple really but it is effective. I am far better… (P4)

Being part of the photography group required commitment, effort and the rearrangement of other occupations in the individuals’ lives. For example, one participant lived “twenty miles away” (P1) and needed to get up early to get the bus each week. Those that lived closer also emphasized the preparation required, such as “getting ready on the Wednesday night, getting my stuff ready” (P3). The group provided routine, structure and a reason to get up in the morning; “I have something to get up for and to get out of the house. You can definitely get into just sitting at home. With the lockdowns, it was an excuse to just sit at home which isn’t really helpful. So, it was nice to have…to know, oh on Thursday… I would be looking forward to it as well during the week” (P3).

The photography group became an established part of the participants weekly routine and missing sessions was rare; “I might have missed one day but I came back, you know. I did most of them now. I done most of them. I'm sticking well at the photography now you know” (P2). The importance of the group was evident when participants described cancelations due to Covid-19:

There’s nothing worse than…. this is one of the things about it, we haven’t been able to do it every week because you get ready and you are ready to go and then you are told that it’s not on, say. That’s hard. (P4)

There were some challenges to participation for a small number of participants, such as fatigue, poor concentration or memory issues, where some skills were forgotten between group sessions. The group offered a safe space to engage in an activity despite mental health challenges like perfectionism or lack of confidence:

Sometimes you would be kind of, “oh I don’t know what I am doing” But, again, you’re not alone. So, it doesn’t matter if I don’t know what I am doing because someone else will be able to help. (P3)

One participant also experienced challenges due to physical ill health, which affected his participation. Nevertheless, photography provided respite from these challenges by letting him be in the moment:

You don’t think about all the problems when you are doing this. I forget myself, you know. On a good day I suppose. Not necessarily always. Even on a bad day I would be tired but I know it is for my good. I am so much better to be pushing myself to go in than sitting at home. (P4)

For this participant, the group provided an opportunity to develop skills and confidence which impacted all areas of his life, not just in the photography group.

In general, I start doing one area, do another area, confidence starts to build up. You feel better and your life becomes better, you’re more…. You can handle more. You’re more resilient. (P4)

Discussion

The four participants described a rich array of experiences while participating in an in-person photography/film group in the context of Covid-19. They each had prior occupational experiences that influenced their involvement but they all developed mastery and competency with the support of a respected tutor and experienced pride in their art. They started to look at the world as photographers, had shared goals within the group and worked together to become a photography team.

As occupational therapists, these results resonated with the concepts of “Doing,” “Being,” “Becoming” and “Belonging,” which Wilcock (2006) describes as core to understanding human participation in occupations and how they relate to health and wellbeing. Threaded throughout the narratives of the participants were examples of how all these concepts were experienced while participating in a photography group.

“Doing” involves active participation in an occupation and the development of skills, abilities and mastery in that occupation over time (Hitch et al., 2014). The participants described how their skills developed through a process of expertly-facilitated photography tuition, supported by teamwork and the planning of the occupational therapist in providing a supportive environment, adequate equipment and funding. Space was given in the group for each participants’ unique “doing” of photography—whether that involved learning the details of all the camera settings, or just stopping to capture “the flowers coming up there for spring.” In this way, the intervention was able to facilitate the second concept above, “Being”—where a person can exercise agency and choice and express their own individuality in an activity through reflection and self-discovery (Hitch et al., 2014).

Living with a mental health difficulty can involve much preoccupation and focus on the inner experience—the thoughts, feelings, perceptions and physical symptoms that can form part of the person’s lived experience and often, the focus of the mental health staff that work with them. Striking in the accounts of the participants was the complete focus on external experiences that accompanied photography activities. During the sessions, participants were focused on “Being” in the present moment, their surroundings, taking the best image that they could, scanning the landscape for possible photographs and engaging with the tutor, the occupational therapist and the other group members to create images or discuss techniques and plans. Many authors have written about the importance of doing activities with full awareness for mental health, a state called “flow” (Csikszentmihalyi, 1996) or in occupational therapy, “occupational presence” (Reid, 2005). For some participants, locating photography in a local landscape that included childhood memories made it even more meaningful. Interestingly, even when the landscape was not familiar (as for participant 3 who was new to the area), the natural surroundings were inspirational—evoking stories and narratives based on movies or books. Being able to bring one’s attention away from uncomfortable psychological experiences to the surroundings or an activity is a valuable therapeutic strategy that can improve mental health symptoms (Villatte et al., 2016).

As the group progressed, the participants were “Becoming” photographers—experiencing growth, development and change through new experiences (Hitch et al., 2014). One person took a leadership role as a patient representative and another spoke about his pride in “showing off” his work in a community arts festival. A key pillar of Recovery-focused mental health services should be the inclusion of mental health service users into the life and activities of their community in a non-medicalised, “ormal” way. In the past, occupational therapy group-based photography interventions were part of segregated care—carried out within institutions (Boucher, 1951). An important focus of this photography intervention was that participants were treated as photography students learning a new skill, rather than patients attending a mental health intervention. Key to this was advocating for funding and employing a professional photography tutor. While the occupational therapist was part of the sessions, the participants’ narratives point to the importance they placed on the expertise and value of learning from a professional tutor.

Lastly, a strong theme for participants was the importance of the team during the photography activities. The group gave a sense of “Belonging” through social interaction, affirmation from others, giving and receiving help and a sense of friendship (Hitch et al., 2014). Photography can be either an individual or a group activity. However, the “esprit de cour” (P4) experienced by the participants would suggest that, in this mental health context, doing photography alone would not have had the same therapeutic impact. Interventions that promote a sense of connectedness form an essential part of Recovery-oriented mental health services (Leamy et al., 2011). Opportunities for connectedness and belonging can be fostered in activity-focused interventions focused on creativity, social inclusion and skill-building such as photography.

Notwithstanding the enjoyable aspects, participation in the group was also challenging in some ways. The commitment and effort required for some participants included getting up early for the bus or preparing their equipment the night before. This shows how an occupation-focused intervention can influence other aspects of a person’s occupational pattern. Participants in a gardening intervention in a similar Irish mental health setting noted how even a weekly group intervention helped develop wellbeing, routines and motivation to take part in other activities. For those not currently able to take paid employment, occupation-focused interventions can provide the skill-development, social and time-use benefits of work (Joyce & Warren, 2016). Because of this, missed group sessions were experienced as “hard”—with one person stating, “there’s nothing worse.” This highlights the importance of making community groups consistent and sustainable, rather than short-term interventions dependent on therapist availability and resources. The Participatory Occupational Justice Framework advises that, like in this example, the role of the occupational therapist can include finding external funding for staff or resources so that the intervention becomes sustainable and embedded in a community context (rather than a clinical one) (Townsend & Whiteford, 2011). Finally, health challenges were present for some in this population. Examples were perfectionism, poor concentration and physical health problems like fatigue. Although some supports were required to enable engagement due to health challenges, interestingly, photography provided motivation to engage despite the challenges and lessened the impact of some health challenges, demonstrating the therapeutic value of creative occupations.

Limitations

The interviews took place in April 2022, approximately 18 months into the participants’ participation in the photography group. Therefore, their narratives are retrospective accounts. There is a small sample size in the study but all participants of the photography group were invited to interview. Four out of the (at the time) five ongoing participants took part. The research team included the occupational therapist (CM) who worked clinically with these individuals and attended the group sessions. Therefore, she needed to bracket her prior knowledge during the data analysis process. An external researcher (JF) carried out the interviews and both authors did initial coding independently. Member-checking of transcripts or developing themes was not done, but there was participant input into designing the interview questions. Although it can be an aspect of qualitative rigor, member-checking can also be burdensome to some populations and in cases of unequal relationships—people can feel pressure to participate (Motulsky, 2021). Finally, the participants’ narratives cover the Covid-19 lockdown periods in Ireland (2020–2022) therefore, they need to be contextualized. However, Covid-19 was not a key theme or topic in the data.

Future directions/Future research

The photography group continued to develop following the completion of this study. The group held a film/photography exhibition during a local Arts Festival and received a grant for cameras and other photography equipment through collaboration with a local family resource center. The group now welcomes new members from the wider community, as well as those attending the mental health services. An expert photographer and occupational therapist remain as co-facilitators. Seeking out partners in civic society as part of occupational therapy mental health practice can reduce the marginalization of people with serious mental illness and improve social inclusion (Smyth et al., 2011). It was planned to carry out future research on this initiative in the form of participatory action research to explore how the members of this arts-based, therapist-led group could be empowered to take more ownership of the initiative. Initial work commenced on a participatory action research project and included participants, the local family resource center, occupational therapist, university partners and the local arts office in an application for grant funding to carry out this research. However, progress on this participatory action research project was stalled by lack of funding and staffing issues. The photograph group continues to grow via the members and family resource center in the absence of this participatory action research.

Conclusion

This study describes the experiences of participants in a photography group which started as medium to enable “doing” photography and social connection during the peak of the Covid-19 pandemic. Over time, the group offered participants an opportunity for “being” and enabled immersion in the photography. The participants “became” photographers, experiencing growth and new opportunities. The consistency of the group provided connection for members, enabling a team spirit and “belonging.” This research emphasizes the need for consistency and sustainability in creative interventions and indicates the importance of occupation-based groups to develop routines and wellbeing.

Research ethics

Ethical approval for this study was granted by the HSE Dublin North East Research Ethics Committee in 2021.

Declaration of conflicting interests

The Authors confirm that there is no conflict of interest

Acknowledgements

The authors would like to thank the participants and staff for their support in conducting this study. The authors wish to acknowledge Charlene Tully and Colm Mullen for their roles in the photography group.

Disclosure statement of funding

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.