A Paradox of Acceptance: Young Adults' Perspectives on Mental Health and Coping

Background: Young adults have high rates of serious mental illness (SMI, i.e. schizophrenia, major mood disorders) and they often do not receive treatment. A multidisciplinary team explored the process of acceptance (lack of acceptance) of one’s mental health condition along with strategies of coping among minoritized young adults with SMI receiving recovery and rehabilitation services.

Method: This concurrent mixed methods study utilized qualitative and quantitative data from a sub-sample who completed an in-depth interview on their “mental health narratives” as part of a larger randomized trial (2018-2020) of multiply-marginalized young adults receiving services for SMI (N=59). First, qualitative data was analyzed by coders who met multiple times to discuss initial codes, grouped codes, memos and emergent themes (rigor was maintained through debriefing and reflexivity discussions). Second, analysts used joint displays to examine the narratives of those who discussed acceptance by demographic, clinical and coping characteristics. Third, analysts utilized bivariate statistics to examine if acceptance was related to fewer symptoms, help-seeking and personal recovery.

Results: The sample was 40.7% Black/African-American, 37.3% Latinx, 18.6% multiracial, and 3% White (N=59). The mean age was 26.1 (Range 18-34, SD=3.2). Four main themes related to acceptance and coping emerged. The first theme, acceptance is an ever-changing process captured how acceptance of a stigmatizing condition changes over time (e.g., “...I have mixed feelings about it because at times I refuse to believe that I have a mental diagnosis...I am in denial about it, but for the most part, I do accept the fact that I have a mental diagnosis.”). Other themes were acceptance and coping (e.g., “...I do accept it, that it is a diagnosis that I have. And it will be in my best interest to take the necessary steps...to treat it and manage it to the extent that I reasonably can.”) and the influence of others (“I came to accept it because...I have small children and I know that if I—I know I need it. And if I got to better myself because of them, that’s exactly what I’m going to do.”). Finally, various coping methods were discussed; that is, both formal (i.e., medication, therapeutic groups) and informal (i.e., music, art, family, “keeping busy”) strategies were detailed. Data suggest that youth who discussed acceptance (n=15) reported being more willing to ask for help (t=-2.62, p<.01), possessing more “agency” (e.g., goal-directed determination and motivation) (t=-2.58, p<.05), and having higher levels of dispositional hope (t=-1.71, p<.10), when compared to those who did not (n=44). Acceptance was not associated with symptoms.

Conclusions and Implications: Data reveal that acceptance of one’s mental health condition is a dynamic process, which is associated with clinical outcomes (i.e., help-seeking, agency, hope). This highlights the importance of psychosocial interventions seeking to understand more about an individual acceptance of their diagnosis. Data support that acceptance can be considered a paradox of change; that is, acceptance of one’s condition is not antithetical to change. Because a person “accepts” their mental illness, they are not resigned to it. Rather, “acceptance” spurs transformation and change.