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
© The Author(s). 2016
Received: 28 May 2016
Accepted: 3 November 2016
Published: 9 December 2016
Despite evidence that connecting people to relevant wellbeing-related resources brings therapeutic benefit, there is limited understanding, in the context of mental health recovery, of the potential value and contribution of pet ownership to personal support networks for self-management. This study aimed to explore the role of pets in the support and management activities in the personal networks of people with long-term mental health problems.
Semi-structured interviews centred on ‘ego’ network mapping were conducted in two locations (in the North West and in the South of England) with 54 participants with a diagnosis of a long-term mental health problem. Interviews explored the day-to-day experience of living with a mental illness, informed by the notion of illness work undertaken by social network members within personal networks. Narratives were elicited that explored the relationship, value, utility and meaning 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 being analysed using a framework analysis.
The majority of pets were placed in the central, most valued circle of support within the network diagrams. Pets were implicated in relational work through the provision of secure and intimate relationships not available elsewhere. Pets constituted a valuable source of illness work in managing feelings through distraction 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 limited or difficult. Despite these benefits, pets were unanimously neither considered nor incorporated into individual mental health care plans.
Drawing on a conceptual framework built on Corbin and Strauss’s notion of illness ‘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 support in the management of long-term mental health problems, and this has implications for the planning and delivery of mental health services.
KeywordsMental health Social network mapping Pets Qualitative research United Kingdom
The ability to manage and to be engaged with everyday life is a key concern of people with a long-term condition, which also 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 [1, 2]. 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 . The latter is considered to require positive and stable emotions and the avoidance of chaos and anxiety . In relation to mental health, ontological security is threatened by the breakdown of, and difficulties in, maintaining relationships with friends and family , challenges in maintaining routine and daily living activities , and feelings of being judged and stigmatised [6, 7].
Having a support network in place provides options for the management of living everyday life with a mental health problem. In this respect, emphasis is often placed on family, friends, and social interaction with other people [8–10]. However, the role of pets is likely to have been under-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 support is widely acknowledged . 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 tie 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 enhance the reach and cohesion of other social relations [1, 10].
Confirmatory evidence of the multifaceted relationships that exist between people with health 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 . 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 . Social capital refers to the social, economic and cultural resources on which individuals draw in responding to long-term health conditions. These represent resources that form an integral part of people’s social networks, which are impacted upon by wider determinants of health . Class-related cultural resources interact with economic and social capital in the structuring of people's health chances, choices, and the unequal distribution of health outcomes .
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  and residential care settings . However, despite AAT gaining popularity in recent years, and therapy animals becoming increasingly familiar sights in care homes, hospices and hospital wards, pets are not considered in care planning processes undertaken for managing mental health on an on-going basis. This may in part be due to a gap in evidence or in evidence failing to inform or reach practitioners and policy makers responsible for care planning arrangements. Whilst the benefits of formalised AAT for conditions such as dementia [18, 19], cancer [20, 21] and childhood developmental disorders [22, 23] are gaining recognition, there is currently a lack of evidence exploring the contribution of pets in the broader context of support networks and the role 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 , improved quality of life [25, 26], improved physical health [27–29], increased social interaction  and reduced loneliness [2, 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 illness 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 conditions . Here we extend the focus of this previous analysis to the role of pets for mental illness, which is currently equivocal and underexplored.
This paper reports on the findings from qualitative interviews focussed on ‘ego’ network mapping to elicit an understanding of personal support 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 experience of living with a mental illness was explored.
The illness work framework
Types of work
Practical Illness work
Work related to health management.
Crisis prevention and management: ‘work that gets things back “on track” in the face of the unexpected, and modifies action to accommodate unanticipated contingencies’ (potential support).
Translation, mediation and embodiment
The translation of abstract knowledge into practical knowledge and then into practice. The difference between knowing and doing. Includes illness-specific work related to diet, exercise and medication (regimen work). Symptom management and diagnostic-related work related to assessment of health status.
Involves combining different entities such as tasks, types of work and people, making them work together within a specific context. Also involves negotiations regarding the ways in which work is done, who does what, when, how and why. The organisation of tasks that need to be done.
The negotiation of contributions and the work done by others on one’s behalf.
Practical everyday work
Housekeeping and repairing; occupational work; child rearing; sentimental work; eating. Includes generic support related to diet and exercise (general shopping and unspecific personal care).
Work related to non-specific, diet-related support (shopping, cooking, going for a meal).
Work related to non-specific, exercise-related support (walking, swimming, going to the gym).
Illness specific emotional work
Work related to comforting when worried or anxious about health-related issues.
Everyday emotional work
Work related to comforting when worried or anxious about everyday issues. Well-being and companionship.
Work related to the actions taken to retain control over the life course and to give life meaning again. This includes the reassessment of personal expectations, capabilities, future plans, identity, relationships and strong emotional bonds. Includes illness-related and non-illness related biographical events.
Definitions of types of work used within the paper
Work related to housekeeping and repairing; occupational work; child rearing; support and activities related to diet and exercise, general shopping and unspecific personal care.
In addition, practical work incorporates the work related to taking medications, crisis prevention and management, regimen work, taking and interpreting measurements, understanding symptoms, making appointments, etc.
Work related to comforting when worried or anxious about everyday matters, including health, well-being and companionship.
Work related to the actions taken to retain control over the life course and to give life meaning again. This includes the reassessment of personal expectations, capabilities and future plans, personal identity, relationships and biographical events.
Participants were recruited from 1) a randomised controlled trial exploring service user and carer involvement in mental health care planning (EQUIP, Manchester) and 2) a sample of people using a Recovery College (Southampton). Participants were recruited via invitation letters and flyers advertising the study. Those who were interested in taking part contacted the research team directly to discuss the study in more depth and then arranged a convenient time, 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 team that theme saturation had occurred and there was consensus that no new themes were arising from the data.
Participants were considered eligible for inclusion in the study if they were aged 18 or above, were under the care of community-based mental health services (or had been discharged within 6 months) and had received a diagnosis from a health professional of a severe mental illness (e.g. Schizophrenia or Bipolar disorder).
Participant characteristics (those with pets n = 25)
Number of pets
Type of pets
Guinea pig only
Face-to-face, semi-structured network interviews were carried out between March 2015 and February 2016 by 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 three concentric circles . Interviewers started the interview by asking the question ‘Who or what do you think is most important to you in managing your mental health?’. Participants could place nominated network members in either the central circle considered most important, the middle circle, considered important but not as important as the central circle or the outer circle, considered important but not as important as the two more central circles. Identified network members included friends, family members, health professionals, pets, hobbies, places, activities and objects. There was no maximum number of network members imposed on participants and they were free to list as few or as many as they considered relevant to their unique situation.
The interviews lasted between 20 and 90 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 1 for an interview schedule). This way, detailed information was collected about the contributions each network member made to the different types of work associated with mental health management. Interviews were digitally audio-recorded, transcribed verbatim, anonymised and allocated to a member of the study team (HB, KR, SW alternatively) for analysis.
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 one informed by a capabilities approach which recognises that the social context and engagement with valued people, places and activities are often hidden from view but are likely to be as important to the management of long-term conditions as traditional therapeutic or self-management support approaches .
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 contained in a word document for transparency purposes.
A framework analysis was undertaken with individual members of the study team coding data relating to work-related codes (practical, emotional and biographical work, see Tables 1 and 2 ) 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 any coding discrepancies discussed amongst the team to enhance rigour and trustworthiness of data. Researchers met regularly to discuss on-going analysis and to discuss, 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 balance of emotional, illness and biographical work; and the hidden work of pets.
Network placement and attributional meaning of pets
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 so I’m only one 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 also give me a sense of wellbeing which I don’t get from any [one else] because most of these interactions with my Mum, Dad, [friend], are all by telephone rather than physical contact and that’s the big difference is the empathetic physical presence. (ID 21, 10 birds, first circle)
Relational work and substitution
Well I just love animals, I just really do love animals. I haven’t got a partner so I have something around me otherwise I’d go totally bonkers. That’s the most important thing to me is my animals (ID 13, range of pets, first circle).
That surprised me, you know, the amount of people that stop and talk to him, and that, yeah, it cheers me up with him. I haven’t got much in my life, but he’s quite good, yeah (ID 9, 1 dog, first circle).
If I didn’t have my pets I think I would be on my own…You know what I mean, so it’s…it’s nice to come home and, you know, listen to the birds singing and that, you know (ID 2, 2 birds, first circle).
I felt in a sense that my cat was my familiar in that he understood or was an extension of my thoughts (ID 7, 1 cat, second circle).
I think it's hard really when you haven't had mental illness to know what the actual experience is for someone who has had the experience. There's like a chasm, deep chasm between us - a growing canyon. They're on one side of it and we're on the other side of it. We're sending smoke signals to each other to try and understand each other but we don't always - we don't always understand each other I don't think. (ID 1, 1 cat, first circle).
Er, there’s a lot less things to worry about. 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 there’d be no hard feelings. That there’s not, you don’t get the nastiness (ID 11, 1 dog, third circle).
Yes, they can give you loving, pets can and you can trust pets not to steal off you (ID 6, 1 guinea pig, first circle).
You know, so in terms of mental health, when you just want to sink into a pit and just sort of retreat from the entire world, they force me, the cats force me to sort of still be involved with the world (ID 5, 2 cats, first circle).
Balancing of emotional, illness and biographical pet work
Negative work and burden
Yes the only thing is my future plans revolve around saving up as 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 keep so (ID 14, 2 dogs and 2 cats, first circle).
Emotional and illness work
When participants talked about the work that their pets did to support them in managing their mental health on a day-to-day basis, narratives about illness and emotional work were conflated at times. Unsurprisingly, pets were rarely implicated in everyday practical work (such as house work) but were considered important in relation to illness-related practical work and emotional work.
Yes, you get comfort from them, because they lick you 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, first circle).
When I’m feeling really low they are wonderful because they won’t leave my side for two days. I will get up and I will let them out to the toilet and I will feed them but I am straight back in bed and I won’t even get myself any food or water and then they’ll just come straight back up and just stay with me until I’m ready to come out of it. They are used to it I suppose (ID 14, 2 dogs and 2 cats, first circle).
But if I’m here and I’m having…having problems with voices and that, erm, it does help me in the sense, you know, I’m not thinking about the voices, I’m just thinking of when I hear the birds singing (ID 2, 2 birds, first circle).
She, sort of, does random stuff, like climbs on the bars and… stuff [laugh] 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, second circle).
I mean I could always go out, take him out of his, er, hutch, give him a stroke or something [if I needed to] (ID 3, 1 hamster, second circle).
Pets were reported to be important in relation to biographical work given their assistance 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 also because of a perception that they mediated how other people viewed them.
And I just try and make sure that I walk him, and that, in the mornings….but sometimes I can’t be bothered to do that, but then I think….I..I think about, you know, that it’s not fair if he doesn’t go (ID 11, 1 dog, third circle).
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 2, 2 birds, first circle).
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).
Well, you know, apart from being fed, they don’t make many demands (ID 10, 2 cats, first circle).
I love budgies and every budgie I’ve had I’ve always managed to get it into a position where it will sit on my shoulder and at the moment I’m just training this one because I’m 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’s why the home said we had to get rid of the bird because she wasn’t leaving the room and consequently we took the bird and she’s getting better in the home she’s in. I look after that bird every day, I wake him up, I sit with him and in the evening I’ll sit for a good hour playing with him on his cage or in his cage. (ID 15, Budgie and goldfish, second circle).
When he comes and sits up beside you on a night, it’s different, you know, it’s just, like, he needs me as much as I need him, sort of thing. (ID 9, 1 dog, first circle).
The hidden work of pets
I mean it’s just a nice feeling to have somebody around that you can l, like, take care of (ID 3, 1 hamster, second circle).
Kind of, knowing about your cats and your friends and your family would feed into them knowing you and understanding you a bit better, and…Which would, in turn, feed into how useful the care plan could be. (ID 5, 2 cats, first circle).
To our knowledge, this is the first qualitative study empirically exploring the role of pets in the social networks of people managing a long-term mental health problem. Using a social network approach incorporating illness work concepts, we identified the attributional meaning attached to pets by those diagnosed with mental health conditions as well as the implicated role of pets in different types of illness work.
Pets contributed, over time, to individuals developing routines that provided emotional and social support. This was set 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 developed in relationships with pets, which reinforced stable cognitions from the creation of certainty that they could turn to and rely on pets in times of need. With reference to how Giddens  used the term, pets provided ontological security through generating a sense of order and continuity to individual experiences and through this close connection provided a sense of meaning to people’s 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 feel alone in her condition and could relate to another network member with whom she perceived to share experiences. In this sense, the work of pets in personal communities provided participants with a seemingly deep and secure relationship, often not available elsewhere within the network or wider community. This became increasingly important 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 point to the value of pets in illness practical work. This included distraction and disruption from distressing symptoms, such as 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 direct impact on managing the stigma associated with mental illness. Pets provided a form of acceptance 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 illness work provide an extension to previous findings about the role of pets for physical illness management  and mental health (i.e. a reduction in stress  reduced loneliness, [2, 31] and the receipt of social capital ). The findings also contrast with previous research that demonstrates the negative impact of pet ownership  and of losing a family pet .
It is not the intention of this paper to indicate that pets play a more important role for one type of health concern 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  and the impact that a diagnosis may have on a sense of self [40, 41]. On the face of things, it appears that the participants raised similar themes as those with physical health conditions . However, in relation to the salience of themes with specific regard to mental health, 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 conditions. 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 one’s sense of ‘self’ than physical illnesses, since the surveillance of moral responsibility may be felt more intensely, and levels of isolation and stigma are likely to be greater [40, 41].
Service implications–the hidden work of pets
The network mapping undertaken as part of this study illuminated the role of pets as a hidden resource for mental health management and supports the idea of a ‘lifestyle’ approach to the management of mental health problems and prevention . The latter involves the incorporation of holistic principles to enhance physical and mental wellbeing, including environmental, behavioural and psychological principles  and this study identifies pets as a hidden asset that could be deployed in this regard. However, the value and utility of pets as part of an active point of discussion and resource for people remains invisible within mental health service provision and in the negotiation of individual care plans. A lack of consideration for individual caring responsibilities for pets also represented a source of worry for some of the participants included in this study when they considered the chance of them being in a crisis in the future (e.g. concern for the care of their pet should they become hospitalised). This suggests the need 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 discussion, to facilitate healthcare discussions. Previous research suggests that service users feel distanced from healthcare and uninvolved in discussions about services [44, 45]. Taking more creative approaches to care planning discussions, including the use of pets, may be one way of addressing this because of the value, meaning and engagement that individuals have 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 particularly useful at times of crisis but potentially restrictive when aspirational goals associated with recovery were considered.
Strengths and limitations
Key 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 approach provided rich data with which the theoretical ‘illness work’ framework  was used to allow 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 data collected, and participants were sampled to ensure a variety of attitudes were encapsulated into the study. Participants were recruited from within two locations in the UK, included only those cared for withing the community and did not recruit any 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.
Drawing 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 health. This was achieved through the identification of the unique role and value of pets in relationships and work associated with managing mental health over time. The implications of this study propose that pets should be considered a main, rather than a marginal source of support, in the management of long-term mental health problems and could be considered as extending more traditional Collaborative Care Models for managing mental health . These insights provide the mental health community with possible areas to target intervention and potential ways in which to better involve service users in service provision through the discussion of valued experiences.
Animal Assisted Therapy
Collaboration for Leadership in Applied Health Research and Care
Community Psychiatric Nurse
Consolidated Criteria for Reporting Qualitative Research
Enhancing the Quality of User Involved Care Planning in Mental Health Services
National Institute for Health Research
Post-Traumatic Stress Disorder
The research team acknowledges the support 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 article.
This is a summary of independent research funded by the National Institute for Health Research (NIHR)’s Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-1210-12007) and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex and Solent NHS Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Availability of data 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.
The Manuscript was written by authors HB and KR, with editorial comments by SW, KL and AR. Data was collected by HB and SW, analysed by HB, KR and SW, and verified by AR. All authors confirmed approval for submission of the work.
The authors declare that they have no competing interests.
Consent for publication
All participants provided consent for the recording and publishing of anonymised data.
Ethics approval and consent to participate
Ethical approval was obtained from the National Research Ethics Committee North West–Lancaster [14/NW/0297] and University of Southampton Ethics and Research Governance Office . All participants provided written informed consent to participate in this study.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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