Hubble, Bubble, Toil and Trouble: Meddling in Mental Health Services Using Participatory Action Research

Allen, Katherine Louise (2018) Hubble, Bubble, Toil and Trouble: Meddling in Mental Health Services Using Participatory Action Research. Doctoral thesis, University of Central Lancashire.

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This thesis explores whether participatory action research (PAR) can be a vehicle for knowledge democracy in mental health by telling the compelling tale of a team of mental health service users formed to conduct a PAR project in adult NHS mental health services. PAR is a methodology that seeks change through action and the collaborative efforts of participants, often people from marginalised groups. The team, self-named PAR Excellence, actively participated in every step of the research process, from the initial identification of the research topic (shared decision making in mental health), literature review, research design, data collection and analysis, to dissemination. The original contribution to knowledge is in two parts: findings on shared decision making and the use of recorded service user experiences in mental health, and findings on the PAR process itself. Through these intertwining efforts, an original analysis of knowledge democracy in the context of adult NHS mental health services in the UK has been reached.
Having chosen shared decision making in mental health, PAR Excellence developed a multi-media library of service user experiences to be used as a shared decision making resource. They explored with NHS mental health staff whether this approach supported shared decision making through qualitative focus groups and interviews. It was concluded that whilst the use of recorded service user experiences as a shared decision making resource was generally welcomed in principle by staff, in practice there was limited utilisation of the resource. However, it was highly valued as an opportunity for staff reflective practice, and when used judiciously, showed the potential for having a profound effect for service users. It was also found that shared decision making is a complex concept that has many different meanings amongst staff, and they work in a system where true shared decision making cannot consistently occur. However, it was discovered that staff found the involvement of service users in the research process gave the project authenticity and credibility over research generated purely by traditional researchers, and were therefore more likely to engage with it. The shared decision making resource also provoked a particularly positive response in staff members who have used mental health services themselves.
Throughout the project, qualitative focus groups were also held with PAR Excellence to explore the participatory process and its outcomes overall. These findings established that the motivations of the team (who were highly critical of mental health services) were rooted in a profound understanding of the power mental health services had over them, dissatisfaction with services, and a deep sense of injustice. This led the team to express a concept of subversive “meddling” in mental health services to address these issues. They found that whilst personal transformation through PAR was achievable, the potential for more general, external transformation was limited due to the enmeshment of the political and economic climate in which mental health services operate.

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