Women's Voices: an anlysis of views on service user involvement in mental health care

Abstract

UK mental health policy increasingly emphasises the necessity to involve service users in aspects of service planning, practice and evaluation. There is also a growing self-organised user movement, demanding greater and more sophisticated levels of such participation. Despite this apparent consensus between policy makers and service users, explicit guidance for implementation is lacking and, arguably, staff resistance and other institutional barriers stand in the way of systematic and meaningful involvement. Historically, mental health services have reproduced various societal structural inequalities in the treatment of women service users, in particular. Service user perspectives, motivations and accounts of experiences of active involvement are relatively under-represented in the published literature.

This study utilised discourse analysis of texts generated by semi-structured interviews with stakeholders in mental health services to explore the ways in which these participants make sense of the notion of user involvement. The overall study included samples of both staff and service users. Twelve staff were interviewed including practitioners, managers and hospital chaplain. Eight service users were interviewed including, service users, service user representatives and a service user advocate.

The findings indicate three broad discourses in the service user narratives. The first discourse constructs different dimensions of identity. Second, is a discourse that expresses ideas coalescing around notions of gender. The third discourse constructs the organisation within which the service user activism takes place. The staff draw upon these same discourses, and also draw upon staff identity in relation to service users and service user involvement. These discourses are presented as affording potential to make a contribution to informed development of mental health services such that user involvement initiatives are better supported and sustained. They are also available to the user movement itself to draw upon in their ongoing political and practical engagement with services and forms of organised involvement.