Service user involvement in Swedish mental health and social care: an analysis of ideological dilemmas and subject positions in a collaboration context

Abstract

Service user involvement is steadily on the rise, bringing questions of tokenism and power imbalance. This article studies service user organisation representatives (URs) and human service organisation representatives (HSORs) in mental health and social care strategic collaboration councils through qualitative interviews and participant observations. Talk on service user involvement through UR is studied through the discourse analytical concepts of ideological dilemmas and subject positions. The participants' constructions, actions, and rhetoric therein are considered. Findings show participants' oscillation between standpoints within two main themes: the ideal vs. the inadequate UR and balancing power positions. The first theme discusses the missing perspective brought by UR narrations in terms of expected conduct and awareness of organisational conditions. This also concerns service users' positions as being simultaneously dependent and independent. The second theme concerns the implicit UR influence and the explicit HSOR influence. User involvement through URs is construed as a needed narration told by citizens with rights and responsibilities, while conditioned, as the UR is a layperson with mental health problems. The actions accompanying such constructions cause HSORs to balance between paternalism and professionalism and URs between adaptation and using their voice. In this, the URs have a stronger influence than acknowledged.

Brukarmedverkan ökar stadigt, och med utvecklingen följer frågor kring tokenism och maktobalans. Genom kvalitativa intervjuer och deltagande observationer undersöks här strategiska samverkansråd inom området psykisk ohälsa och de ingående brukarrepresentanterna (BR) och representanterna från människobehandlande organisationer (MBOR). Tal om brukarmedverkan genom BR studeras genom diskursanalytiska begrepp: ideologiska dilemman och subjektspositioner. Deltagarnas konstruktioner, handlingar och retorik fokuseras. Resultaten visar deltagarnas pendling mellan ståndpunkter inom två teman: den ideala vs. den otillräckliga brukarrepresentanten samt balansera maktpositioner. Det första temat diskuterar det saknade perspektivet BR bidrar med genom berättelser i termer av förväntat beteende och medvetenhet om organisatoriska villkor. Detta rör även brukarnas position som samtidigt beroende och oberoende. Det andra temat rör BRs implicita inflytande och MBORs explicita inflytande. Brukarmedverkan genom BR konstrueras som en behövd berättelse berättad av medborgare med rättigheter och skyldigheter, som samtidigt är villkorad då BR är lekmän med psykisk ohälsa. Handlingar som följer sådan konstruktion orsakar MBOR att balansera mellan paternalism och professionalism, och BR mellan anpassning och att använda sin röst. I detta har BR ett starkare inflytande än vad som erkänns.

Keywords:

• service user involvement
• service user organisation
• collaboration
• ideological dilemma
• subject position

Nyckelord:

• brukarmedverkan
• brukarorganisationer
• samverkan
• ideologiska dilemman
• subjektspositioner

Disclosure statement

No potential conflict of interest was reported by the author.

Notes on Contributors

Linda Mossberg is a Ph.D. student at the Department of Social Work, University of Gothenburg, Sweden, and the Vårdal Institute. She is an educated social worker with experience from social care, elderly care, and the mental health field. Her academic work concerns collaboration within the mental health field between representatives from human service organisations as well as service user organisations.

Notes

1. Professional groups in this context are discussed elsewhere (Mossberg, 2014).