Patients, professionals and power dynamics: Exploring the role of mental health service improvement work within a person’s experience of recovery

Abstract

Over the past 30-40 years health policy and literature internationally has emphasised increased user involvement in the shaping of mental health care. However, little has been written to contextualise such involvement experiences within people’s own recovery from mental health crisis and their ‘life story’.
This qualitative study interviewed individuals who have accessed mental health services and become involved in working with care providing organisations. Its aim was to contextualise experiences within their life ‘story’ and recovery, exploring identities and roles assumed by the narrators. Ten participants were recruited using a theoretical sampling strategy. The interviews were structured around an oral history/life story approach and the transcription process incorporated performance aspects, as well as spoken content.
Drawing on Braun & Clarke’s approach to thematic analysis key emergent themes were clustered to identify overarching themes across all interview narratives. Storytelling devices important to life stories were also explored. The narratives recorded could be broadly split into three phases or ‘acts’; ‘life before mental health crisis’, ‘entering the mental health system’ and ‘enlightenment and changing the script’. The analysis and discussion identified overarching themes of ‘Survival’, ‘Institutional Power and Dominance’, and ‘Asserting Power & Forging a New Identity’, which traversed these acts.
The study concluded that to experience recovery from mental health crises, user involvement activity had significant value up to a point. To regain a true sense of autonomy, restoration/formation of identity and challenge services to improve their care, however, a person often needs to step outside of the mental health system. Recommendations about how this might be achieved and areas for future research are discussed.

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Identifiers

ORCID for Dawn-Marie Walker: orcid.org/0000-0003-2135-1363

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