Accepting and Negotiating Service Users' Choices in Mental Health Transition Meetings

Abstract

Across Western welfare regimes, policies emphasize that service users should have more choices regarding their services. This article examines how service choices are presented, responded to and decided in interactions between service users and professionals in mental health transition meetings. Choice is often associated with consumerist user involvement ideas, but in mental health choice also relates to democratic user involvement approach and to shared decision making between professionals and service users. The results of the study show that professionals construct service users as consumers by offering service options in choice making sequences, expecting users to make appropriate choices. Service users mostly act like consumers by responding to these choice options. However, the study also demonstrates that the professionals do not always accept the user' first choice but respond to them as non-preferred. Sometimes they also suggest choices on behalf of the users. In these 'non-accepting' sequences choices are negotiated in interaction between the parties, rather than users acting as autonomous choice makers. The sequences are based on two kinds of professional reasoning: first the professional-led needs assessment and second the structure of the service package that the user is being offered. This negotiation has elements of shared decision making and the 'logic of care'. But it also has elements of paternalist control which 2 challenge both consumerist and democratic service user involvement and suggests consideration of more collectively oriented service user actions.

Dependence and resistance in community mental health care—Negotiations of user participation between staff and users

“…Juhila et al. () claim that professionals construct service users as consumers by offering service options in choice‐making sequences. However, professionals in this study aimed to make users conduct themselves in ways the professionals considered to be the “right” way, in line with ideas of governmentality.…”

“…Others compromised themselves to avoid unpleasant situations or losing services. Juhila et al (2014) claim that professionals construct service users as consumers by offering service options in choice-making sequences.…”

“…Furthermore, the traditional psychiatric focus on diagnosis should be replaced with ideals of person‐centred care and user participation (WHO ). This ideological shift involves a transition from welfare dependency and professional control towards more active service‐user roles with associated rights and responsibilities (Juhila, Hall, Günther, Raitakari, & Saario, ). Consequently, people who are in need of services from community mental healthcare services are expected to participate in decisions about their health and life in close cooperation with the professionals.…”

Implementation of user organizations in Swedish health care and social services for persons with substance use disorders

“…User involvement in social service and health care service is grounded in a shift from professional control towards a more active role for patients (Juhila et al 2015). One active role for patients is when participating in 'user organizations', other types of user involvement could be patient participating in decisions concerning their own treatment and care (Tambuyzer and Van Audenhove 2011) or participating in the development of clinical guidelines (Harding et al 2011).…”

Attitudes of mental health professionals towards service user involvement

“…Although policy documents recommend that service users and carers should be given an opportunity to be actively involved in mental health services, the literature suggests that they have not been sufficiently involved (11,13,24,25). Roper and Happell (26) argue that the primary underlying barrier to patient involvement in mental health services is negative attitudes among healthcare professionals.…”