Epistemic citizenship under structural siege: a meta-analysis drawing on 544 voices of service user experiences in Nordic mental health services

Abstract

This paper presents a meta-analysis, drawing exclusively on qualitative research (n = 38), which contributes to findings on mental health service user experiences of received provisions and/or encounters in contemporary social and mental health services in the Nordic countries. The main objective is to identify facilitators of, and barriers to, various notions of service user involvement. Our findings provide empirical evidence regarding service users’ experiences of participation in their encounters with mental health services. We identified two overarching themes, professional relations and the regulative framework and current rule and norm system, in the reviewed literature concerning facilitators and hindrances of user involvement in mental health services. By including the interrelated policy concept of ‘active citizenship’ and theoretical concept of ‘epistemic (in)justice’ in the analyses, the results provide foundations for broader exploration and problematization of the policy ideals of what we call ‘epistemic citizenship’ and contemporary practices in Nordic mental health organizations. Our conclusions include suggestions that linking micro-level experiences to organizational macro-level circumstances opens up avenues for further research on service user involvement.

Developing sustainable service user involvement practices in mental health services in Sweden: the “Userinvolve” research program protocol

“…One issue raised in the GoR, is that of insufficient professional PCC competence in primary care, which would help in recognizing SUs symptoms of mental illness or conforming to SUs needs and/or requested treatment methods. The GoR report further highlights the value and necessity of experiential knowledge in the ongoing development of welfare services for individuals with mental illness, in line with current research ( 2 ).…”

“…Swedish government official reports (GoR) ( 5 ) address the need for evidence-based and competence-enhancing working methods, combined with an increased focus on participation and influence for SUs - in line with the 2030 Sustainable Development Agenda. Concurrently, existing challenges in mental health service organizations and primary care are addressed, highlighting the gap between the ideals of SU participation, and the current situation of individuals with mental illness who are situated as ‘service users’ of welfare state services ( 2 ). One issue raised in the GoR, is that of insufficient professional PCC competence in primary care, which would help in recognizing SUs symptoms of mental illness or conforming to SUs needs and/or requested treatment methods.…”

“…Including the voices and knowledge of the service user (hereafter abbreviated to SU) is core to the delivery and quality development of mental health services and is recognized as an essential component both in Sweden and internationally (1)(2)(3). In Sweden, Government commissions of inquiry have highlighted SU involvement as a prioritized concern (4, 5) and there is a growing emphasis on specific methods and interventions to increase SU involvement (6,7).…”