Interaction, Ideology, and Practice in Mental Health Rehabilitation

Abstract

This paper investigates how two ideologies of mental health rehabilitation-recovery ideology and communal approach-are realized in interactional practices associated with psychosocial rehabilitation. More spesifically, the paper discusses employee selection in the context of the Clubhousecreated Transitional Employment (TE) programme, which offers employment opportunities for rehabilitants. The paper describes how joint decisions are established during the moment-by-moment interactional processes at the Clubhouse. Drawing from the data set of 29 video-recorded rehabilitation group meetings, and Conversation Analysis as a method, the paper analyzes two questions: (1) How do the participants talk about the decision-making process associated with the TE on a ''meta'' level? And (2) how are the TE employees actually selected in the turn-by-turn sequential unfolding of interaction? When discussing the TE employee selection procedure on a ''meta'' level, the values of recovery ideology focusing on client empowerment and selfdetermination are prevalent. Also, the central ideals of the communal approach-openness and collaboration-are defended as decision-making guidelines. However, in the meetings where decisions on the TE employees are concretely made, there is a mismatch between the two ideological approaches to rehabilitation and the actual practices observable in the relevant interactional encounters. Keywords Rehabilitation Á Professional ideology Á Joint decision-making Á Conversation analysis Á Social interaction ''We made a democratic selection with the members who were interested in the job. It was a joint decision and the selection process went really well.''-Support worker evaluates a selection process of a transitional employment worker.

Promoting Client Participation and Constructing Decisions in Mental Health Rehabilitation Meetings

“…This is what happens in Extract 3a, where the participants discuss the so-called "transitional work"a Clubhouse-created employment program, the aim of which is to assist those Clubhouse members who wish to seek competitive employment in the future. It involves a part-time placement at the employer's place of business, lasting from 6 to 9 months (Valkeapää, Lindholm, Tanaka, Weiste, & Stevanovic, 2019). Here, a support worker (SW1) suggests that a group of Clubhouse members from another community could visit the group to report their experiences of transitional work (lines 1-7; lines 3-7 not shown in the transcript).…”

Constructing young citizens’ deontic authority in participatory democracy meetings

“…Similar to the dual orientation described by Peräkylä (2002), and the mismatch in participants role in decision-making as shown by Valkeapää (2019), the politicians and public servants display rights to direct the adolescent's future actions while acknowledging the adolescents as deontic subjects. Even when the deontic room for maneuver is seemingly horizonless and the participants are instructed to base their suggestions on individual desires regarding what society should look like, the authority to designate this deontic authority lies with the institution.…”

“…This is described as an enactment of dual orientation to which the institutionally superior participant’s authority is oriented while remaining attentive to the institutionally subordinate participant’s agency (Peräkylä, 2002). A parallel study of how ideals of democratic participation unfold in actual mental health rehabilitation interaction, Valkeapää et al (2019) show that the superior party introduces actions to empower the subordinate participants by introducing guidelines for how to participate and what to bear in mind when making decisions. However, in the actual situations of decision-making, there is a mismatch with regard to the ideals introduced.…”

Joint decision making in a mental health rehabilitation community: The impact of support workers’ proposal design on client responsiveness

“…As has been discussed in prior Clubhouse literature (e.g. Valkeapää, Lindholm, Tanaka, Weiste, & Stevanovic, 2019), the possibility to enter the program is the utmost importance to many clients at the Clubhouse and the decisions related to the running of the program can therefore often be emotionally loaded.…”