User Involvement within Scottish
Mental Health Policy:
Locating Power and Inequality
Lydia Lewis
Department of Sociology
University of Aberdeen
Outline
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Policy background
A gender perspective
Research question
Discourse analytic approach
User involvement policy discourses: implicit
assumptions, hidden gendered meanings,
competing and contradictory discourses
Implications & ways forwards for user
involvement policies
Policy Background
n ‘User
involvement’ a significant recent
development within mental health
services in Scotland
n Mental health inequalities and the drive
for ‘social justice’
n Fit between the two policy initiatives
n Considerations of gender?
A Gender Perspective
n Gender
as a key dimension in mental
health services
n Often over-looked in mental health
policy
n A Feminist critique
n Contributing to the general progression
of mental health service provision
Research Question
What are the likely implications
of user involvement policies
for women and men who use
mental health services?
Study Design
n Selection
of policy documents
- A Framework for Mental Health Services in Scotland
- ‘New Horizons - A Joint Endeavour’: A Framework for
Mental Health Services in Grampian
n The
wider study
Discourse Analytic Approach
n Language
as a generative mechanism
important in constructing social life
n Implicit
assumptions, functions and
silences within the discourse(s)
n Relationships
and contradictions
between discourses/texts
n Social
and cultural context
Implicit assumptions within user
involvement policy discourses
n Users
of services form a coherent
and homogenous group
n The appropriateness of existing
service provision and structures
n The value of focusing on individual
needs
Hidden Gendered Meanings
Emphasis on “individuals with
severe and enduring mental health
problems, including the small
number who present a danger to
themselves or to others” (SO,
1997)
Competing and Contradictory
Discourses
n Involvement
of service users / social
control function of mental health
services
n Construction of the service user
concealing notions about normality
and deviance
n Psychiatric paradigm / personal
empowerment
Implications
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User involvement policies:
- highlight the moral imperative of a more active role for service users
- feed into wider processes of change and conscientization
- provide a lever for reform and a vehicle for users to express views
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But are unlikely to significantly benefit users of
mental health services, particularly women, as
they:
- fail to engage with important dimensions of power and inequality
- act as smokescreen to more meaningful change
- encourage denial of social/cultural influences on mental
health/experiences of using mental health services
Ways forward for user
involvement policies
n Addressing
issues of power
n Addressing
issues of difference and
n Countering
the dominance of psychiatric
inequality
approaches
n ‘Rights’,
‘needs’ and the social justice
policy agenda