Service-user involvement in Irish mental health services: a sociological analysis of inherent tensions for service-users, service-providers and social movement actors

There is very little critical analysis of the relatively new policy of Service User Involvement (SUI) in Irish mental-health services (MHS), in spite of lessons from decades of SUI practice internationally. SUI is endorsed by top MHS management as a reform strategy, while for service-users, it is linked to civil and human rights, originating from contestations of current practice in MHS, yet is often confined to a consideration of how better to implement existing services. No study of SUI in Ireland has contrasted and compared the service-user experiences with that of professionals in real world instances of SUI. The research question asks what are the understandings and experiences of service-users and service-providers who become involved in SUI? The research adopts survivor standpoint epistemology in a case study of SUI occurring with a local multidisciplinary team. Eight local service-users and eleven service-providers were interviewed about their understandings of SUI and the practicalities of making this happen, the challenges and opportunities they have experienced. This local experience is triangulated by the perspectives of a top manager and twelve national user/survivor movement activists. The overarching theme for service-user participants are the tensions inherent between their contestation of the current MHS, collaboration in the opportunities for reform presented by SUI and the risk of co-option given the power imbalances inherent in their positioning vis-à-vis the MHS. An additional tension for movement activists is the appropriateness of SUI as a movement strategy. The overarching theme among the service-provider participants is the inherent tension between their collaboration with service-users to change how service-users are positioned, with differing perspectives on the risks of co-option and tokenistic involvement. The key findings are further analysed using Gaventa’s (2006) conceptual model of the power cube which provides a useful social movement tool to conceptualise the complexities and dynamics of SUI.