Meeting places in Norwegian community mental health care: A participatory and community psychological inquiry

Abstract

This Ph.D.-dissertation revolves around meeting places in community mental health care. Norwegian meeting places often entail local easy-access daytime services that offer people who have experienced psychosocial hardships conversations with peers and staff, activities, and affordable meals. Over 50 years after the commencement of deinstitutionalisation, people who have faced psychosocial hardships are still considered amongst the most excluded groups across western societies. In Norway, meeting places became amongst the prioritised services to counter social exclusion and isolation from the early 2000s following the National Action Plan for Mental Health. However, in England, also during the early 2000s, meeting places were conversely beginning to be contested for being implicated in excluding service users from civil society. The contestation aligns with a broader questioning of the field of community mental health care that seems to have become more pronounced over the 2000s. The two aims for the dissertation and the overall participatory inquiry was: (1) to illuminate and explore meeting places from a community psychological perspective and (2) to produce practically relevant knowledge and to stimulate processes that may benefit people who use or may use meeting places. The theoretical lenses guiding the inquiry were a critical community psychology tradition, an emancipatory participatory research tradition, and Foucauldian discourse analysis in psychology. The dissertation explicitly intended to engage in moral and socio-political analysis and discussions, in relation to not only meaning, but also the material world, in line with Parker’s (2014/1992, p.1) discourse dynamics, critical community psychology, emancipatory participatory research, and as underlined by the practice-oriented aims. Resonating with the general focus of our team on the interests of people in psychosocial hardships, two discourse-analytical questions have guided the inquiry: (i) how do central contemporary discourses intertwined with Norwegian meeting places appear? and (ii) the positioning of service users: which consequences do the discourses appear to bring for service users in meeting places, including possibilities and restrictions? The following three more specific research questions have guided the empirical focus related to the three articles (every question was intended to subsume all elements of both questions above): (1) how do meeting-place employees discuss their encounters with service users and their experiences? (2) how do service users discuss their encounters with the spaces and people of meeting places? and (3) how do service users and staff of meeting places explicitly and implicitly address not talking (silence) about psychosocial hardships in meeting places? What seems to be pronounced implications of central discourses of silence for service users? To illuminate and explore these questions, co-researchers with first-hand knowledge of psychosocial hardships and I engaged in focus group interviews with 37 participants in total: three focus groups with 15 staff members and four focus groups with 22 service users from various meeting places in a region of western Norway. Guided by Parker's (2014/1992) version of Foucauldian discourse analysis, and the other theoretical lenses, I and the team developed a participatory discourse analysis. We traced and analysed the empirical data ‘outwards’ in relation to relevant socio-historical, cultural, political, economic, scholarly and material contexts. Article 1: We analysed staff accounts of service user involvement (brukermedvirkning). In the first of two distinct discursive constructions that we identified, service user involvement was predominantly discussed in terms of consultations for management, which were localised in a neoliberal discourse. Through a neoliberal responsibilisation strategy, involvement appeared to be a duty to be performed for management rather than a statutory right intended to act in the interests of service users. The second and marginally present discursive construction was social-democratic collaboration between service users and staff, which we localised in a Nordic social-democratic discourse. Whilst a neoliberal discourse entails basic beliefs about management and those managed sharing interests unilaterally established by upper management, a social-democratic discourse acknowledges social inequality, diverging interests, and goals aimed at reducing inequality through collaboration. This analysis implies that meeting places may offer spaces in which service users can resist responsibilisation, defend employed staff, and strengthen everyday democracy. Article 2: We analysed service users’ accounts of meeting places and civil society. Mostly through discussions relating to civil society, we reconstructed a discourse of sanism that blamed and excluded service users for not trying harder to overcome their misfortunes and systematically privileged ‘rational ‘people and their understandings. Against a sanist civil society, we detailed four discursive constructions of meeting places, which were localised in four discourses: (1) a public welfare arrangement compensating for aspects of civil society’s shortcomings, which was localised in a Nordic social-democratic welfare discourse where service users were identified as equal citizens with social rights; (2) a peer community that seemed to imply a space of accepting peers with shared identities, interests and knowledge, which drew on a discourse of solidarity among peers; (3) spaces of compassion, which were localised in a discourse of compassion where service users were identified as fellow human beings; and (4) metaphorical greenhouses that appeared to facilitate growth conditions for service users to expand their horizons of possibility, which were localised in a humanist developmental discourse. The analysis suggests that meeting places offer opportunities that may expand service users’ horizons of possibility and that appear less accessible in everyday life in a sanist civil society. Article 3: On the basis of both sets of focus group interviews with service users and staff, we detailed five discursive constructions of not talking about illness (silence) in meeting places, drawing on five discourses. Unsurprisingly, (1) a biomedical discourse was identified as colonising illness-talk. (2) The access of biomedical psychiatry to meeting places; however, appeared to be restricted, drawing on a humanist developmental discourse. From just a few conversations, (3) censorship of service users’ freedom of speech was identified and analysed to draw on a discourse of liberalism. By contrast, (4) discussions, particularly amongst people attending meeting places, frequently addressed silence as protection from the further burdening and exploitation of nonconsenting people who are in the midst of struggles, localised in a social-democratic welfare discourse. We also detailed (5) a construction of silent knowledge of the peer community, which was localised in a discourse of solidarity among peers. Here, service users appeared to be identified as sharing understandings of hardships, often without speaking. We found that silence could imply a resistance to civil society demands for service users to legitimise their distress and needs for welfare arrangements such as meeting places. As such, the analysis suggests that silence, in its complexity appears to range from having under-privileging implications to operating in the interests of people who attend meeting places. A central concern of this dissertation is to trace which consequences that the identified discourses interrelated to meeting places appear to bring for service users, including possibilities and restrictions. Through the analyses of these discourses, meeting places stand out as profoundly valuable for people who attend this service. Without the meeting place, few to no public community spaces were available during the daytime that provided somewhere that a person could go to structure her day and just be in times of distress together with other people outside the private sphere, where distress could be temporarily assuaged. Moreover, few to no places were available to obtain staff support and facilitation when needed throughout the day, and to occupy themselves with activities according to their changing expendable resources after working hard to keep themselves afloat, to mention some of the possibilities of meeting places suggested by our analyses and the reviewed literature. No shortage of systematic sanist rejections and demands emerged in everyday life of civil society. Unless civil society is able to make meeting places and the possibilities they appear to bring, redundant, an implication of this dissertation and most of the reviewed literature is that the continued prioritisation of meeting places as safety nets in local communities appears to be in the interest of people who attend meeting places.