Discourses of consumption or consumed by discourse? A consideration of what “consumer” means to the service user

Abstract

Background: Consumers and consumerism in a healthcare context are often read as evidence of creeping privatization and marketization. This paper considers discourses of consumption, in a mental health context, from data collected in the Republic of Ireland. Drawing on typifications of western welfare regimes, it will consider processes of commodification and consumption.Aims: The purpose of this paper is to explore the political connotations of the consumer discourse and to focus attention on the implications of utilizing discourse(s) of consumption for service users.Method: Data were generated through interviews with ten mental health service users who were members of mental health social movement organizations. This was analysed using a discourse-analytic technique. The analysis considers consumer discourse(s) and delimits the utility of this way of talking about being a service user.Results: The impacts and inferences of using a consumer discourse are identified. Under some conditions it can be a positive event for the healthcare consumer, but the discourse tends to favour the healthcare professional and/or the state, in that it implicitly reasserts the primacy of the medical model.Conclusion: The consumer discourse is a complex construct that speaks to and for both the state and the service user. However, use of this discourse carries political and therapeutic connotations for the service user. The political connotations relate to the consumer discourse as a feature of a state sanctioned re-positioning of healthcare provision within a more explicitly market based context. The therapeutic connotations relate to a lack of genuine alternative explanatory systems to that of the medical model and an often implicit championing of medical discourses as evidenced in the consumer discourse.Declaration of interest: This research was in part funded by a scholarship from the Irish Research Council for Humanities and Social Sciences (IRCHSS).