Empowerment and pathologization: A case study in Norwegian mental health and substance abuse services.

Tone Larsen,Hildegunn Sagvaag

doi:10.1111/hex.12828

Abstract

ContextService user involvement in service development and research is an international goal. However, research illuminating the patient stakeholder role is limited.ObjectiveThe aim was to explore what may hinder patients’ voices being heard when collaborating with staff and leaders to improve services.DesignThis action research project targeted Norwegian public mental health and substance abuse services, utilizing co‐operative inquiry principles. Data were collected and member‐checked collaboratively by the researcher and coresearchers.ResultsResults centre on patient involvement in services, service development and research. The patient voice was regarded as important but not necessarily decisive, as patients’ change needs could be perceived as pathology‐based. Patients provided feedback about fellow patients and medication—opioid maintenance treatment, in particular. Barriers to patient involvement included patients not being permitted to influence other patients’ individual treatment and a leader's difficulty accepting patients’ medication advice. Additionally, an apparent hierarchy among the professionals may have disempowered some staff members.DiscussionResults point to an organizational diagnostic culture, where stigmatizing and risk pathologization may limit patient input. Empowerment appeared to be perceived as something allowed by the staff and leaders, at their discretion. Although all parties may have agreed that patient involvement was valuable, acting as a united group about opioid maintenance treatment appeared difficult.ConclusionBarriers to patient involvement may hinder the availability and efficacy of patients’ perspectives in service development. Awareness about reciprocal empowerment might contribute to service users’ voices being heard, enabling a united voice from service users and providers regarding service development.

Highlights

The World Health Organization (WHO) lists service user involvement and making services more responsive to service users’ needs as key objectives in their Comprehensive Mental HealthAction Plan 2013-2020
Prior research has shown that patient involvement is necessary in service development, there is limited research about the patient stakeholder role.[2,3,4,5,6,7,8,9]
|2 health and social services” has been a policy aim since 198810 (p. 28); it was a prerequisite for upgrading public services in national action plans for mental health and substance abuse services.[11,12]

Summary

Introduction

The World Health Organization (WHO) lists service user involvement and making services more responsive to service users’ needs as key objectives in their Comprehensive Mental HealthAction Plan 2013-2020. There is a need for more research on service development that includes inputs from these stakeholders.[1] prior research has shown that patient involvement is necessary in service development, there is limited research about the patient stakeholder role.[2,3,4,5,6,7,8,9] In Norway, “user participation in 28); it was a prerequisite for upgrading public services in national action plans for mental health and substance abuse services.[11,12] user participation in these services has been evaluated as insufficient.[7,13] While service user participation in decision making has been explored,[14,15,16] obstacles to patient voices in mental health and substance abuse service development remain under-researched |2 health and social services” has been a policy aim since 198810 (p. 28); it was a prerequisite for upgrading public services in national action plans for mental health and substance abuse services.[11,12] user participation in these services has been evaluated as insufficient.[7,13] While service user participation in decision making has been explored,[14,15,16] obstacles to patient voices in mental health and substance abuse service development remain under-researched

Objectives

Discussion

Conclusion