Pour nous, être citoyens à part entière, ça veut dire…

Abstract

One of the four main chapters of the consultation document proposed by the Québec Ministère de la santé et des services sociaux (Health and Social Services), in preparation for the National Forum on the Mental Health Action Plan 2014-2020, is dedicated to the full exercise of citizenship. This paper reports the dialogue that took place between the CEO of a university mental health institute and a group of service users, in order to participate in the consultation process regarding the full exercise of citizenship. Since May 2013, a dozen service users have gathered in the Projet citoyen at the Research Centre of Institut universitaire en santé mentale de Montréal (IUSMM). The Projet citoyen is a culturally adapted transposition, in Québec, of the Citizens Project that is in place in New Haven, Connecticut. One of the key components of both the Projet citoyen and the Citizens Project interventions is a group training regarding citizenship. Participants discuss what it means for them to be full citizens and they support each other in achieving personal or collective goals. To assess progress made in such matters, a new Citizenship Measurement has been developed by the Yale Program for Recovery & Community Health, and translated into French. This Mesure de la citoyenneté is in the process of being validated; peer research assistants conducted data collection by asking 178 people who use the mental health services of Quebec to complete the French Mesure de la citoyenneté. The preliminary results of a statistical analysis were used to structure the dialogue between the IUSMM CEO and the participants of the Projet citoyen. Three sub-scales emerged from preliminary statistical analysis (clusters). Colleagues of the Projet citoyen were invited, through a focus group conducted by one of them, to give evocative labels to these sub-scales. Regarding the first one, we felt that it was about asking ourselves what we can bring to others' lives, wondering how we, as members of the community, can make a difference for a more inclusive civic cohabitation. The label "contribution to the community" was chosen. For the second sub-scale, personal and social spheres emerged as both being essential to the achievement of full citizenship. These spheres must be respected in complementarity. Hence we chose the label: "personal and social integrity." Finally, the third sub-scale seemed to combine items that have the common elements of respecting human rights, respecting the person, and respecting the autonomy of the person. "Rights and freedom of choice" was chosen as a label for that sub-set. The IUSMM CEO immersed herself in the Projet citoyen and as her dialogue with the participants deepened around these features, a sense of mutual respect and friendliness got stronger. Participants were pleasantly surprised to see that an influential CEO can be sensitive and comfortable expressing this sensitivity, even with her emotions while interacting with service users as they are exercising their own citizenship as research colleagues. This case study illustrates a way of triangulating qualitative and quantitative data sets generated from a participatory-action research project for which people who use mental health services have been active research partners throughout. A mobilizing effect was found among participants of the Projet citoyen who become multipliers once back in their respective communities and neighborhoods. This effect can also affect a senior manager. The ISUMM CEO was inspired to relay and communicate this innovative thinking on the full exercise of citizenship as a governmental priority in mental health. It could thus be recommended to implement and network some Projets citoyens in other educational, research and clinical settings. This would provide opportunities for service users to contribute to the community - here, the scientific community. It would exemplify respect for personal and social integrity by channeling the expression of the lived experience into an instrument of change. These Projets citoyens would advocate for the rights and freedom of choice of service users as partners, in action, of a citizenship-oriented mental health system.