Insiders or outsiders? Mental health service users' journeys towards full citizenship

Meeting in the middle: experiences of citizenship in community-engaged psychosis research

Purpose

Previous research has highlighted the importance of engaging people with lived experience (PWLE) in the knowledge creation process. However, diverse approaches to engagement exist. In addition, tensions remain in community-engaged research (CER), including how to address structural inequalities in research settings. This study aims to consider how CER interacts with citizenship within and beyond the research context.

Design/methodology/approach

This study discusses the authors’ experiences as a majority-PWLE of psychosis research team in Canada, including successes and challenges the authors experienced building their team and navigating research institutions. This study also reflects on the authors’ pathways through citizenship, prior to and during the research process. This study discusses divergent models of CER and their applicability to the cyclical process of citizenship and community participation.

Findings

Relationships between academic and peer researchers developed organically over time. However, this study was limited by structural barriers such as pay inequality and access to funding. The authors recognize that there are barriers to full citizenship and acknowledge their resources and privilege of being well supported within their communities. Team members built on a foundation of citizenship to access participation in research. This led to opportunities to engage in community spaces, and for PWLE to participate in research as partners and leaders. This study also found that citizenship is a way of giving back, by building a sense of social responsibility.

Originality/value

Academic and peer researchers can reflect on the authors’ experiences to build more inclusive research teams and communities by using a citizenship approach to research participation.

Developing and establishing the psychometric properties of the Strathclyde Citizenship Measure: A new measure for health and social care practice and research

There has been increasing interest and research attention towards citizenship-based practices and care within health and social care settings. A framework for implementing citizenship-based interventions has helped support the participation in society of persons who have experienced major life disruptions. Yet, having ways to measure the impact of citizenship 'in action' within specific socio-cultural contexts has proved challenging. We report on the development of the Strathclyde Citizenship Measure (SCM) which seeks to establish a psychometrically sound measure of citizenship that is relevant to the Scottish context. We outline the three phases of developing the SCM: (1) item generation, (2) item reduction and piloting, and (3) measure validation. Having generated items for the SCM using concept mapping techniques, we piloted it with 407 participants who completed an online survey of a 60-item version of the SCM. The aims were to assess the validity of the items and reduce the number of items using principal components analysis for the final measure. This resulted in a 39 item SCM. We then sought to establish the psychometric properties of this shorter version of the SCM through testing its reliability, convergent, concurrent and discriminant validity. The 39 item SCM was administered online to 280 Scottish residents along with additional measures including the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), the Depression, Anxiety and Stress Scale (DASS21), the Sense of Belonging Instrument (SOBI-A); the Big Five Personality Inventory (Shortened Version; BFI-10) and the Personal Social Capital Scale (PSCS-16). The factor structure and dimensionality of the SCM was examined using exploratory factor analysis and it was found to be reliable and valid. This paper explores the potential for the application of the SCM across health and social care settings and identifies future work to develop citizenship tools to facilitate dialogues about citizenship across health and social care practice settings.

Citizenship matters: Translating and adapting the Citizenship Measure to Norwegian

Citizenship is considered intertwined with recovery, and may be a useful perspective for advancing quality of life among marginalised groups. Yet, matters of citizenship among persons with co-occurring substance use and mental health problems are underrepresented both in research and practice. Aims: In order to measure citizenship among persons with co-occurring problems in a Norwegian study, a measure of citizenship was translated from English to Norwegian. The aims of the study were to 1) translate and adapt the Citizenship Measure, developed by Rowe and colleagues at the Yale Program for Recovery and Community Health, to Norwegian, and 2) to assess the internal consistency and convergent validity of the Norwegian translated measure. Methods: The translation process was carried out using forward and back translation procedures. To examine measurement properties, a convenience sample of 104 residents with co-occurring problems living in supported housing completed the measure. Results: Two factors were identified, related to rights, and to relational citizenship. The Norwegian translation of the Citizenship Measure showed high internal consistency and adequate convergent validity. Conclusions: We argue that the measure can be useful in assessing perceived citizenship, and in initiating efforts to support citizenship among persons with co-occurring problems.

A Mixed Methods Study Examining Citizenship Among Youth With Mental Health Challenges

Introduction

Multiple stakeholders have recently called for greater research on the barriers to citizenship and community belonging faced by people with mental health challenges. Citizenship has been defined as a person's access to the rights, roles, responsibilities, resources and relationships that help people feel a sense of belonging. Factors that may impact citizenship include financial precarity; intersecting forms of marginalization and oppression (e.g., racism); and the mental health care people receive. Research has yet to examine experiences of citizenship among youth with mental health challenges. To address this gap, this study will examine how youth experience citizenship; predictors of citizenship; how citizenship shapes recovery; and the degree to which youth are receiving citizenship-oriented care.

Methods

The research objectives will be evaluated using a multiphase mixed methods research design. Quantitative data will be collected cross-sectionally using validated self-report questionnaires. Qualitative data will be collected using a hermeneutic phenomenological method using semi-structured interviews and focus groups.

Analyses

Multiple stepwise regression analyses will be used to determine predictors of citizenship and if of citizenship predict recovery. Pearson correlations will be computed to determine the relationship between participants' perceived desire for, and receipt of citizenship-oriented care. Phenomenological analysis will be used to analyze qualitative data. Findings will then be mixed using a weaving method in the final paper discussion section.

Conclusion

Findings from this study may support the development of citizenship-oriented healthcare in Canada.

Destabilising social inclusion and recovery, and pursuing 'lines of flight' in the mental health sector

People who have been diagnosed with serious mental illness have a long history of confinement, social stigma and marginalisation that has constrained their participation in society. Drawing upon the work of Gilles Deleuze and Felix Guattari, we have used the concepts of: assemblages, major and minor and deterritorialisation to critically analyse two pervasive and 'taken-for-granted' assemblages in mental health: recovery (including clinical recovery, social recovery and recovery-oriented practice) and social inclusion. Our analysis explores how dominant and oppressive forces have been entangled with liberating and transformative forces throughout both of these assemblages - with dominant forces engaging in ongoing processes of capture and control, and transformative forces resisting and avoiding capture. In pursuit of social transformation for people categorised with serious mental illness, deterritorialisation is posited as a potential way forward. To have transformation in the lives of mental health service users, we present the possibility that ongoing, disruptive movements of deterritorialisation can unsettle majoritarian practices of capture and control - producing liberating lines of flight.

A heuristic model for collaborative practice-part 2: development of the collaborative, dialogue-based clinical practice model for community mental health and substance abuse care

BACKGROUND

Various models for collaborative practice in mental health care incorporating the perspectives of service-user participation and collaboration in the care have been developed. However, the emphasis in these practice models has not been on identifying specific features of "how" collaboration and service-user participation can occur and be nurtured. This suggests a need for a collaborative practice model that specifies essential strategies operationalizing the tenets of service-user participation and collaboration applicable in mental health and substance abuse (MHSA) care.

METHODS

A double helix approach of coalescing theoretical ideas and empirical findings to develop a practice model that is applicable in MHSA practice. A theoretical analysis is carried out to identify the critical, foundational elements for collaborative practice in MHSA practice, and has identified the philosophical-theoretical orientations of Habermas' theory of communicative action, Bakhtin's dialogicality, and the philosophy of personhood as the foundational features of collaboration. This base is juxtaposed with the results of a qualitative meta-analysis of 18 empirical articles on collaboration in MHSA to advance a collaborative practice model specifically in the domain of service user/professional collaboration.

RESULTS

"The collaborative, dialogue-based clinical practice model" (CDCP Model) for community mental health care is proposed, within the structure of four main components. The first specifies the framework for practice that includes person-centered care, recovery-orientation, and a pluralistic orientation and the second identifies the domains of collaboration as service user/professional collaboration, inter-professional collaboration, and service sector collaboration. The third identifies self-understanding, mutual understanding, and shared decision-making as the essential principles of collaboration. The fourth specifies interactive-dialogic processes, negotiated-participatory engagement processes, and negotiated-supportive processes as the essential strategies of collaboration applicable in service user/professional collaboration which were extracted in the empirical work. An illustration of the CDCP Model in a clinical case is given.

CONCLUSIONS

The CDCP Model presented fills the gap that exists in the field of community MHSA practice regarding how to operationalize systematically the tenets of person-centeredness, recovery-oriented, and pluralism-oriented practice in terms of user/professional collaboration.

From the rhetoric to the real: A critical review of how the concepts of recovery and social inclusion may inform mental health nurse advanced level curricula - The eMenthe project

OBJECTIVES

This critical review addresses the question of how the concepts of recovery and social inclusion may inform mental health nurse education curricula at Master's level in order to bring about significant and positive change to practice.

DESIGN

This is a literature-based critical review incorporating a rapid review. It has been said that if done well, this approach can be highly relevant to health care studies and social interventions, and has substantial claims to be as rigorous and enlightening as other, more conventional approaches to literature (Rolfe, 2008).

DATA SOURCES

In this review, we have accessed contemporary literature directly related to the concepts of recovery and social inclusion in mental health.

REVIEW METHODS

We have firstly surveyed the international literature directly related to the concepts of recovery and social inclusion in mental health and used the concept of emotional intelligence to help consider educational outcomes in terms of the required knowledge, skills and attitudes needed to promote these values-based approaches in practice.

RESULTS

A number of themes have been identified that lend themselves to educational application. International frameworks exist that provide some basis for the developments of recovery and social inclusion approaches in mental health practice, however the review identifies specific areas for future development.

CONCLUSIONS

This is the first article that attempts to scope the knowledge, attitudes and skills required to deliver education for Master's level mental health nurses based upon the principles of recovery and social inclusion. Emotional intelligence theory may help to identify desired outcomes especially in terms of attitudinal development to promote the philosophy of recovery and social inclusive approaches in advanced practice. Whilst recovery is becoming enshrined in policy, there is a need in higher education to ensure that mental health nurse leaders are able to discern the difference between the rhetoric and the reality.

The rights and responsibilities of citizenship for service users: some terms and conditions apply

ACCESSIBLE SUMMARY

What is known about the subject? Citizenship is an important yet largely overlooked concept within psychiatric and mental health nursing practice Many service users are subject to legally mandated restrictions that place conditions on their rights and responsibilities as citizens. What this paper adds to existing knowledge? Even though service users have legal status as citizens, they continue to experience many conditions on their rights and responsibilities. Concerns about services users' trustworthiness and doubts about their levels of insight impact on their status as full citizens. What are the implications for practice? Nurses' understandings of the conditions placed on the citizenship rights and responsibilities of service users will ensure inclusive and less restrictive care and treatment Integration of the principles of therapeutic reciprocity and procedural justice within practice will help nurses balance both the rights of services users and legal restrictions on their liberty and autonomy

INTRODUCTION

Service users have long been lobbying for equal participation as citizens, yet citizenship is an important and largely overlooked concept within nursing education and practice.

AIMS

The study explored service users' understandings of their rights and responsibilities of citizenship and the conditions placed on these.

METHODS

A total of 17 service users participated in semi-structured interviews. Isin's theory of the content of citizenship was used to analyze the data using a framework approach.

RESULTS

Service users experience conditional citizenship that includes barriers to their participation and their rights and responsibilities that others in society enjoy.

DISCUSSION

When the world of the service user is constructed through the language of the biomedical model, nurses may unwittingly reinforce psychiatric labels and thus perpetuate the stereotype that service users lack the competence to fully enact their rights and responsibilities.

IMPLICATIONS FOR PRACTICE

When providing care, nurses should incorporate the notion of therapeutic jurisprudence and the principles of reciprocity, procedural justice and the implementation of advanced directives to reduce conditions on service users' status as citizens.