User Involvement in Mental Health Services: A Case of Power Over Discourse
User Involvement in Mental Health Services: A Case of Power Over Discourse
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DOI：
10.5153/sro.3265
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发表时间：
2014-03-05
影响因子：
1.6
通讯作者：
Lewis, Lydia
中科院分区：
文献类型：
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作者：
Lewis, Lydia
在许多州，公众参与规划和实施医疗保健已成为政府的一项任务。在英国的心理健康服务中，这一用户参与政策可以追溯到近30年前，现在已经被载入政策。然而，在为服务用户实现有意义的参与和影响方面，执行方面的差距仍然存在。本文旨在阐明出现这种差距的一些政治话语过程，并得出对政策倡议和服务用户参与的有效方法的影响。它展示了一项基于英国的关于用户参与心理健康服务的定性、本地化研究的结果，该研究从批判性话语分析的角度进行，根据一个新出现的特征-话语权力。讨论了与这一话语式规则有关的三个主题：游戏规则、交战规则和议程设置。这篇文章表明，尽管政策倡议为围绕精神卫生服务发展的地方舞台上的话语辩论提供了机会，但这些辩论的主要特征是遏制和控制以及沉默。因此，用户参与的论述过程使其潜在的变革性影响化为乌有，并进一步边缘化了妇女服务用户和其他群体。对用户参与服务调试的发展提出了建议。
Public participation in planning and implementing health care has become a government mandate in many states. In UK mental health services, this 'user involvement policy dates back nearly three decades and has now become enshrined in policy. However, an implementation gap in terms of achieving meaningful involvement and influence for service users persists. This paper aims to illuminate some of the political discursive processes through which this gap emerges and to educe implications for the policy initiative and for effective approaches to service user involvement. It presents findings from a qualitative, localised UK-based study of user involvement in mental health services, conducted from a critical discourse analytic perspective, according to one emergent feature - power over discourse. Three themes relating to this discursive regulation are discussed: the rules of the game, the rules of engagement and agenda-setting. The article shows how although the policy initiative was providing opportunities for discursive contestation in local arenas surrounding mental health service development, these were pre-dominantly characterized by containment and control and by silences. Consequently, the discursive processes of user involvement worked to nullify its potentially transformative influence and to further marginalize women service users and other groups. Implications for the development of user involvement in service commissioning are provided.