User Involvement in Mental Health Services: A Case of Power over Discourse

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.