In our society, work is generally considered central to citizenship and individual well‐being. However, paid employment is often out of reach for individuals with mental illness. The Clubhouse model is a community‐based rehabilitation programme that therefore offers people with mental illness the possibility to enjoy some social advantages of work. However, the status of the day‐to‐day Clubhouse activities as “work” is a matter of discursive contestation. Drawing on 29 meetings of a Clubhouse rehabilitation group as data, and using conversation analysis and discourse analysis as methods, this study examines two competing interpretive repertoires that are systematically manifested in this context: the capitalist “paid work” repertoire used by Clubhouse clients and the more flexible “productive activity” repertoire used by support workers. The adoption of these two repertoires reflects two competing discursive agendas, which define the scope of mental health rehabilitation and the role of the client in their own rehabilitation process in distinct ways. From this perspective, the support workers' central institutional task is essentially of a discursive and ideological nature—exposing the clients to new ways of talking about their lives with reference to work.
Purpose
The integration of mental health rehabilitees into the labour market is an important policy objective everywhere in the world. The international Clubhouse organization is a third-sector actor that offers community-based psychosocial rehabilitation and supports and promotes rehabilitees’ state of acting and exerting power over their lives, including their (re)employment. In this article, we adopt the perspective of discursive psychology and ask how mental health rehabilitees’ agency is constructed and ideally also promoted in the Clubhouse-based Transitional Employment (TE) programme.
Methods
The data consisted of 26 video-recorded TE meetings in which staff and rehabilitees of one Finnish Clubhouse discussed ways to further their contacts with potential employers. The analysis was informed by discursive psychology, which has been heavily influenced by conversation analysis.
Results
The analysis demonstrated how rehabilitees adopt agentic positions in respect to TE-related future activities, and how Clubhouse staff promote and encourage but also discourage and invalidate these agentic positionings. The analysis demonstrated the multifaceted nature of agency and agency promotion in the TE programme.
Conclusions
Although ideally, Clubhouse activities are based on equal opportunities, in everyday interaction practices, the staff exercise significant power over the question whose agency is promoted and validated in the TE programme.
Narratives about clients’ service experiences in healthcare organizations constitute a crucial way for clients to make sense of their illness, its treatment, and their role in the service process. This is important because the client’s role has recently changed from that of a passive object of care into an active responsible agent. Utilizing Bamberg’s narrative positioning analysis as a method, and 14 thematic interviews of healthcare clients with multiple health-related problems as data, we investigated the expectations of the client’s role in their narratives about negative service experiences. All the narratives addressed the question of the clients’ “activeness” in some way. We identified three narrative types. In the first, the clients actively sought help, but did not receive it; in the second, the clients positioned themselves as helpless and inactive, left without the care they needed; and in the third, the clients argued against having to fight for their care. In all these narrative types, the clients either demonstrated their own activeness or justified their lack of it, which—despite attempts to resist the ideal of an “active client”—ultimately just reinforced it. Attempts to improve service experiences of clients with considerable service needs require a heightened awareness of clients’ moral struggles.
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