Points of interest• We are a participatory research team that explored meeting places in Norwegian community mental health care in relation to their larger contexts. • In this article, we report on an analysis of employees' group discussions that primarily focus on service user involvement. • In Norway, service user involvement is a legally protected right.• The dominant form of involvement looked less like a right and more a duty and responsibility for service users, and appeared to relate to management requesting suggestions and then making decisions on behalf of service users. Throughout the analysis, service users were portrayed as resisting such processes.
Since the 1960s, deinstitutionalisation has been salient in mental health reforms across the West. In Norway, this culminated in the National Action Plan for Mental Health (1999-2008), where meeting places in community mental health care were deemed a prioritised strategy to counter social isolation among people in psychosocial hardships. However, during the same period in England, meeting places were beginning to be contested for could mean everything to the people who attend them by facilitating opportunities considered less accessible elsewhere in their everyday lives in a sanist civil society.
Research on the topic of not talking about psychosocial hardships describes the presence of 'house rules' against illness-talk in common areas in 'meeting places' ('day centres') in community mental health care. The aim of this article was to explore the complexity of not talking about psychosocial hardships ('silence') in meeting places in Norwegian community mental health care. The research team consisted of first-hand and academic knowers of community mental health care (participatory research team). We performed two series of focus group discussions with service users and staff of meeting places. The focus group interviews were analysed within a discourse analytic framework, and five discursive constructions were identified: (1) biomedical colonization of illness-talk, (2) restricted access for biomedical psychiatry and problem-talk in the common spaces of meeting places, (3) censorship of service users' civil and human rights to freedom of speech, (4) protection from exploitation and burdens and (5) silent knowledge of the peer community. Based on the analysis, we suggest that not talking about illness (silence) entails a complexity ranging from under-privileging implications to promoting the interests of people who 'use' meeting places. For instance, restricting biomedical psychiatry may imply the unintended implication of further silencing service users, while silently shared understandings of hardships among peers may imply resistance against demands to speak to legitimize one's situation. The discussion illuminates dilemmas related to silence that require critical reflexive discussions and continuous negotiations among service users, staff and policymakers in community mental health care.
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