"Het zit gewoon niet goed in mijn systeem'

Abstract

In recent years, the use of the experiential expertise of (former) clients in mental health care has become increasingly important, both in the Netherlands and internationally. People who are or have been clients in mental health care themselves use their experiential knowledge to be actively involved in the delivery of care and support. However, this development is not without controversy. In this dissertation, an ethnographic research approach is used to reveal – in detail – how experiential expertise is handled in professional mental health practices, and under what conditions it is embedded in organized public services. The theoretical framework is based on administrative and organizational literature. Three areas of tension for professionals are distinguished, connected with the ‘knowledge society’, a tension between: ‘hard’ and ‘soft’ knowledge; collaboration and segmentation; trust and accountability. Processual and relational concepts of professional knowledge, experiential knowledge and professionalism are used as a theoretical lens. Three treatment (FACT) teams in mental health care were observed, each during a period of three weeks. In each team, experiential experts and four mental health professionals were shadowed and interviewed. Data collection, data analysis and the writing of findings and conclusions took place in a continuous and iterative process, guided by the theoretical framework. We analyzed how professionals cooperate with experiential experts, and if and how they use the experiential knowledge of this relatively new professional group in the care and service to clients. The observations and interviews show that professionals often strive for space for clients' own direction and perspective, as well as space for their professional action. They indicate that experiential expertise can contribute to this. However, large mental health care institutions in which these professionals work contain barriers for organizing spaces. Existing regulations are one of these barriers, e.g., linked to budget allocation and accountability. In the teams studied, this leads to substantial performance and accountability pressures, as well as tendencies to control and risk aversion. In addition, implicit ideas about knowledge and professional actions play a role. Healthcare professionals are required to work according to scientifically based guidelines. This leads to doubts about the value of experiential knowledge, which is based on individual experiences. Professionals and experiential experts struggle with their role: are they professionals, or primarily ‘fellow sufferers’? The use of clients' experiential knowledge in mental health institutions requires adjustments in organization and regulation, as well as professional attitudes and actions. Strengthening experiential expertise in professional services requires multiple changes. We sketch three routes: further professionalization of experts by experience; opting for voluntary commitment; or looking for the best form for each context and situation. Each route contains specific recommendations; think of more flexibility in regulations, so that performance and accountability pressures are reduced, and control and risk aversion become less dominant; time for teams and professionals to discuss mutual expectations and beliefs; training and education of professionals who can work together and bridge the boundaries between different types of knowledge and perspectives. Strengthening experiential expertise implies jointly organizing experiential expertise.