Feathers and Thorns: the politics of participation in mental health services

A key development in mental health service planning and delivery in the UK over the last fifteen years has been the introduction of user participation. Alongside this development has been the growth and expansion of the service user/survivor movement. Research in Canada and Australia has documented the 'unsettling relations' created by these demands for participation and power sharing. Research in the UK has also raised questions about the ability of user participation to create the cultural change some believe is required to prevent services from being disempowering. Feathers and Thorns explores the 'unsettling relations' and the conflict and power dynamics of user participation in mental health services, in a UK context, to address the lack of systematic research in this area. The study uses qualitative methods to investigate user participation in two statutory mental health settings in England, between 1997 and 1999. Feathers and Thorns found that the uncritical adoption of the consumerist approach has led to a 'business as usual' model of participation and a consequent lack of discernible organisational and cultural change. The influence of user groups within statutory mental health services rarely extends to setting agendas, with the 'rules of the game' of participation still firmly controlled by statutory partners. There was evidence of professional and organisational resistance, as user participation destabilised the roles of both users and professionals and boundaries became increasingly blurred. It is suggested

that this destabilising of traditional roles provides evidence of a shift in power relations, despite continued organisational and professional resilience to change. Although user participation was considered to be an effective strategy to legitimate existing power relationships and give the illusion of change: there was evidence that user groups and individuals have also gained from these processes, particularly in terms of raised consciousness, increased activism and self-assurance.