title: User participation in district psychiatry. The social construction of 'users' in handovers and meetings.
abstract: An ideal in mental health care is user participation. This implies inclusion and facilitation by clinicians to enable users to participate in decisions about themselves and in the design of suitable treatment. However, much of the work of clinicians consists of handovers and other meetings where patients are not present. It is therefore interesting to study how the patient perspective is handled in such meetings and whether it forms a basis for user participation. We conducted fieldwork in three different inpatient wards in Norwegian District Psychiatric Centres. We used an interactional perspective in our analysis, where speech acts, framing and footing were key concepts. The findings show that the talk in the handovers and meetings contained five main themes and that there was a clear correlation between what was said and how it was said, and whether clinicians related to the content in a decisive, person-centred or indecisive manner. We discuss potential participation statuses for patients and their limited opportunity to influence the talk and possible decisions about themselves. Our conclusion is that handover meetings primarily function as an aid in organising clinicians' work and could ultimately be seen as counteracting user participation.
authors.affiliation: Faculty of Health Sciences, Department of Health and Care Sciences, The Arctic University of Norway, Tromsø, Norway.
authors.forename: Vår
authors.initials: V
authors.lastname: Mathisen
authors.affiliation: Faculty of Health Sciences, Department of Health and Care Sciences, The Arctic University of Norway, Tromsø, Norway.
authors.forename: Aud
authors.initials: A
authors.lastname: Obstfelder
authors.affiliation: Faculty of Health Sciences, Department of Health and Care Sciences, The Arctic University of Norway, Tromsø, Norway.
authors.forename: Geir F
authors.initials: GF
authors.lastname: Lorem
authors.affiliation: Faculty of Social Sciences, University of Nordland, Bodø, Norway.
authors.forename: Per
authors.initials: P
authors.lastname: Måseide
mesh_terms: D003142:Communication; D006282:Health Personnel; D006801:Humans; D008605:Mental Health Services / Q000706:statistics & numerical data; D009664:Norway; D062209:Patient Handoff; D010358:Patient Participation / Q000523:psychology*; D011570:Psychiatry / Q000458:organization & administration*; D036301:Qualitative Research
keywords: district psychiatry; handovers and meetings; mental health care; participation status; speech acts; user participation