Participation in a ‘low threshold’ community mental health service: an ethnographic study of social interaction, activities and meaning

An overall aim of this thesis was to contribute with knowledge about social interaction, activity and user participation in low threshold community mental health services, what participation in such settings meant for service users in daily life and how professionals in the same service experienced their mental health work and professional roles. Other aims were that findings from the empirical study should contribute to the further developments of community mental health work and a broader understanding of ‘participation’ as a theoretical concept and perspective applied to mental health work and rehabilitation. The empirical study had an ethnographic design; conducted as fieldwork within a low threshold community mental health service for eighteen months. Research methods were participant observation, individual interviews with service users and focus group interviews with professionals. An increase in psychiatric hospitals in the first half of last century, followed by a reduction of such institutions during the second half has been an international trend. Such developments have practical consequences in daily life for many who live with mental health problems. Services with an open, flexible organisation, offering a mix of professional- and peer-support have, thus, been encouraged as part of a ‘recovery oriented’ approach in some countries. In Norway, such services have recently also been recommended as a strategy of health promotion in the mental health area. Findings from this study suggests that a mix of professional and peer-support provides opportunities for receiving social support, as well as for active participation and mutual relationships among service users in daily life. For informants in the study, participation and mutual support enhanced self-confidence and experiences of recognition. Attending the service based on their own felt needs helped many to also participate in the wider community. Professionals described knowledge and experience as important for a flexible, low threshold approach in mental health work. This service organisation permitted more egalitarian relationships with users, than work in institutions. The study contributes with knowledge about participation in the mental health area, and how both social support and challenges may enhance participation by providing opportunities for mutual recognition for people with mental health problems. Social exclusion and experiences of mental distress are barriers to such experiences and community mental health services should support peoples’ possibilities for sustaining a life situation in the community