Mellan norm och praktik. Strategisk samverkan och brukarmedverkan inom verksamhetsområdet psykisk ohälsa.

Abstract

There is a steady critique towards the mental health field stating that people with mental health problems do not get the assistance they need. Often, this critique states that collaboration between different organisations is lacking or non-functional. As an increasingly common part in collaboration, service user participation has also been included in this critique as not being adequately performed. Within the mental health field, many studies has focus on collaboration and service user participation on operational level, with and between professionals in direct interaction with service users. Not as many has studied the strategic level of collaboration, between leaders and managers, planning and structuring the organisation of mental health services. This level has also within the operational level studies often been pointed out as paramount to collaboration on operational level. The present thesis aims to describe and analyse collaboration and service user participation on strategic level. The following research questions are included: how are the strategic collaboration councils composed, and how do the participants handle the work within them? What experiences and opinions on collaboration do the participants have? How do the participants handle possibly contradicting expectations and interests from the surroundings and from their own organisations? How are service users and service user participation socially constructed, and what do such constructions entail? How do the participants handle collaboration as a practically unavoidable way of working? Eight strategic collaboration councils from the north, middle, and south of Sweden were included in the study. The participants in these represented mostly social and mental health services, and in some cases Arbetsförmedlingen (the Swedish Public Employment Service), Försäkringskassan (Sweden’s social insurance agency), and service user organisations. 80 participants in all were included in the study, mostly managers. The councils were observed during one year, and the participants were asked to participate in an interview and a questionnaire. The material was analysed with the assistance of NVivo 9 and SPSS, and by the theoretical aid of new institutionalism, discourse analytic perspective, and negotiation. The results showed a collaboration between the participants that revolved around norm and practice of collaboration. While all participants had very homogenous opinions and experiences of collaboration, showing of a strong norm supported by laws and regulations, there were also a discussion that showed of the possibility to negotiate that norm. Through negotiation and normative arguments, the participants could adhere to the norm that brings legitimacy to the organisation and the collaboration council, while further own interests and interpretations. Negotiation about collaboration meant that the participants could discuss collaboration in itself. Through choosing normative arguments, they could put forward certain aspects of the collaboration norm which gave latitude within the norm. Here, the norm came forward as collaboration should be done by being or becoming to be united, while having good relationships and an open discussion. The dilemma that showed through the negotiation and normative arguments was that while collaboration must be built on good relationships that can withstand disagreements and criticism, one cannot jeopardize the relationships by bringing up contentious topics. But, if pressing matters because of this are not allowed to be discussed, collaboration is at risk to be perceived as pointless. Collaboration through negotiation showed negotiation as a mean to get things done and to handle interests and interpretations in the collaboration councils. These negotiations were both implicit and explicit and were based in the collaboration norm. Normative arguments also served a purpose in building and strengthening the relationships between the participants, putting relationships as a central part of collaboration. Through normative arguments based in the collaboration norm, participants could preserve consensus and discuss disagreements, interpretations, and interests without risking the relationships. Service user representatives tended to be a part in negotiation about collaboration, but not in collaboration through negotiation. Even so, the service user representatives made a mark within the collaboration councils in discussions and agendas, showing a plausible increasingly stronger position within in strategic collaboration.