Helen P. Hamer

Service user involvement in undergraduate mental health nursing in New Zealand

This paper describes a service user role in the mental health component of an undergraduate nursing programme in New Zealand. The paper provides a background to mental health nursing education in New Zealand and discusses the implications of recent reforms in the mental health sector. The undergraduate nursing programme at the University of Auckland has a strong commitment to service user involvement. The programme aims to educate nurses to be responsive and skillful in meeting the mental health needs of service users in all areas of the health sector and to present mental health nursing as an attractive option for nurses upon graduation. We outline the mental health component of the programme, with an emphasis on the development of the service user role. In the second half of the paper, we present a summary of responses to a student satisfaction questionnaire. The responses indicate that the service user role is an important element of the programme and is well received by a substantial proportion of students. We consider the implications for nursing education and for recruitment into mental health nursing. Finally, we discuss some issues related to service user involvement in the development of new models of mental health service delivery.

“The Re‐covery Model” – An integrative developmental stress–vulnerability–strengths approach to mental health

This paper describes the “Re‐covery Model”, an innovative approach to facilitating recovery in people with enduring symptoms of psychosis and other extreme states. This model has been developed by experience‐based experts (EBEs), and mental health professionals, some of whom are also EBEs. It provides a shared understanding of the “human condition” in the bio‐socio‐psycho‐cultural and spiritual developmental context in which resilience and vulnerabilities shape the person. It is easily understood and helps service clients, clinicians, and significant others to come to a shared identification of the patterns that create vicious cycles of stigma and deteriorating function. It offers a hope‐inducing pathway towards victorious cycles of building resilience and manifesting a life worth living, and integrates intervention strategies from a variety of evidence based therapies to facilitate recovery. The approach and its implementation are discussed in detail.

Finding citizenship: What works?

ABSTRACT Citizenship is a foundation for mental health recovery and community integration. Achievement of full citizenship in the community is curated by a person’s social environment, including social connections and the support and capital offered by those connections. This article presents qualitative findings of community integration experiences of individuals with serious mental illness (SMI) and details social environment elements they identified as critical to integration. Three primary themes were identified as contributing to achievement of citizenship among participants: (1) macrosocial interactions, described by a civic consciousness and receipt of positive social recognition; (2) microsocial interactions, including intimate relationships with family and friends; and (3) interactions at an intermediate level, fleeting relationships with passersby in public spaces. All three were underlain by the importance of social recognition of acts of giving. Individuals with SMI who were identified as successful in their path to citizenship indicated that their social environment played a major contributing factor in their success. The findings of this study suggest community-based interventions with this population should consider (1) supporting engagement at a macrolevel, including advocacy on nonmental health issues; (2) supporting the support and capital provided by families, friends, and providers and the ability of a person with SMI to support others; and (3) valuing and protecting shared public spaces and promoting small acts of civility as valuable counters to stigma-related microaggressions.

Citizens un-interrupted: Practices of inclusion by mental health service users

ABSTRACT Inclusion, participation, and the recognition as being an equal is important for the well-being and resilience of all citizens. The notion of homo occupacio describes the persona of the citizen as the self-directed, self-initiated occupational human who takes possession of his or her world through a repertoire of occupations located within the rules and norms of society. For those in society who have been labelled with a psychiatric diagnosis, the ability to participate and exercise the rights and responsibilities as citizens can be conditional, often interrupted and, at times, denied. Once labelled, service users report that they are regarded as the marginalised and excluded immanent Other; their status is then relegated to subject rather than citizen and political actor. Thus positioned on the margins of the democratic processes of the state, service users enter the state of exception as homo sacer, regarded as the outcast, the banned and dangerous Other, whereby the personal power of the citizen no longer seems to hold. This paper presents service users’ stories of distressing exclusion that interrupted their rights to occupational justice, and marginalised them from occupation. The paper also presents the practices of inclusion that service users engaged in that restored their rights and responsibilities as occupied and active citizens. The successful stories of inclusion are framed within one of Isin’s four domains of his citizenship theory: the extent of citizenship, and the rules and norms of inclusion and exclusion.

‘The right thing to do’: Fostering social inclusion for mental health service users through acts of citizenship

The theoretical framework of citizenship is increasingly being used in mental health settings to inform practice. This exploratory qualitative study describes in more detail the acts of citizenship embedded in the everyday practices of mental health workers that promote the social inclusion of people in their care. Acts make a claim for justice when ones rights and responsibilities of citizenship are denied. Semistructured interviews were conducted with 12 participants, seven mental health clinicians and five peer support workers, recruited from a mental health facility in Connecticut, USA. Two themes are presented, breaking the rules and the right thing to do, a rights-based practice that fosters inclusion for service users. Results suggest that staff undertake hidden acts of citizenship to promote inclusion and rights of service users by responsibly subverting the rules and norms of the organization. Changes to organizational practices to make visible such inclusionary acts are required. Implications for practice and considerations of organizational change through the development of a citizenship framework to underpin practice are recommended.