Mari Holen

‘After all, you should rather want to be at home’. Responsibility as a means to patient involvement in the Danish health system

This article discusses how the neo-liberal regulations in a Danish hospital – which are said to increase patient involvement – risk reducing patient involvement in practice. To do this we analyse how three different patients are positioned as responsible or irresponsible in different ways in the concrete practices of a hospital ward. This analysis focuses on how the relationship between home and hospital is practised. Drawing from Faircloughs concept of ‘orders of discourse’, we reveal how different ways of practising the relationship between home and institution are affected by dominant discourses of medicine, care and neo-liberalism. The different discourses enable differentiated ways to become responsible, but the various discourses also influence and challenge each other in the concrete practices. We suggest that the hegemonic relationship between the discourses is changing and it appears that the discourse of neo-liberalism in a mixed version with a biomedical discourse has become dominant. Thus, the article points to the paradox that neo-liberal discourses have the effect of narrowing the space for patient involvement in practice.

Hell no, they'll think you're mad as a hatter: Illness discourses and their implications for patients in mental health practice

This article examines how discourses on mental illness are negotiated in mental health practice and their implications for the subjective experiences of psychiatric patients. Based on a Foucauldian analysis of ethnographic data from two mental health institutions in Denmark—an outpatient clinic and an inpatient ward—this article identifies three discourses in the institutions: the instability discourse, the discourse of “really ill,” and the lack of insight discourse. This article indicates that patients were required to develop a finely tuned and precise sense of the discourses and ways to appear in front of professionals if they wished to have a say in their treatment. We suggest that the extent to which an individual patient was positioned as ill seemed to rely more on his or her ability to navigate the discourses and the psychiatric setting than on any objective diagnostic criteria. Thus, we argue that illness discourses in mental health practice are not just materialized as static biomedical understandings, but are complex and diverse—and have implications for patients’ possibilities to understand themselves and become understandable to professionals.

How patient participation is constructed in mental health care: a grounded theory study

AIM The aim of the study was to explore how patient participation is constructed in social interaction processes between nurses, other health professionals and service users, and which structures provide a framework for the participation of service users in a psychiatric context? METHODOLOGICAL DESIGN Ten tape-recorded interviews of nurses and observations of interactions between nurses, other health professionals and service users reflected differing constructed views of patient participation. Charmazs interpretation of the grounded theory method was used, and the data were analysed using constant comparative analysis. ETHICAL ISSUES AND APPROVAL The study was designed in accordance with the ethical principles of the Helsinki Declaration (1) and Danish law (2). Each study participant in the two psychiatric departments gave informed consent after verbal and written information. FINDINGS The articulation of patient participation emphasises the challenge between, on the one side, orientations of ethical care, and, on the other, paternalism and biomedicine. The core category was generated from four inter-related categories: (i) taking care of the individual needs; (ii) the service user as expert; and (iii) biomedicine, and (iv) paternalism, and their 13 subcategories. CONCLUSIONS This study illuminates the meaning of patient participation in a psychiatric context based on social interaction between nurses, other health professionals and service users. This can contribute to dealing with the challenges of incorporating patient participation as an ideology in all service users in a psychiatric context and is therefore important knowledge for health professionals.