Creating a new NHS England: Health Education England, NHS Digital and NHS England have merged. Learn more.

Promoting Excellence In Psychological Health & Wellbeing

Resistances to Service User Involvement

17 Jul 19

Read more about this project by Tim Moore

I am a Counselling Psychologist and have worked in recovery teams and specialist services for Sussex Partnership foundation Trust.  Prior and during my professional training I worked in a residential therapeutic community.  In this work I witnessed the transformative power of what is now called service user involvement or co-production.  I believe that meaningful user involvement, as well as providing a rich therapeutic opportunity for service users, should challenge traditional power structures within mental health services as it elevates the status of lived experiential knowledge in relation to professional expertise.  This process is likely to evoke an emotional response from professionals.  In the therapeutic community I got used to the idea that the anxiety the work generated in me could, with the help of supervision and reflective practice, contribute to positive change. 

However, if such anxieties are left unexamined I believe they can give rise to unhelpful defensive processes and find expression in forms of resistance.  We can fall back on more rigid, familiar ways of working that limit our openness to change, development and truly collaborative ways of working.

Existing research indicates that service users can experience professionals as acting in ways which impede effective user involvement.  Whilst much research finds professionals supportive of user involvement in principle, others call for a more nuanced examination, both of the psychodynamic processes of change for professionals involved in user involvement (e.g. Forbat, 2006) and into the often conflicting organisational demands and dynamics within which professionals engage in this work (e.g. Brosnan, 2012).

I have been lucky enough to gain NIHR funding to complete a Research Masters.  This has given me time and academic support to plan and carry out research into these issues.  I have been interviewing mental health professionals about their experiences of user involvement in an attempt to examine how power dynamics and emotion contribute to resistances to this work.  My analysis draws on psycho-social thinking, which integrates sociological and psychoanalytic theory to examine how individuals are both products of their social contexts and their own psychic processes.  At present I am fairly overwhelmed by the analysis process, but I hope to emerge with findings which resonate with others involved in user involvement work and help them to reflect on and free up their own practice and resistances.

Brosnan, L. (2012).  Power and Participation:  An Examination of the Dynamics of Mental Health Service-User Involvement in Ireland.  Studies in Social Justice.  6(1):  45-66.

Forbat, l. (2006).  Practitioner views on service user involvement:  rhetoric and contradictions.  The Journal of Mental Health Workforce Development.  1(3):  24-31.

Tim Moore

Counselling Psychologist