User involvement in mental health care

This publication is based on a review of the research literature and the grey literature on the topic user involvement in mental health work with a particular emphasis on health and care services in communities. Users are defined as adults (over 18 years) who receive mental health services, or people who are affected by the service indirectly. The publication provide knowledge about central research and development, laws and regulations, government documents and other material that could give the individual reader an overview of the topic.

Key developments

User involvement makes great demands on both service users, service providers, and communities. User involvement is necessary in order to provide high quality mental health care. User involvement in Norwegian communities is currently not systematically organized. It is not an integral part of mental health services in most communities, by either individual treatment or organizational decisions. User involvement can accommodate different forms in mental health care, ranging from user representation in community councils to users expressing their own wishes and needs during treatment.

Recovery is described as a basis understanding and a foundation in the mental health care in Norwegian communities. A precondition for recovery-oriented healthcare is the hiring of employees with user experience.

With the political processes and organizational changes towards more local community services, there has also been a change in the view of the patient role. From being in a passive role as a mental health service user, one is now expected to be an active participant in the treatment. The new role requires users to practice their experience competence, and it requires the professionals to let users participate.

Employees with user experience is one of the results within the innovation in the field. There is controversy in the field as regards both requirements for expertise, education and expectations for the work of employees with user experience. Programs with user employees are new, and much is unclear.

Policy guidelines in Norwegian mental health care encourages rapid diagnosis, standardization of procedures with manuals and generalized, evidence-based therapies that makes implementing user involvement into services even more complex.

Challenges and needs

Norwegian communities have paid more attention to user involvement at the system level. However, user involvement is most frequently practiced as individual adjustment of the relationship between users and professionals. There is a need to focus on systematic implementation of user involvement on an individual level in Norwegian communities. Furthermore, there is a need for a wide specter of user employment in the communities. Consequently, education for mental health service users who want to work as experience consultants or employees with user experience is required, and it is important to establish procedures for such employment in the communities. It is also necessary to pay more attention to user involvement and participation in research and community development projects. User involvement knowledge is necessary and useful in community mental health services, and should be a more central part of practice, education and research.