Alliances in action: Opportunities and threats to solidarity between workers and service users in health and social care disputes

This paper reflects upon the recent mental-health nurses' strike following the sacking of Karen Reissman by Manchester Mental Health and Social Care Trust. Nursing strikes are rare, though there is a significant strand of militancy in the history of nursing. Analysis of the Manchester dispute and associated media coverage is relied on as a point of departure for a more general discussion around issues of solidarity and connections between trade union and service-user activism. These issues are explored in a context of the industrial and social relations of mental-health care. It is argued that regressive, stereotypical representations of mental health, which appeal to fears surrounding public safety, are a feature of this industrial-relation territory. This paper proposes that social relations of work and connections with the wider community could be transformed by a dual strategy: pursuing a more progressive and inclusive understanding of mental health and building stronger alliances between trade union, community and service-user activists

Relational union organising in a healthcare setting: a qualitative study

This article explores the impact of a relational organising model within a local UNISON NHS branch. While initial outcomes were modest, we argue that relational approaches have the potential to increase branch engagement with organising activity and to provide a focus on the importance of community within the workplace

Failure to care: Nursing in a state of liquid modernity?

Editorial regarding the context and politics of nursing practice

Alliances and communicative action: one possibility for reframing theory and praxis.

The papers by Plumb, Beresford and colleagues, Thomas, and Spandler and Calton which were a point of departure for the symposium are replete with both the complexity of competing ideas for framing the theory and politics of mental health survivor identity in a context of wider ‘disability’ struggles and the sense that activism for change is paramount. Different theories or means of making sense of the social position of mental health survivors have the potential to underpin movement activism. Questions arise over the extent to which different understandings, and the means by which they are arrived at, might foster solidarity or division with potential allies. This paper will not directly seek to develop critique of the merits or otherwise of social models of disability for the mental health context. Rather, it will explore understandings of ways by which individuals and groups might take part in discussion and debate to arrive at more agreeable theories or politics of mental health. A critical look at Habermas’s (1986, 1987) theory of communicative action will be developed and its relevance for this context discussed. The idea of the university as an interesting social space for deliberations on movement politics and theory will be highlighted, bringing together movement activists and critically engaged academics

Linking the Academy and Activism: From constructed subjectivities to participatory, communicative agency.

This thesis presents a narrative that connects discussion of a number of my papers submitted for consideration of the award of PhD by published work with reflections on methods and theory within a critical sociological context. This analysis of my publications is extended by a critical engagement with communicative action theory to consider its relevance for thinking about service user involvement activity in university settings. The thesis explores methodological and theoretical ideas by first narrating the thematic consistency of the portfolio of published work presented for consideration and, second, considering analytic connections with wider critical social theory and emancipatory goals. In part this is accomplished by exploring a scholarly interest in the subjective: tracing in my own papers a development of thought from an affinity for critical post-structuralist concepts of a de-centred subject, as illustrated in my use of Q-methodology as a particular means of accessing forms of subjective expression, through to a current interest in forms of critical social theory, aligned to the Frankfurt School. Despite some acknowledged philosophical tensions, it is argued that there is a consistency of theoretical exposition whereby a line of reasoning via Habermas’s theory of communicative action, focuses on a radical subjectivity which is not antithetical to the aforementioned post-structural accounts. A contribution to original knowledge is demonstrated with respect to theorising social constructions of difference and identity in a mental health context and critical analyses and commentary on the mental health service user/survivor movement. Themes of radicalism and emancipation in research methods and praxis, and their critique, connect with a concluding focus on academic alliances with user movement activists including an analytic reflection on the university as a particular social space which may be amenable to forging effective solidarity

The UCLan Engagement and Service User Support (Comensus) project: Valuing authenticity making space for emergence.

Objective  To develop and evaluate service user, carer and community involvement in health and social care education. Background  Despite the high policy profile of involvement issues, there appear to be no published accounts of schemes that have used a systematic whole-faculty approach to community engagement in health and social care higher education. Focus of this paper  The set up and early development of a faculty-wide community engagement project. Setting and participants  Staff from the faculty of health in one University, local service users and carers and community group project workers and local National Health Service (NHS) and public sector staff. Design  Participatory action research including document review, field notes, questionnaires and interviews. Analysis  Thematic analysis. The emerging themes were tested by seeking disconfirming data, and through verification with stake-holders. Results  Prior to the study, there were examples of community engagement in the participating faculty, but they occurred in specific departments, and scored low on the ‘ladder of involvement’. Some previous attempts at engagement were perceived to have failed, resulting in resistance from staff and the community. Despite this, an advisory group was successfully formed, and project framing and development evolved with all stake-holders over the subsequent year. The four themes identified in this phase were: building accessibility; being ‘proper’ service users/carers;moving from suspicion to trust: mutually respectful partnerships as a basis for sustainable change; and responses to challenge and emergence. Conclusions  Successful and sustainable engagement requires authenticity. Many problems and solutions arising from authentic engagement are emergent, and potentially challenging to organizations

Democratic Learning for Democratic Practice: Co-Operation and Deliberation

In this chapter we suggest that education for a critical understanding of democracy is central to the delivery of high-quality patient-centred care. Development of skills and knowledge which support change in practice can and must be brought into the classroom, offering opportunities for positive role modelling and real-time learning. Techniques by which such understandings can be cultivated will be explicitly referred to in the course of the chapter. For the purpose of highlighting these ideas and practices, we refer to selected initiatives focusing upon undergraduate nurse education concerned with professional support for service-user involvement in nursing practice; teaching leadership to registered nurses; and wider general initiatives which bring service-user involvement into practitioner learning in higher education. The exemplars are illustrative and do not claim to be the only examples of our focus on involvement and democracy across the three universities. They are, however, initiatives in which we have been substantially involved

Service user involvement in practitioner education: movement politics and transformative change

This paper will attempt to both celebrate key developments and best practice involving the users of health and social care services in programmes of practitioner education in a UK context, and offer a critical appraisal of the extent to which such initiatives meet some of the more transformative objectives sought by service users activists for change. The approach is largely that of a discussion paper but we illustrate some of the themes relating to movement activism with selected data. These data relate to earlier research and two specially convened focus groups within the Comensus initiative at the University of Central Lancashire; itself constituted as piece of participatory action research. We conclude that universities represent paradoxical sites for the facilitation of debate and learning relevant to key issues of social justice and change. As such, they are places that can impede or support movement aims. Particular strategic responses might be more likely to engender progressive outcomes. These ought to include the presence of critically engaged academic staff operating within a scholarly culture that fosters forms of deliberative democratic decision making

Looking back, looking forward: recovery journeys in a high secure hospital

A qualitative study of staff and service users’ views of recovery was undertaken in a UK high secure hospital working to implement recovery practices. 30 staff and 25 service users participated in semi-structured interviews or focus groups. Thematic analysis identified four broad accounts of how recovery was made sense of in the high secure environment: the importance of meaningful occupation; valuing relationships; recovery journeys and dialogue with the past; and recovery as personal responsibility. These themes are discussed with an emphasis on service user strategies of cooperation or resistance, respectively advancing or impeding progress through the system. In this context the notion of cooperation is, for many, commensurate with compliance with a dominant medical model. The policy framing of recovery opens up contemplation of treatment alternatives, more participatory approaches to risk management, and emphasise the value of relational skills, but may not elude the overarching bio-psychiatric episteme

The design, delivery and evaluation of ‘Human Perspectives VR’: An immersive educational programme designed to raise awareness of contributory factors for a traumatic childbirth experience and PTSD

Background A traumatic childbirth experience affects ~30% of women each year, with negative impacts on maternal, infant, and family wellbeing. Women classified as vulnerable or marginalised are those more likely to experience a psychologically traumatising birth. A key contributory factor for a traumatic childbirth experience is women’s relationships with maternity care providers. Aims To develop, design and evaluate an immersive educational programme for maternity care providers to raise awareness of traumatic childbirth experiences amongst vulnerable groups, and ultimately to improve women’s experiences of childbirth. Methods A critical pedagogical approach that utilised virtual reality (VR) underpinned the design and development of the educational programme. This involved: a) collecting vulnerable/disadvantaged women’s experiences of birth via interviews; b) analysing data collected to identify key hotspots for traumatic experiences within interpersonal patient – provider relationships to develop a script; c) filming the script with professional actors creating a first person perspective via VR technology; d) using existing literature to inform the theoretical and reflective aspects of the programme; e) conducting an evaluation of the education programme using pre-and post-evaluation questionnaires and a follow-up focus group. Findings Human Perspective VR was very well received. Participants considered the content to have enhanced their reflective practice and increased their knowledge base regarding contributory factors associated with a traumatic childbirth experience. A need for further work to implement learning into practice was highlighted. Conclusion While further research is needed to evaluate the impact of the programme, Human Perspective VR programme offers an innovative approach to reflective education and to enhance participants’ care practices