Background: Therapeutic relationships in psychiatry services have been shown to have a significant impact on outcomes for people in severe mental distress. Service user experience-based studies consistently show relationships are an important factor in either helping or hindering recovery. Few studies have conducted a detailed exploration into the interpersonal mechanisms within these relationships by asking service users directly about what emotional impact these relationships have had on them. This is important knowledge for improving the quality of mental healthcare for people in severe mental distress. Aims: The purpose was to co-create a piece of research with a service user organisation that explored services users' experiences and perceptions of helpful and hindering relationships with mental health practitioners. The aim was to gain a greater understanding of the components in the relationship that brought about psychological change. Little research about relationships in psychiatry settings has been conducted in collaboration with service users outside of government-led mental health services. Participants: Eight participants were recruited from the service user organisation. The participants self-reported as having a mental health problem. Seven of the eight participants had long-term experience of using psychiatry services. Method: This research was service user-informed. The data was collected using single in-depth interviews focused on service users' views of their relationships with mental health practitioners. Interpretative Phenomenological Analysis (IPA) methodology was used to analyse the data and explore the participants' lived experiences of relationships in mental health services. Findings: The main themes identified were 'Trying to survive: am I a person or just an object in the system', 'Traumatic experiences and relationships' and 'Transformative relationships'. The findings showed the transformative components of these relationships were power, security and identity. The findings highlighted how the participants experienced a relationship to the system of psychiatry through their relationships with staff. Conclusions: How the components of power, security and identity were managed by practitioners determined whether relationships helped or hindered recovery. The responsibility for relationships in psychiatry needs to be broadened beyond the interpersonal relationship provided by practitioners. The systemic institution of psychiatry based on statutory control, risk aversion, the biomedical model and under resourcing were a cause of many of the problems in relationships in psychiatry settings.

No

Abstract Service user involvement in service and policy development is vital in order to provide services that meet their needs. In the sensitive and challenging area of statutory child protection, where service users are often marginalized and disempowered, such involvement is likely to be contested and complex. It is, nonetheless, of great importance in order to provide effective responses to the protective needs of children and to the needs of their families, in order to ensure child safety. This qualitative study explores the participation of parents in statutory child protection policy processes in the state of Queensland, Australia. The aims of the study were to understand the Queensland statutory child protection policy context, and to explore the issue of parent participation in policy processes from a number of different perspectives. An analysis of a range of Department of Child Safety (DChS) policy related documents, from the period 1999 – 2007, was undertaken. Focus group interviews were undertaken with statutory child protection practitioners and policy officers, and with non government child and family welfare practitioners. Individual semi structured interviews were undertaken with a number of parents who are statutory child protection service users. What has emerged is a picture of a service system where parents are likely to be excluded at all levels of decision making. The study found that following inquiries into the failure of the service system, in particular the Crime and Misconduct Commission Inquiry (CMC), DChS has emerged as an individualistic child focused service system with a focus on forensic investigation, risk assessment and management, and with a corresponding loss of focus on family support. The findings indicate that how DChS has redefined its approach to child protection impacts significantly on how parents are engaged by the service system. They highlight inequities in the way service user participation rights have been incorporated into policy and enacted in practice, and the lack of recognition afforded parents as service users and stakeholders in the service system. The findings also suggest that DChS policy processes are focused more on progressing reform agendas and efficient service delivery than they are on service user involvement. Negative portrayals and perceptions of parents, and a perceived lack of understanding of the nexus between disadvantage and child welfare, were also found to contribute to their exclusion. The parent interviews provided valuable insights into their experiences of the service system, indicating the sorts of issues they are likely to bring to the policy table. However, the findings illustrate that they lack the necessary information, support and encouragement to participate, and their experiences of the service system have left them mistrustful of engaging in policy processes, should the opportunity arise. Overall, the findings show that while there is likely to be a number of benefits to parent participation in policy processes, and parents themselves have an interest in participating, there are many barriers to this. While a few potential strategies to engage parents in policy processes were identified, these were often also perceived to have limitations. It is considered that a comprehensive socio-structural approach would be needed in order to reposition parents as participators in policy and service development.

Yes / BACKGROUND: Service user involvement is embedded in the United Kingdom's National Health Service, but knowledge about the impact of involvement on service users, such as the benefits and challenges of involvement, is scant. Our research addresses this gap. OBJECTIVE: To explore the personal impact of involvement on the lives of service users affected by cancer. DESIGN: We conducted eight focus groups with user groups supplemented by nine face-to-face interviews with involved individuals active at a local, regional and national level. Thematic analysis was conducted both independently and collectively. SETTING AND PARTICIPANTS: Sixty-four participants, engaged in involvement activities in cancer services, palliative care and research, were recruited across Great Britain. RESULTS: We identified three main themes: (i) 'Expectations and motivations for involvement'- the desire to improve services and the need for user groups to have a clear purpose, (ii) 'Positive aspects of involvement'- support provided by user groups and assistance to live well with cancer and (iii) 'Challenging aspects of involvement'- insensitivities and undervaluing of involvement by staff. CONCLUSIONS: This study identified that involvement has the capacity to produce varied and significant personal impacts for involved people. Involvement can be planned and implemented in ways that increase these impacts and that mediates challenges for those involved. Key aspects to increase positive impact for service users include the value service providers attach to involvement activities, the centrality with which involvement is embedded in providers' activities, and the capacity of involvement to influence policy, planning, service delivery, research and/or practice.

As social workers we understand that service users are the most impacted stakeholders involved in service delivery models at various agencies. When it comes to the field of child welfare, there are added barriers and complications that impact a worker’s ability to develop relationships with service users. What do child welfare service users consider to be “good” social work practice, and what do they expect from their workers? This thesis will focus on the voices of those who have been most impacted by the system: those who are or have been in the care of a child welfare system. At McMaster University, a program is being initiated in partnership between the School of Social Work and various local Children’s Aid Societies in Hamilton and the surrounding areas, which will explore how child welfare service users can be incorporated into the education of social work students who plan to work in the field of child welfare. This thesis will explore what individuals who are or have been youth in the care of an Ontario Children’s Aid Society want to teach the students of this program before they become child welfare social workers. This expert feedback will then be incorporated into the curriculum of McMaster’s program, entitled: “Preparing for Critical Practice in Child Welfare” (PCPCW), which will be carried into practice by the students who graduate from the program to become child welfare social workers. / Thesis / Master of Social Work (MSW)

Yes / The International Centre for Participation Studies and Sharing Voices Bradford (for information on these organisations, see Appendices 3 and 4) maintain that participation is an important part of a healthy democracy, with benefits for all. However, participation can be anything from empowering to tokenistic, and must be critically examined if we are to understand how to use it effectively. This paper considers the contribution of participation to improved service delivery in the health service. For beneficiaries, participation can be about ownership and responsibility for the services we use, as well as rights and the chance to express what we want from them. For service providers, participation is widely recognised as an effective way of tailoring services to the needs of the different communities they serve. The NHS and other service providers have made great strides in developing mechanisms for participation by service users. However, these do not always reach all sections of the community. Many individuals feel sceptical about getting involved, unconvinced that their contribution could make a real difference. Through the Participation ¿ Why Bother? workshops, we set out to explore these feelings, to reflect on perceived barriers and identify changes that might help overcome them. The aim was not to look at the substance of service delivery issues, but to try and work out how the process of involving people in decision-making in the NHS could be improved, to make it easier for voices from Black and Minority Ethnic (BME) communities to be heard. / Bradford District Care Trust; South and West PCT; City tPCT

This research project aims to explore service user and mental health social workers’ (MHSW) perspectives and experiences of practice in the area of personality disorder. It seeks to answer three research questions: how service users and MHSWs understand personality disorder, how they understand MHSW practice and how practice in this area might be better informed. The study’s attention to the experiences and perspectives of both groups sets the research within the interpretivist paradigm and relies on a relativist ontology, subjectivist epistemology and inductive, qualitative methodology. The involvement of both groups means that this project makes an original contribution to MHSW research and practice. Constructivist grounded theory (CGT) has been used to generate a conceptual, theoretical analysis. The research was divided into two phases. Phase 1 involved ten semi-structured interviews with ten service users from a community service for people with personality disorder. This data was analysed before Phase 2 began, comprising twelve semi-structured interviews with twelve MHSWs from three regions of England. NVivo 7 was used to analyse the data in and across case. The analysis identified participants’ understanding of personality disorder, mental health social work practice and how this practice might be better informed. The analysis was supplemented by documentary analysis of policies relevant to personality disorder and MHSW. The findings suggest that traumatic experience impacts on the lens through which the person views self and others. Distress can be overwhelming, lead to extreme and unsafe behaviours, which reinforce disconnection from self and others. In supporting a relationship between personality disorder and traumatic experience, this study suggests the relevance of mental health social work (MHSW) to personality disorder. The findings suggest that more humane, empathic responses are required. Practice founded on understanding the impact of traumatic experience and the ways in which the individual might be trying to cope with their distress. The findings reveal the importance of MHSWs’ relational skills and interventions that offer practical support, encouragement and effective liaison with others. Through more caring, protective bonds and broad social supports MHSW might empower individuals’ response to traumatic experience. The findings raise implications for MHSW and mental health professionals more generally. The findings also indicate that practice would be better informed by greater knowledge and understanding of the person and the diagnosis; the provision of feedback to the person; modelling; greater transparency and consistency; support for the person’s social and family network, and more practical support. This project makes an original contribution to knowledge about personality disorder and to MHSW knowledge and practice in this area.

Doctor of Philosophy (PhD) / After two decades of public management reform, the ‘new accountability’ of performance measurement is a routine feature in the relationships between Australian government agencies and the non-profit organisations they fund to provide child and family services. While performance measurement offers to resolve tensions about how governments manage the quality and productivity of contracted services, the indicators they commonly adopt raise well-documented practical, political and epistemological challenges in social services. Left unresolved, these challenges risk biasing representations of service performance, by emphasising the most tangible dimensions of service activities (such as measures of client throughput) over relationship building and care. Capturing only part of service activity compromises the usefulness of performance data for managing quality and outcomes, and denies policy makers critical information about the value and meaning of care in users’ lives. This thesis identifies and critically explores one set of challenges for performance measurement: the role of service users. Uniquely, I explore how user involvement in social service evaluation can make visible how these services enhance the quality of family and personal life. Using a case study of family support services in New South Wales, the research makes a series of empirical and theoretical contributions to problems of user involvement in social service evaluation. Firstly, the research examines the performance indicators currently used by government to monitor the efficiency and effectiveness of family support services in NSW. This shows that performance indicators in family support capture output more thoroughly than outcome, and confirms the minimal role that service users play in assessing service quality and outcomes. But while service users are largely excluded from participation in performance measurement, theoretical perspectives as diverse as managerialism and feminism treat service users as well placed to capture and report otherwise elusive information about care quality and outcomes. Further, participation in evaluation facilitates the exercise of users’ rights to self-expression and self-determination in the social service delivery and policy process. After identifying the widespread exclusion of service users’ perspectives from performance measurement in NSW family support, the thesis makes its more substantial contribution, in documenting findings from a detailed study involving adult family support service users (parents) and their workers (the ‘Burnside Study’). This qualitative study was conducted in four socio-economically disadvantaged service delivery sites located around New South Wales. Using focus group, interview and observational methods and a modified grounded theory approach, the study contributes exploratory evidence of what these service users think of, and how they think about service quality, outcomes, and evaluation in family support. The parents’ accounts of using family support capture their unfulfilled social ideals and the broader visions of the justice they hoped these social services would help them achieve. Their criteria for measuring service outcomes and service quality, and their views on evaluation methods embody core themes that social theorists have struggled to analyse, about the purpose of social services and the nature of ‘a good life’. The theoretical framework I develop highlights the role of family support in the context of service users’ struggles for social justice, and in particular, their struggles for self-realisation, recognition and respect (Honneth, 1995). The research extends theories of recognition beyond publicly articulated social movements to those struggles in social life and social politics that exist in what Axel Honneth terms the ‘shadows’ of the political-public sphere (2003a: 122). After establishing a conceptual framework that facilitates deeper interpretation of users’ perspectives, I present the findings in three categories: users’ perspectives on service outcomes; users’ perspectives on service quality; and users’ perspectives on evaluation methods. The findings show how service users define ‘service outcomes’ in the context of their struggles for recognition and respect, highlighting the contribution welfare services and welfare professionals make beyond the managerial ‘Three E’s’ of economy, efficiency, and effectiveness. Further, the findings confirm the importance of ‘helping relationships’ to the quality of service delivery in family support, despite the invisibility of service relationships in existing performance indicators. The complexity of worker-client bonds highlights the difficulty of evaluating social services using simple numerical counts of client or service episodes, and plays into broader debates about strategies for revaluing care work, and the role of care recipients. Finally, the findings show the role performance measurement processes and methods might play in facilitating users’ struggles for recognition. Users identified a role for evaluation in making visible the contribution of family support in pursuing their social justice goals, and saw evaluation as an opportunity in itself to facilitate recognition and respect. Overall, the thesis offers concrete evidence about how family support service users experience and define service quality and outcomes, and how they see their own role in evaluating the services they use. The research shows how users’ perspectives both contest and confirm the ‘new accountability’ of performance measurement, pointing to new directions, and further challenges, for conceptualising – and evaluating – social services.

In a new reform in 2001, Swedish authorities emphasized the need for support for persons with psychiatric disabilities living in the community. This reform included the establishment of a new occupation: the Swedish case manager, personligt ombud (PO). In examining this new occupation, the overall aim of this thesis is to analyze how the Swedish case manager, PO, as an evolving occupation, affects and is affected by the organisational and professional field in which it enters. More specifically, the aim is to describe and analyse, using organisational and professional theories, the changing processes that the PO con-tributes to in the welfare system and the practice of social policy, the field of social psychiatry focusing on the discretion for professionals and in the under-standing of the professional role to help as described by clients. Three studies have been carried out. The first study, for the licentiate´s degree, focused on the PO occupational role and functions for the welfare system as well as for mental health service users. In the second study, the results from the first study were analyzed together with the results of another reform, namely, the Swedish care manager reform, in order to investigate their joint implications for social policy and its practice. The third study focused on what meaning the PO has for the clients and particularly what features of the service the clients find to be helpful. In summary, the results indicate that the PO contributes to the development of a negotiated rights model, by taking on the assignment of advocacy as a client representative, and then defining the social worker as a representative for the organisation with the assignment of needs assessment. In the field of social psychiatry, the PO fills a vacancy by supporting the legitimacy of the professionals as well as their organisations. Furthermore, the PO has a function of providing organised transparency through restricting the discretion of other professionals. The discretion of the PO itself has weak boundaries allowing for great liberty of action. Finally, the PO service has led to a new understanding of the professional role, as built on reciprocity with the client, using knowledge evolving from the interaction between the professional PO and the client. These findings suggest that the PO could be understood as a new occupation evolving from weak professional traits to, as suggested, a new model for professionalism, called user-mandated professionalism. This emphasizes the reciprocative foundation of knowledge between the service user and the professional.

Doctor of Philosophy (PhD) / After two decades of public management reform, the ‘new accountability’ of performance measurement is a routine feature in the relationships between Australian government agencies and the non-profit organisations they fund to provide child and family services. While performance measurement offers to resolve tensions about how governments manage the quality and productivity of contracted services, the indicators they commonly adopt raise well-documented practical, political and epistemological challenges in social services. Left unresolved, these challenges risk biasing representations of service performance, by emphasising the most tangible dimensions of service activities (such as measures of client throughput) over relationship building and care. Capturing only part of service activity compromises the usefulness of performance data for managing quality and outcomes, and denies policy makers critical information about the value and meaning of care in users’ lives. This thesis identifies and critically explores one set of challenges for performance measurement: the role of service users. Uniquely, I explore how user involvement in social service evaluation can make visible how these services enhance the quality of family and personal life. Using a case study of family support services in New South Wales, the research makes a series of empirical and theoretical contributions to problems of user involvement in social service evaluation. Firstly, the research examines the performance indicators currently used by government to monitor the efficiency and effectiveness of family support services in NSW. This shows that performance indicators in family support capture output more thoroughly than outcome, and confirms the minimal role that service users play in assessing service quality and outcomes. But while service users are largely excluded from participation in performance measurement, theoretical perspectives as diverse as managerialism and feminism treat service users as well placed to capture and report otherwise elusive information about care quality and outcomes. Further, participation in evaluation facilitates the exercise of users’ rights to self-expression and self-determination in the social service delivery and policy process. After identifying the widespread exclusion of service users’ perspectives from performance measurement in NSW family support, the thesis makes its more substantial contribution, in documenting findings from a detailed study involving adult family support service users (parents) and their workers (the ‘Burnside Study’). This qualitative study was conducted in four socio-economically disadvantaged service delivery sites located around New South Wales. Using focus group, interview and observational methods and a modified grounded theory approach, the study contributes exploratory evidence of what these service users think of, and how they think about service quality, outcomes, and evaluation in family support. The parents’ accounts of using family support capture their unfulfilled social ideals and the broader visions of the justice they hoped these social services would help them achieve. Their criteria for measuring service outcomes and service quality, and their views on evaluation methods embody core themes that social theorists have struggled to analyse, about the purpose of social services and the nature of ‘a good life’. The theoretical framework I develop highlights the role of family support in the context of service users’ struggles for social justice, and in particular, their struggles for self-realisation, recognition and respect (Honneth, 1995). The research extends theories of recognition beyond publicly articulated social movements to those struggles in social life and social politics that exist in what Axel Honneth terms the ‘shadows’ of the political-public sphere (2003a: 122). After establishing a conceptual framework that facilitates deeper interpretation of users’ perspectives, I present the findings in three categories: users’ perspectives on service outcomes; users’ perspectives on service quality; and users’ perspectives on evaluation methods. The findings show how service users define ‘service outcomes’ in the context of their struggles for recognition and respect, highlighting the contribution welfare services and welfare professionals make beyond the managerial ‘Three E’s’ of economy, efficiency, and effectiveness. Further, the findings confirm the importance of ‘helping relationships’ to the quality of service delivery in family support, despite the invisibility of service relationships in existing performance indicators. The complexity of worker-client bonds highlights the difficulty of evaluating social services using simple numerical counts of client or service episodes, and plays into broader debates about strategies for revaluing care work, and the role of care recipients. Finally, the findings show the role performance measurement processes and methods might play in facilitating users’ struggles for recognition. Users identified a role for evaluation in making visible the contribution of family support in pursuing their social justice goals, and saw evaluation as an opportunity in itself to facilitate recognition and respect. Overall, the thesis offers concrete evidence about how family support service users experience and define service quality and outcomes, and how they see their own role in evaluating the services they use. The research shows how users’ perspectives both contest and confirm the ‘new accountability’ of performance measurement, pointing to new directions, and further challenges, for conceptualising – and evaluating – social services.