Inside the city walls: Mental health service users’ journeys towards full citizenship

• Main Author: Hamer, Helen Paris
• Other Authors: Finlayson, Mary
• Published: ResearchSpace@Auckland 2012
• Online Access: http://hdl.handle.net/2292/11915

This study was undertaken at a time when mental health service users were lobbying to be treated as full citizens with the same participation, rights and responsibilities as other citizens. It explores mental health service users‟ understandings of citizenship and whether the recovery approach helps or hinders their journey towards full citizenship. The study uses Isin‟s (1999, 2002, 2008b) conceptual framework of citizenship to interpret data from indepth individual and focus group interviews with 17 service users and 12 key stakeholders. Isin‟s conceptual framework focuses on the social, civil and political dimensions of citizenship. The overarching finding was that service users experience conditional citizenship, which includes barriers and restraints to their participation and to the rights and responsibilities that others in society enjoy. Conditional citizenship results from labelling which has its genesis in the bio-medical model, the predominant treatment approach used in mental health services. The labelling of service users leads to stigma and discrimination in wider society and results in service users being Othered. In an attempt to blend in with the rest of society service users shape their behaviour through self-surveillance and self-policing to mitigate risk to themselves and others. Additionally in an attempt to be accepted they engage in practices of inclusion. These practices include self-disclosing about their illness, working in education and leadership roles to bring about acceptance of those with mental illness, and the expansion of the prevailing behavioural norms. For service users, deeper, existential and spiritual connections with others is essential for their sense of belonging. In some cases they make a claim for their full rights by engaging in acts of citizenship such as private and public practices of responsible subversion. The findings from this study have important implications for the recovery approach that should ideally underpin mental health service delivery. The thesis concludes by outlining recommendations for nursing practice, nursing education and policy.