Professional understanding and service user

Professional understanding and service user

Professional understanding and service user

Introduction

Service user (a term inclusive of consumers, clients, patients and carers for the purposes of this paper) involvement is defined as an active and equitable collaboration between professionals and service users concerning the planning, implementation and evaluation of services and education. Implicit in this definition is the transfer of power or control over aspects of service delivery from professionals to service users (Wright and Rowe, 2005).

Discussion

Government directives in the United Kingdom, and internationally, advocate the involvement of service users in health service provision and the education of health professionals. However, it would appear that this drive for service user involvement is mainly emanating from policy directives and users themselves who have campaigned for a voice in health services and education. Widespread professional commitment to the fundamental philosophical need for user involvement initiatives is not apparent. Moreover, while service user involvement in the planning, delivery and evaluation of services has increased over recent years, research indicates that there is a disparity between the philosophy of service user involvement and the pragmatics of practice. Despite an espoused commitment to service user participation, users still express the view that they are not listened to. In an analysis of the UK Commission for Health Improvement's (CHI) first 175 clinical governance reviews, one of the main findings was that few service providers are routinely involving users and carers in the development of services and policies(Happell et al., 2002).

A number of reasons for including service users in health services and education have been cited in the literature which relate to demands from consumers themselves to increase the power, control and influence of service users; to challenge entrenched perceptions and attitudes of health professionals; to break down the barriers of hierarchical and paternalistic services and improve clinical standards and service delivery. More controversially, some have promoted it as a form of therapy - to increase users self esteem and confidence as the roles of 'helper' and 'helped' are reversed argues that this is empowerment of service users rather than therapy.

The cited potential barriers to service user involvement include the perception of service user involvement as threatening to staff and their sense of professional autonomy. There is concern that the stress of involvement may damage users' health. Service users themselves may be reluctant or lack interest with factors such as age, gender, cultural background, diagnosis, previous health care experiences, personality characteristics and educational background playing a part. Not adequately remunerating service users for their contributions can be viewed as exploitative. However, until user involvement is viewed as an essential part of service provision or education it is recognised that resources are limited(Hanson and Mitchell, 2001).

The primary reason for involving service users in the training and education of mental health professionals is the anticipation that it will produce practitioners capable of delivering improved and more relevant outcomes for users and their carers. Furthermore, underlying the policy statements of service user involvement in education ...