Power to the people? A co-produced critical review of service user involvement in mental health professions education

Abstract

Meaningful service user involvement in health professions education requires integrating knowledge held by “lay” people affected by health challenges into professional theories and practices. Involving service users redefines whose knowledge “counts” and implies a shift in power. Such a shift is especially significant in the mental health field, where power imbalances between health professionals and service users are magnified. However, reviews of the literature on service user involvement in mental health professional education do little to explore how power manifests in this work. Meanwhile critical and Mad studies scholars have highlighted that without real shifts in power, inclusion practices can lead to harmful consequences. We conducted a critical review to explore how power is addressed in the literature that describes service user involvement in mental health professions education. Our team used a co-produced approach and critical theories to identify how power implicitly and explicitly operates in this work to unearth the inequities and power structures that service user involvement may inadvertently perpetuate. We demonstrate that power permeates service user involvement in mental health professional education but is rarely made visible. We also argue that by missing the opportunity to locate power, the literature contributes to a series of epistemic injustices that reveal the contours of legitimate knowledge in mental health professions education and its neoliberal underpinnings. Ultimately, we call for a critical turn that foregrounds power relations to unlock the social justice-oriented transformative potential of service user involvement in mental health professions education and health professions education more broadly.

Appendices

Appendix

Appendix 1: search strategy

Database: Ovid MEDLINE(R) < 1946 to September Week 2 2018 > 

• 1. (co-produc* or coproduc*).mp. (2711)

• 2. (co-design* or codesign*).mp. (268)

• 3. (co-creat* or cocreat*).mp. (430)

• 4. (collaborat* adj2 methodol*).mp. (199)

• 5. ((patient* or client* or service user* or consumer* or survivor* or informant* or lived experience* or research subject* or family or families or peer*) adj2 (educat* or teach* or moderat* or facilitat* or participa* or involv* or instruct* or navigat* or advisor*)).mp. (225794)

• 6. ((collaborat* or participatory) adj2 research*).mp. (10404)

• 7. ((community-based or experience-based) adj2 research*).mp. (4898)

• 8. ((patient* or client* or service user* or consumer* or survivor* or informant* or lived experience* or research subject* or family or families or peer*) adj2 active* adj2 (involve* or collaborar* or participa*)).mp. (506)

• 9. ((patient* or client* or service user* or consumer* or survivor* or informant* or lived experience* or research subject* or family or families or peer* or communit*) adj2 engag*).mp. (8668)

• 10. ((patient* or client* or service user* or consumer* or survivor* or informant* or lived experience* or research subject* or family or families or peer* or communit*) adj led).mp. (2203)

• 11. ((user*-centred or user*-centered or patient*-centred or patient*-centered or client-centered or client-centred or experience-based or lived experience*) adj2 (partnership* or research* or collaborat* or education)).mp. (871)

• 12. patient participation/ (22879)

• 13. community participation/ (15905)

• 14. or/1-13 [co-production concept] (261369)

• 15. ((health or healthcare) adj2 (profession* or work*) adj3 (educat* or train* or course* or class* or workshop* or module* or curricul* or program* or student* or graduat* or accreditat* or qualification*)).mp. (14543)

• 16. ((psychiatry or psychiatrist*) adj3 (educat* or train* or course* or class* or workshop* or module* or curricul* or program* or student* or graduat* or accreditat* or qualification* or resident* or residency or residencies or intern*)).mp. (4661)

• 17. ((psychology or psychologist*) adj3 (educat* or train* or course* or class* or workshop* or module* or curricul* or program* or student* or graduat* or accreditat* or qualification* or resident* or residency or residencies or intern*)).mp. (5129)

• 18. (psycholog* adj3 (educat* or train* or course* or class* or workshop* or module* or curricul* or program* or student* or graduat* or accreditat* or qualification* or resident* or residency or residencies or intern*)).mp. (8954)

• 19. (medical adj3 (educat* or train* or course* or class* or workshop* or module* or curricul* or program* or student* or graduat* or accreditat* or qualification* or resident* or residency or residencies or intern*)).mp. (181202)

• 20. ((physician* or doctor*) adj3 (educat* or train* or course* or class* or workshop* or module* or curricul* or program* or student* or graduat* or accreditat* or qualification* or resident* or residency or residencies or intern*)).mp. (32199)

• 21. ((nurse* or nursing) adj3 (educat* or train* or course* or class* or workshop* or module* or curricul* or program* or student* or graduat* or accreditat* or qualification* or intern* or placement* or co-op or co-ops or coop or coops)).mp. (115150)

• 22. (social work* adj3 (educat* or train* or course* or class* or workshop* or module* or curricul* or program* or student* or graduat* or accreditat* or qualification* or intern* or placement* or co-op or co-ops or coop or coops)).mp. (1410)

• 23. (occupational therap* adj3 (educat* or train* or course* or class* or workshop* or module* or curricul* or program* or student* or graduat* or accreditat* or qualification* or intern* or placement* or co-op or co-ops or coop or coops)).mp. (1471)

• 24. ((addict* or substance*) adj2 (counsel* or worker*) adj3 (educat* or train* or course* or class* or workshop* or module* or curricul* or program* or student* or graduat* or accreditat* or qualification*)).mp. (34)

• 25. (mental* adj2 (profession* or work*) adj3 (educat* or train* or course* or class* or workshop* or module* or curricul* or program* or student* or graduat* or accreditat* or qualification*)).mp. (610)

• 26. ((pharmacy or pharmacist*) adj3 (educat* or train* or course* or class* or workshop* or module* or curricul* or program* or student* or graduat* or accreditat* or qualification*)).mp. (10505)

• 27. education, medical/ or education, medical, continuing/ or education, medical, graduate/ or “internship and residency”/ or education, medical, undergraduate/ or teaching rounds/ or exp education, nursing/ or exp education, pharmacy/ (236920)

• 28. or/15-27 [healthcare education] (364915)

• 29. ((mental* or psychiatr*) adj3 (health or ill* or diagnos* or disorder* or condition* or challenge* or issue* or disabilit*)).mp. (330572)

• 30. ((substance* or drug* or alcohol* or tobacco or nicotine or cannabis or marijuana or opioid* or opiate* or heroin or cocaine) adj1 (“use” or misus* or abus* or addict* or depend*)).mp. (206679)

• 31. stigma*.mp. (26078)

• 32. trauma*.mp. (336499)

• 33. (recovery or recoveries).mp. (401979)

• 34. (posttraumatic or post-traumatic or PTSD).mp. (60490)

• 35. depressi*.mp. (371340)

• 36. bipolar.mp. (64863)

• 37. anxiety disorder*.mp. (42101)

• 38. (obsessive compulsive or OCD).mp. (18302)

• 39. borderline personalit*.mp. (7253)

• 40. schizophreni*.mp. (125255)

• 41. (schizoaffective or schizo-affective).mp. (5010)

• 42. (psychosis or psychotic or psychoses).mp. (76817)

• 43. exp mental disorders/ (1134218)

• 44. exp substance-related disorders/ (260055)

• 45. or/29-44 [MH or A] (2197400)

• 46. 14 and 28 and 45 (2330)

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Appendix 2: Extraction sheet template

Article overview
What type of article is this (e.g., program evaluation, research study, commentary or review)?
What is the stated purpose of the article, if available?
How were service users credited in the work (e.g., as authors or acknowledged at the end of the article)?
If service users appear among authors, where are they named in the order (first author, second, last author, etc.)?
Health professions education program
What is the name of the education program, if available?
Which area of health professions is it in?
In which country did the work take place?
How is it embedded in the curriculum (mandatory/elective education; in classroom/hospital/ community)?
How long is the program (number of classes/meetings, number of hours, duration of the program)?
How is education provided? (lectures, workshops, online modules, informal meetings, small group discussions, etc.)
Who are the learners in the program? (undergraduate/postgraduate students or health care professionals undertaking continued professional training or faculty development)
Who are involved as service users in the program? (service useres with lived experience of mental health challenges, learning disabilities, substance use challenges, intellectual and developmental disability, dementia, etc.)
How many service users are involved?
How are service users recruited?
How are service users involved (in curriculum development, delivery, evaluation, assessment, etc.)?
How are service users compensated?
Who facilitates or directs the program?
What do the program creators hope to do for the learners?
What is the program content (briefly described)?
How is service user knowledge conveyed?
What do service users focus on?
What does the program achieve? And how are the outcomes determined? (e.g., authors’ or program leads’ reflections, program evaluation, research)
Study details
How do the authors describe the research paradigm of the study (e.g., positivism, post-positivism, constructivism, interpretivism, critical theory)?
What theoretical approach do the authors rely on to make sense of the data?
What is the stated research question?
How do the authors describe the research design (e.g., qualitative/quantitative; exploratory, evaluation, conceptual, pilot, randomized control trial study)?
How are service users involved in the research?
Who are the study participants and how many are there (learners, service users, program directors/facilitators)?
What methods are used to collect data (e.g., interviews, surveys, observations, questionnaires, focus groups)?
How do the authors analyze the data?
What are the main findings of the study? Or what are the main themes/arguments/points that are put forward?
What limitations are acknowledged?
Discussion of power
How do the authors explicitly or implicitly name/define/understand power? What language/words/terms do they use to describe power relations? (e.g., inequity, privilege, oppression, intersectionality, power)
What theory is used to describe power relations, if any? What theory/theorist is used to describe power relations, if any?
Why do the authors think addressing power is important?
Whose interactions/relations are described through power?
How do the authors describe the influence/impact that power relations have? (e.g., power in research/in the program/in the wider contexts/structures/discourses. What does power produce? Do they discuss resistance or other challenges?)
What modifications or changes do the authors propose to mitigate or respond to power relations?
Supplemental information
What do the authors find to be the most significant implication/recommendation of their work?
Please flag this article if you think it is so important that everyone should read it
Please flag this article if this extraction rubric does not adequately capture its essence
Please flag this article if you think it does not meet eligibility criteria and should be excluded
Do you have any additional comments?