Background
Place and recovery in the context of community mental health services
Care relationships and productive power
Aim
Methods
Recruitment of participants and sample
The interviews
Data analysis
Stage 1 | Discursive constructions | How were the place’s influence on personal recovery constructed in the data? |
Stage 2 | Discourses | What discourses are the statements drawn upon and how are they related? |
Stage 3 | Action orientation | What do the constructions achieve and what is gained from deploying them? |
Stage 4 | Positioning | What subject positions are made available by these constructions? |
Stage 5 | Practice | What possibilities for action are mapped out by these constructions? |
Stage 6 | Subjectivity | What might the users and professionals feel, think and experience from the available positions? |
Ethical considerations
Findings
Constructions of place as a potential for recovery
“I don’t have to be stressed doing housework before Caroline comes. You want to make a good impression when you are having guests. It is not like that when she comes. You don’t have to make up an excuse and delay the visit—just because you could not handle the housework. She is not a friend. It is something else” (Hanna, user).
“A user can say; “It’s enough”, and I have to comply to his or her wishes. In my opinion, they have more power at home than here (…). “This is my home. I smoke whenever I want to”. In fact, that is difficult. To be in someone’s home when he or she smokes a lot. To have to change clothes after you have left. Their autonomy… where you can sit, where to go… it is their homes. They decide. When you are there, they control you a little as well. I have my space, but it is far less than the user’s. This is my space. I have to ask for permission. “May I use the bathroom?” I cannot just take another piece of cake or coffee if the user has not asked me to” (Lars, professional).
“When I have an appointment, it helps me to get out. Get up in the morning, get out of the house, and make sure I get there on time. When I am ill and feeling down, I usually stay at home. It is of great importance, especially in situations like that, to get out”. (Greta, user)
“They came to check if I have done the things we agreed on. (…) When it happened, it was all right. I had an excuse to clean and clear up. It would be difficult to do it if they did not come to check. It is a kind of motivation”. (Anna, user)
“Sometimes I suggest that we do the dishes as we talk about what the week was like, when it is messy in a person’s home. It is part of working on the relationship, doing something practical and helping the person doing some housework” (Linda, professional).
“When a person is at home, it is easier to understand what he or she struggles with. They can sit in my office saying everything is all right at home, or just the opposite. When you come home to a person, you make an assessment yourself” (Lars, professional).
Constructions of place as a barrier against recovery
“There was a time I did not make myself dinner. It was not because I did not know how to. It was because I would rather not eat. I remember a health worker who came to my house to help me make dinner. They said I needed to practice cooking. I did not want it to happen, but I did not dear to say no. Wanted to be a good client. Was afraid of the consequences if I resisted… I was afraid of several things. I was afraid they would be mad at me, that it would lead to many negative things. That Tobias (fictive name on the professional) would be mad and talk about it a lot. Even worse… Maybe he did not want to talk to me again” (Siv, user).
“Health workers can feel threatened and be afraid of accusations when they visit a person at home. Sometimes we go two mental health workers when we feel insecure… Sometimes sexual matters affects the situation. You can be accused of things you have not done. I have never been in a situation like that, but sometimes I am afraid to be accused of having other intentions than I have. When it comes to avoiding physical attacks, it is smart to be two, too”. (Martin, professional)
“Usually they come to talk in my office. (…) I go to the waiting room to bring him or her to my office when it is time, because the doors are locked. I show him or her to my office and the conversation takes place here. I use to sit here and the user there (points at the chairs”) (Anna, professional).
“It depends on the setting… This is kind of my domain. This is my office. We also have a meeting room. I don’t like it so much because it is cold and impersonal. In our office, there are chairs and a little table in the middle. It is so much more comfortable… I don’t like to talk with clients the way we sit right now (in the meeting room, chairs on each side of the table). It is almost like an examination. And I don’t mean to examine them” (Lars, professional).