David Armes BA ( Hons ) PhD

1. ‘In-Sight’ & the Service-User/Survivor Movement: Uniting ‘Stroppy Resisters’ with ‘Movers and Shakers’? David Armes BA (Hons) PhD

2. Outline • Introduction to the current policy context, the continuing need for a campaigning movement and the continuing relevance of my PhD research • Formalising pressure since the early 1990s • Aims and Methods • Pioneer findings – Discursive formations of Reformism, Rationalisation, Professionalism, and Pride • Conclusions • Question to Dr Straughan • Further Questions

3. Introduction • Introduction of Recovery Model • Introduction of ‘New Ways of Working’ • Continuing need for a campaigning and critical Service-user and Survivor Movement pushing for greater social inclusion, better therapies and treatments, and to challenge the ways in which service-users/survivors are portrayed • Continuing relevance of my PhD research regarding formalisation of the Movement

4. Formalising Pressure since the early 1990s • Formal contracts in exchange for money to provide services will almost inevitably apply formalising pressure on the BUSM groups to work in the increasingly bureaucratic ways of whichever purchasing authority. • Language – purchasers own whatever service user/survivors sell – whatever the terms of the contract – buying and selling is the bottom line (contracts between user/survivors and purchasers are not awards, grants, or gifts on the whole). • The above may seem to be the obvious rules of the game – but my work has been criticised for assuming that formal contracts with NHS/social services purchasing authorities will inevitably exert a formalising pressure on the service-user/survivor movement.

5. Aims & Methods The Main Aim was to explore the contradictory potential of community care policy where there is a formal relationship between local and/or health authorities and mental health services user/survivor-led groups Methods • One-to-one semi-structured interviews with 8 individual user/survivor pioneers of the movement. • 3 discussion group interviews with local activist, regional activist/researcher, and professional researcher user/survivors. • Discourse analysis was undertaken to produce findings (code statements; compare statements and identify discourses; cross-compare discourses to identify discursive formations: reformism, rationalisation, professionalism, and pride).

6. Pioneer findings: Reformism We’ll get there eventually! • Respondents’ statements which identified joint work with non-user/survivor allies, in formal and hierarchical settings, as important in the furtherance of the aim of reforming mental health services through the informal mutual support, and experience based knowledge, existing within the BUSM: To what extent people are motivated by a kind of long term desire and vision about changing society or changing mental health services - I’m not sure. I mean I think there are a proportion of people who get involved in service user groups who kind of have those feelings and maybe they’re the ones that kind of stay involved over long periods (Niall: consultant).

7. Pioneer Findings: Rationalisation If you can’t beat them - join them! • For user/survivors an acceptance of the ascendancy of formal rationality within the state may result in a belief that in order to safeguard involvement in ‘consumerist activities’ (which are valuable to the user/survivor community), the BUSM has to reluctantly engage with the dominant formal way of doing business on the terms of professionals and purchasers. In the following quote a respondent offers an analysis of formalisation from a rationalisation and reformist perspective: I think in a way it’s natural that that happens - because, eventually you’re going to need money from somewhere and with that money’s going to come responsibilities - which will mean people getting paid. But I think this kind of situation can complement the grassroots user movement - rather than create a divide - I mean it shouldn’t create a divide (Julien: user support worker)

8. Pioneer findings: Professionalism We can do it! • For user/survivors to obtain paid employment and achieve respect for professional behaviour can be personally empowering for the people involved and act as an empowering, although possibly simultaneously disempowering, role model for other user/survivors. Being professional is also about trying to provide the best available support services for user/survivors in distress and/or need: Q: Do you think motivations have changed over the last 10 years? or since you first started being involved? A: Yes, I suppose so - cause you can carve out a career as being a professional lunatic. I don’t think 20 years ago there was any idea that you could be a professional lunatic (Max: user support worker).

9. Pioneer findings: Pride Take us as we are! Respondents reported feeling a sense of pride about rejecting hierarchies, celebrate the mutual support of the BUSM, believing in the experienced based expertise of user/survivors, and openly challenging public perceptions of people in mental distress. For example: So there is a real danger that instead of having advocates, we will end up with people who act as a key worker - key workers who don’t understand the issues or it just becomes another profession. You know, there’ll be a formal, ‘this is the advocacy degree and this is how you do it’. And then that understanding of, ‘well this is what its like to be a service user and I know what it feels like to be told I’ve got to do this and do that’ - that element will get lost because you’re into your functions and your businesses and your report writing. And the reality will just disappear into yet another profession (Virginia: advocacy advisor).

10. Pioneer findings: Taxonomy • Figure 1: Discursive Tactics of Resistance Collaboration Reformism Rationalisation Informal Formal Pride Professionalism Self-reliance

11. Overarching Goals Identification of overarching tactics of pride and hope mean that the taxonomy outlined in Figure 1 can be modified in the following manner - Figure 2: Unity within user/survivor discourse: Hope Goal of pride In an informal BUSM Figure 1. Taxonomy: Tactics of Resistance

12. Selected Conclusions On the one hand, user/survivor resistance to formalisation based on pride suggests that an informal, empathetic, self-help, and altruistic culture, possibly an expression of wider political vision of empowerment, exists within the movement. On the other hand, discursive tactics of resistance such as reformism, rationalisation, and professionalism are surely examples of user/survivors coming to an accommodation with the contractual pressures to formalise their empowerment activities.

13. Question to Dr Straughan Does the launch of ‘In-Sight’ represent a new chapter in the development of the movement, with service-users and survivors practising the formal business, clinical and managerial culture of the outside world, whilst simultaneously supporting service-users and survivors when they express concerns about these formal working practices? In essence, are you re-packaging service-user and survivor concerns, capabilities, limitations, and ways of doing things, to the health authorities and outside world more generally, as something which they can, after all, live with?

14. Selected References • Armes, D. (2006), Enablement and Exploitation: the Contradictory Potential of Community Care Policy for Mental Health Services User/Survivor-led Groups,Unpublished University of Luton Doctoral Thesis. • Armes, D. (2009).Mission informed discursive tactics of British Service-User/Survivor Movement (BUSM) resistance to formalisation pressures accompanying contractual relationships with purchasing authorities.Journal of Mental Healthvol 18(4):344-352. • Barnes, M. and Bowl, R. (2001), Taking Over the Asylum: Empowerment and Mental Health, Basingstoke: Palgrave. • Curtis, T., Dellar, R., Leslie, E., and Watson, B. (eds), (2000), Madpride: A Celebration of Mad Culture, London: Spare Change Books. • Wallcraft, J., Read, J., and Sweeney, A. (2003), On Our Own Terms: Users and Survivors of Mental Health Services working Together for Support and Change, London: The Sainsbury Centre for Mental Health.