Service user involvement in Swedish mental health and social care: an analysis of ideological dilemmas and subject positions in a collaboration context

Service user involvement is steadily on the rise, bringing questions of tokenism and power imbalance. This article studies service user organisationrepresentatives (URs) and human service organisation representatives (HSORs) in mental health and social care strategic collaboration councils through qualitative interviews and participant observations. Talk on service user involvement through UR is studied through the discourse analytical concepts of ideological dilemmas and subject positions. The participants' constructions, actions, and rhetoric therein are considered. Findings show participants' oscillation between standpoints within two main themes: the ideal vs. the inadequate UR and balancing power positions. The first theme discusses the missing perspective brought by UR narrations in terms of expected conduct and awareness of organisational conditions. This also concerns service users' positions as being simultaneously dependent and independent. The second theme concerns the implicit UR influence and the explicit HSOR influence. User involvement through URs is construed as a needed narration told by citizens with rights and responsibilities, while conditioned, as the UR is a layperson with mental health problems. The actions accompanying such constructions cause HSORs to balance between paternalism and professionalism and URs between adaptation and using their voice. In this, the URs have a stronger influence than acknowledged. Brukarmedverkan okar stadigt, och med utvecklingen foljer fragor kring tokenism och maktobalans. Genom kvalitativa intervjuer och deltagande observationer undersoks har strategiska samverkansrad inom omradet psykisk ohalsa och de ingaende brukarrepresentanterna (BR) och representanterna fran manniskobehandlande organisationer (MBOR). Tal om brukarmedverkan genom BR studeras genom diskursanalytiska begrepp: ideologiska dilemman och subjektspositioner. Deltagarnas konstruktioner, handlingar och retorik fokuseras. Resultaten visar deltagarnas pendling mellan standpunkter inom tva teman: den ideala vs. den otillrackliga brukarrepresentanten samt balansera maktpositioner. Det forsta temat diskuterar det saknade perspektivet BR bidrar med genom berattelser i termer av forvantat beteende och medvetenhet om organisatoriska villkor. Detta ror aven brukarnas position som samtidigt beroende och oberoende. Det andra temat ror BRs implicita inflytande och MBORs explicita inflytande. Brukarmedverkan genom BR konstrueras som en behovd berattelse berattad av medborgare med rattigheter och skyldigheter, som samtidigt ar villkorad da BR ar lekman med psykisk ohalsa. Handlingar som foljer sadan konstruktion orsakar MBOR att balansera mellan paternalism och professionalism, och BR mellan anpassning och att anvanda sin rost. I detta har BR ett starkare inflytande an vad som erkanns.