Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Adv Health Sci Educ Theory Pract. 2024 Mar;29(1):273-300. doi: 10.1007/s10459-023-10240-z. Epub 2023 May 29.
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.
有意义的服务使用者参与卫生专业教育需要将受健康挑战影响的“外行”所拥有的知识融入到专业理论和实践中。让服务使用者参与进来重新定义了谁的知识“重要”，并意味着权力的转移。这种转变在精神卫生领域尤为重要，因为卫生专业人员和服务使用者之间的权力不平衡更加突出。然而，对服务使用者参与精神卫生专业教育的文献综述并没有很好地探讨权力在这项工作中是如何体现的。与此同时，批判和疯狂研究学者强调，如果没有真正的权力转移，包容实践可能会导致有害的后果。我们进行了一项批判性审查，以探讨描述服务使用者参与精神卫生专业教育的文献中是如何处理权力问题的。我们的团队使用共同生产的方法和批判理论来识别权力在这项工作中是如何隐含和显式地运作的，以揭示服务使用者参与可能无意中延续的不平等和权力结构。我们表明，权力渗透在服务使用者参与精神卫生专业教育中，但很少被看到。我们还认为，由于错过了定位权力的机会，文献为一系列认识论不公正现象做出了贡献，这些现象揭示了精神卫生专业教育中合法知识的轮廓及其新自由主义基础。最终，我们呼吁进行批判性的转变，将重点放在权力关系上，以释放服务使用者参与精神卫生专业教育和更广泛的卫生专业教育中的社会正义导向的变革潜力。
