Recovery conversations: The centrality of consumer participation in developing and sustaining recovery-oriented public mental health services for people experiencing low prevalence disorders and enduring mental illness in the Loddon Mallee catchment in Victoria

Submission note: A thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy by published work to the La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bundoora.

Thesis with publications.

This thesis reports on a cooperative inquiry that explored the way consumer participation is utilised in the development and sustenance of a recovery-oriented clinical mental health service. Particular attention was paid to the way the participation of people experiencing a low prevalence disorder was acknowledged and accommodated within the service. The study was underpinned by a participatory, relational methodology and was guided by an organisational action research method. Participants included consumers, clinicians and a carer, who over a 12-month period, reflected together on the meaning of recovery and recovery-oriented mental health services. At a service delivery level understanding of consumer participation, recovery and recovery-oriented care appeared to be underdeveloped. Consumer participation, identified as a concept to promote recovery-oriented care was mapped against key service functions and was identified as being poorly integrated within the service. Asymmetrical power in health care relationships, dominant biomedical perspectives and participation frameworks contributed to the under utilisation of the knowledge of the people who use the mental health service. Leadership, governance and culture, evidence-based programs and evaluations have the potential to enable new ways of working to be embedded in mental health services. An organisational change approach that draws on the concept of co-production is recommended to strengthen the existing consumer participation framework. An explicit organisation change approach supports culture change toward recovery-oriented practice at a service delivery level.