Meeting boundaries - An empirically grounded reflection on the contribution of meeting events to changing political, social and personal conceptions of mental health.

摘要

This paper is an empirically grounded argument in which meetings are considered as events linking differences (Luhmann 2006) and thus contributing to the ongoing displacement of boundaries between self and system, and between system and environment. It draws on a research that aimed to evaluate a mental health reform in the Brussels Region (Belgium), through professional and organizational practices subsequent to a shift from institutionalized to community-based mental health care. A key objective underlying this reform is the inclusion of service users within wider society. This research was specifically designed to understand the relationship between organizational changes and services users’ care and social trajectories. It drew focus on the trajectories of people in particularly vulnerable situations, including homeless and migrant populations, as well as users suffering from mental illness and addiction problems. The research methods were designed to gather a diversity of mental health service users and professionals through meeting events (Schwartzman 1989, Freeman 2008, Duffy 2016). It combined the use of focus groups (n=4), ethnographic meetings (n=9), semi-structured interviews (n=15) and informal discussions, which aimed either to prepare the focus groups or to deepen a question raised by group discussions. Circulating through meetings enables participants, from contrasting professional status and with diverse experiences with mental health services, to meet different ways of viewing the world and of understanding mental health. As a result, participant interactions in a given setting create meetings events, construed as interrelated systems of communication (Thunus & Walker 2018), allowing for opportunities to observe and make sense of individual narratives and the social context in which they unfold in a new light. Processing newly observed differences entails the continuous displacement of boundaries within and surrounding meetings. This paper discusses how the research process focusing on meetings contributes to displacing boundaries between self, system and environment. Based on a qualitative, thematic analysis of empirical data collected through meeting events, it evidences that the research process supported incremental changes in researchers, professionals as well as users’ perspectives on the very meaning of mental health, on the care system being assessed, and on the political objective of social inclusion. Specific attention is drawn to the internationally relevant question of mental health and occupation (Eu compass for action on mental health and well-being, 2016), which dominates the research results. In this respect, this paper demonstrates that meeting gathering professionals and users with different experiences and backgrounds, which usually prevent them from meeting together, enables the emergence of an alternative conception of the question of mental health and occupation. This conception entails a clear call to shift from curative to preventive policies. To conclude, this paper thus outlines a future research aiming to raise the question of mental health and occupation at the European level, through gathering participants with different health conditions and from diverse socio-economic status.