Patient participation as discursive practice: a critical discourse analysis of Danish mental healthcare

Patient participation is one of the most prevailing focus areas in the Danish healthcare debate the resent years; also within a psychiatric context. In the literature, it is not clear what is meant by 'patient participation' and several discourses of patient participation exist side by side. This implies that professionals within the psychiatric healthcare sector and patients and their relatives each represent their legitimate focus and special perspectives on patient participation. Accordingly, this study aims to explore how patient participation is articulated in official documents and in patient records relating to a psychiatric context and to explore its implications for patients and relatives.  The study is designed as an explorative document analysis, where official documents and nurses notes in patient records from in- and outpatients in a psychiatric hospital constitute the empirical material. The documents are analyzed according to Fairclough’s critical discourse analysis and show, how patient participation is subject to discourses of biomedicine, bio-power and paternalism in both legal and governmental documents and patients’ records. Patient participation is seen as a consequence of a neoliberal society where people despite of diseases implicitly is expected to make an active effort to recover and be independent of professional help. The political documents aim to stimulate cultural changes in metal health at the operational level where the patient participation relate to a discourse of care. The visions of an individual patient-controlled treatment are overshadowed by the discourse of biomedicines demands for standardization, course packs, evidence and efficient quality requirements.