Brugerinddragelse i psykiatrien: professionel viden, ansvar og relationsarbejde i forandring.

User involvement is currently a cornerstone in the transformation of the health sector in most Western European countries, as part of a “shared governance for health “(Kickbusch ,2011) involving citizens as co-producers with new roles, responsibilities and duties in relation to health provision (Barnes and Cotterell 2013). This, affects professional work, knowledge and identities of professionals, and may become one of the main drivers of change in knowledge bases, in clinical decision making, and in the positions of the professionals.

In this paper we will present research on user involvement in the health sector in Denmark in 2017, based on ethnographic field studies within psychiatry. In psychiatry users are supposed to take on a major responsibility for mastering and monitoring their own health, and so cooperation with the patient is a centerpiece for professional work in psychiatry, but particularly so in the outpatient part of the sector where our study takes place. To include patients’ choices and life situations is considered essential for successful care and treatment. Engaging in long term relations and managing affections is a core competency and yet an absolutely tacit and unaccountable professional knowledge, which enables user involvement. We explore how the professionals manage knowledge and quality when they engage in coproduction with patients, and we show how the balance between responsibility and risk is played out in new ways. Focus is on how the health professionals, nurses, psychiatrists, physiotherapists and psychologists, struggle to meet the patients’ requests while maintaining their professionalism. I.e. the professionals direct their work towards individuals, which coincides with gate-keeping functions.