How user involvement is transforming professional work, knowledge and identities –: Studies in Danish Psychiatry

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. This, affects professional work, knowledge and identities of professionals, and may become one of the main drivers of change in knowledge bases, in professional autonomy, and in the positions of the professionals. User involvement is driven by different rationalities. Neoliberal discourses on the active responsible and empowered citizen play a dominant role, depicting this kind of empowerment as a way of rationalizing and slimming the most costly sectors of the welfare state such as social care and health care (Newman & Clarke 2009). However, also other discourses are at play. As e.g. Barnes and Coterell (2013) observe, ideas of democratization based on ideas of citizenship both in relation to professional systems, the health sector and wider society do also play a role. This is due to the upcome of strong user movements, particularly within fields as psychiatry and disability, whose main claims are recognition and ‘full citizenship’ as opposed to the dominance of professionals and the systems of the welfare state. In other fields as e.g. elderly care, rationalities of austerity and efficiency play a dominant role. Thus, user involvement takes on different forms as discussed by eg Vrangbaek, 2015, and must be studied contextually. This is important in order to understand the tensions and paradoxes that are introduced in care work (Kamp and Dybbroe, 2016; Brown and Korczynski, 2017). In this paper we present our ongoing research on user involvement in Denmark based on ethnographic field studies in 2017 and 2018 within two fields: psychiatry and elderly care, where user involvement is positioned differently. The paper points out how these differences matter when user involvement is practiced in care work. We explore how the professionals manage knowledge, meaning and professional ethics, when they engage in coproduction with patients and clients. We point out how emotional labour plays an increased role in these two fields, and we show how the balance between responsibility and risk is played out in new ways.