A participatory discourse analysis of service users’ accounts of meeting places in Norwegian community mental health care
DOI:
https://doi.org/10.7577/njsr.2149Keywords:
Participatory research, community mental health care, mental health day centres, discourse analysis, service users, sanism, social democratic welfare stateAbstract
Since the 1960s, deinstitutionalisation has been salient in mental health reforms across the West. In Norway, this culminated in the National Action Plan for Mental Health (1999-2008), where meeting places in community mental health care were deemed a prioritised strategy to counter social isolation among people in psychosocial hardships. However, during the same period in England, meeting places were beginning to be contested for contributing to social exclusion. This is an inquiry of meeting places in Norway guided by the following research question: How do service users discuss their encounters with the spaces and people of meeting places? Situated in community psychology and participatory research traditions, we engaged in a participatory discourse analysis of four focus group discussions with 22 service users from meeting places. We detail and discuss four central discursive constructions of meeting places against the backdrop of a civil society identified as fraught with sanism that stigmatises and excludes service users: a compensatory public welfare arrangement positioning service users as citizens with social rights; a peer community positioning service users as peers who share common identities and interests; spaces of compassion validating service users as fellow human beings who are precious in their own right; and greenhouses facilitating service users to expand their horizons of possibility. This inquiry implies that meeting places could mean everything to the people who attend them by facilitating opportunities considered less accessible elsewhere in their everyday lives in a sanist civil society.
References
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Argentzell, E., Håkansson, C., & Eklund, M. (2012). Experience of meaning in everyday occupations among unemployed people with severe mental illness. Scandinavian Journal of Occupational Therapy, 19(1), 49-58. https://doi.org/10.3109/11038128.2010.540038
Argentzell, E., Leufstadius, C., & Eklund, M. (2012). Factors influencing subjective perceptions of everyday occupations: Comparing day centre attendees with non-attendees. Scandinavian Journal of Occupational Therapy, 19, 68-77. https://doi.org/10.3109/11038128.2011.560963
Bachke, C. C., & Larsen, I. B. (2017). Fra behandling til recovery. En review-studie av forskning på dagsenter for mennesker med psykiske lidelser [From treatment to recovery. A literature review of research on day centers for people with mental health problems]. Nordisk Tidsskrift for Helseforskning, 13(2). https://dx.doi.org/10.7557/14.4213
Bergem, R., & Ekeland, T. J. (2006). Citizenship of people with mental illness [only in Norwegian]. Tidsskrift for Velferdsforskning, 9, 26-38.
Borg, M., & Kristiansen, K. (Eds.). (2009). Medforskning: Å forske sammen for kunnskap om psykisk helse [Service user involvement in research: Doing research together for knowledge about mental health]. Oslo, Norway: Universitetsforlaget.
Brandal, N., Bratberg, Ø., & Thorsen, D. E. (2013). The Nordic model of social democracy. London, UK: Palgrave Macmillan. https://doi.org/10.1057/9781137013279
Bryant, W. (2011). Mental Health Day services in the United Kingdom from 1946 to 1995: An 'untidy set of services'. The British Journal of Occupational Therapy, 74, 554-561. https://doi.org/10.4276/030802211X13232584581371
Bryant, W., Craik, C., & McKay, E. A. (2004). Living in a glasshouse: Exploring occupational alienation. Canadian Journal of Occupational Therapy, 71, 282-289. https://doi.org/10.1177/000841740407100507
Brydon-Miller, M., Kral, M., Maguire, P., Noffke, S., & Sabhlok, A. (2011). Jazz and the Banyan tree. Roots and riffs on participatory action research. In N. K. Denzin, & Y. S. Lincoln (Eds.), The Sage handbook of qualitative research (4th ed., pp. 387-400). Thousand Oaks, CA: Sage.
Catty, J. S., Burns, T., Comas, A., & Pool, Z. (2008). Day centres for severe mental illness (review). The Cochrane Library, 3, 1-16. https://doi.org/10.1002/14651858.CD001710.pub2
Chamberlin, J. (1990). The ex-patients' movement: Where we've been and where we're going. The Journal of Mind and Behavior, 11, 323-336.
Dencker-Larsen, S., & Lundberg, K. G. (2016). Depicted welfare-recipient stereotypes in Norway and Denmark: A photo-elicitation study. Nordic Journal of Social Research, 7. https://doi.org/10.7577/njsr.2098
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Ekeland, T. J., Stefansen, J., & Steinstø, N. O. (2011). Clinical autonomy in the era of evidence. Governmental challenges for clinical practice. Tidsskrift for Velferdsforskning, 14(1), 2-14.
Eklund, M., Hansson, L., & Ahlqvist, C. (2004). The importance of work as compared to other forms of daily occupations for wellbeing and functioning among persons with long-term mental illness. Community Mental Health Journal, 40(5), 465-477. https://doi.org/10.1023/B:COMH.0000040659.19844.c2
Eklund, M., & Sandlund, M. (2014). Predictors of valued everyday occupations, empowerment and satisfaction in day centres: Implications for services for persons with psychiatric disabilities. Scandinavian Journal of Caring Sciences, 28(3), 582-590. https://doi.org/10.1111/scs.12085
Eklund, M., & Tjörnstrand, C. (2013). Psychiatric rehabilitation in community-based day centres: Motivation and satisfaction. Scandinavian Journal of Occupational Therapy, 20(6), 438-445. https://doi.org/10.3109/11038128.2013.805428
Elstad, T. A., & Eide, A. H. (2009). User participation in community mental health services: Exploring the experiences of users and professionals. Scandinavian Journal of Caring Sciences, 23, 674–681.https://doi.org/10.1111/j.1471-6712.2008.00660.x
Evans-Lacko, S., Knapp, M., McCrone, P., Thornicroft, G., & Mojtabai, R. (2013). The mental health consequences of the recession: Economic hardship and employment of people with mental health problems in 27 European countries. PLoS One, 8, e69792. https://doi.org/10.1371/journal.pone.0069792
Fine, M. (2012). Troubling calls for evidence: A critical race, class and gender analysis of whose evidence counts. Feminism & Psychology, 22, 3-19. https://doi.org/10.1177/0959353511435475
Fjellfeldt, M., Eklund, M., Sandlund, M., & Markström, U. (2016). Implementation of choice from participants’ perspectives: A study of community mental healthcare reform in Sweden. Journal of Social Work in Disability & Rehabilitation, 15(2), 116-133. https://doi.org/10.1080/1536710X.2016.1162121
Foucault, M. (1988). Madness and civilization: A history of insanity in the age of reason (R. Howard, Trans.). New York, NY: Vintage Books. (Original work published 1961)
Hall, S., & Cheston, R. (2002). Mental health and identity: The evaluation of a drop-in centre. Journal of Community & Applied Social Psychology, 12, 30-43. https://doi.org/10.1002/casp.639
Hamre, B., Fristrup, T., & Christensen, G. (2016). The subject of exemption: Through discourses of normalization and individualization in Denmark. Nordic Journal of Social Research, 7. https://doi.org/10.15845/njsr.v7i0.899
Harvey, D. (2005). A brief history of neoliberalism. Oxford, UK: Oxford University Press.
Hedegaard, T. F. (2016). Neo-liberalism and the Nordic welfare model: A study of the liberal alliance and ideological adaptation in Denmark. Nordic Journal of Social Research, 7. https://doi.org/10.7577/njsr.2099
Horghagen, S., Fostvedt, B., & Alsaker, S. (2014). Craft activities in groups at meeting places: Supporting mental health users' everyday occupations. Scandinavian Journal of Occupational Therapy, 21, 145-152. https://doi.org/10.3109/11038128.2013.866691
Kalseth, J., Pettersen, I., & Kalseth, B. (2008). Psykisk helsearbeid i kommunene - tiltak og tjenester. Status 2007/2008 og utvikling i Opptrappingsplanperioden. [Community mental health care in municipalities - initiatives and services. Status 2007/2008 and developments in the Action Plan period] (SINTEF report A8823). Trondheim, Norway: SINTEF. Retrieved from http://www.sintef.no
Larsen, I. B. (2015). Dialogiske omgivelser som betydningsfulle for mennesker med psykiske problemer. ‘Vi blir friskere av å gå her’ [Dialogical environments as significant for people with psychological problems. ‘We become healthier from attending this place’]. In D. Ulland, A. B. Thorød, & E. Ulland (Eds.), Psykisk helse. Nye arenaer, aktører og tilnærminger (pp. 30-37). Oslo: Universitetsforlaget.
Larsen, I. B., & Topor, A. (2017). A place for the heart: A journey in the post-asylum landscape. Metaphors and materiality. Health and Place, 45, 145-151. https://doi.org/10.1016/j.healthplace.2017.03.015
LeFrancois, B. A., Menzies, R., & Reaume, G. (Eds.). (2013). Mad matters: A critical reader in Canadian mad studies. Toronto, Canada: Canadian Scholar's Press Inc.
Malterud, K. (2012). Fokusgrupper som forskningsmetode for medisin og helsefag [Focus groups as a research method for medicine and health sciences]. Oslo: Universitetsforlaget.
Mattheys, K. (2015). The coalition, austerity and mental health. Disability & Society, 30, 475-478. https://doi.org/10.1080/09687599.2014.1000513
Ministry of Health and Care Services. (1998). Om opptrappingsplan for psykisk helse 1999-2006. St.prp. nr. 63 (1997-98). [Report No. 63 to the Storting (1997–1998) on the Escalation plan for mental health 1999–2006]. Oslo, Norway: Ministry of Health and Care Services.
National Social Inclusion Programme. (2008). From segregation to inclusion: Where are we now? A review of progress towards the implementation of the Mental Health Day services commissioning guidance. London, UK: National Inclusion Programme.
Nelson, G., Prilleltensky, I., & MacGillivary, H. (2001). Building value-based partnerships: Toward solidarity with oppressed groups. American Journal of Community Psychology, 29, 649-677. https://doi.org/10.1023/A:1010406400101
Nilsson, I., Argentzell, E., Sandlund, M., Leufstadius, C., & Eklund, M. (2011). Measuring perceived meaningfulness in day centres for persons with mental illness. Scandinavian Journal of Occupational Therapy, 18(4), 312-320. https://doi.org/10.3109/11038128.2010.522592
Norwegian Council for Mental Health. (1995). Velferdsstatens forsømte gruppe [The neglected group of the welfare state]. Oslo: The Norwegian Council for Mental Health. Retrieved from http://www.nb.no/nbsok/nb/da967be511dbc872a612f7f5d3add109.nbdigital?lang=no#6
Norwegian Directorate of Health. (2005). Veileder. Psykisk helsearbeid for voksne i kommunene [Guidance. Community mental health care for adults in the municipality]. Oslo, Norway: Norwegian Directorate of Health.
O'Malley, P. (2009). Responsibilization. In A. Wakefield & J. Fleming (Eds.), The SAGE dictionary of policing (pp. 277-279). London, UK: SAGE Publications Ltd. https://doi.org/10.4135/9781446269053
Osborg Ose, S., & Slettebak, R. T. (2012). Kommunale tiltak i psykisk helsearbeid 2012. Årsverksstatistikk og analyser av kommunal variasjon [Municipal activity in community mental health care 2012. Statistics on full time equivalents and analyses of municipal variations]. (SINTEF report No 60H215/ 102001067). Trondheim, Norway: SINTEF. Retrieved from http://www.sintef.no
Parker, I. (2014). Discourse dynamics: Critical analysis for social and individual psychology. London: Routledge. (Original work published in 1992)
Pinford, V. (2000). 'Building up safe havens...all around the world': Users' experiences of living in the community with mental health problems. Health & Place, 6, 201-212. https://doi.org/10.1016/S1353-8292(00)00023-X
Rise, M. B., Westerlund, H., Bjørgen, D., & Steinbekk, A. (2013). Safely cared for or empowered in mental health care? Yes, please. International Journal of Social Psychiatry, 60, 134-138. https://doi.org/10.1177/0020764012471278
Social Exclusion Unit. (2004). Mental health and social exclusion. Social Exclusion Unit report. Retrieved from http://hdl.handle.net/10822/1039428
Tjörnstrand, C., Bejerholm, U., & Eklund, M. (2011). Participation in day centres for people with psychiatric disabilities: Characteristics of occupations. Scandinavian Journal of Occupational Therapy, 18, 243-253. https://doi.org/10.3109/11038128.2011.583938
Ynnesdal Haugen, L. S., Envy, A., Borg, M., Ekeland, T. J., & Anderssen, N. (2016). Discourses of service user involvement in meeting places in Norwegian community mental health care: A discourse analysis of staff accounts. Disability & Society, 31(1-2), 1-18. https://doi.org/10.1080/09687599.2016.1139489
Andersson, M., Eklund, M., Sandlund, M., & Markström, U. (2016). Freedom of choice or cost efficiency? The implementation of a free-choice market system in community mental health services in Sweden. Scandinavian Journal of Disability Research, 18, 129-141. https://doi.org/10.1080/15017419.2014.995220
Andvig, E., & Hummelvoll, J. K. (2016). ‘I dare’: Experiences of young adults at risk participating in a one-year inclusive-theater project in Norway. Nordic Journal of Social Research, 7. https://doi.org/10.15845/njsr.v7i0.873
Argentzell, E., Håkansson, C., & Eklund, M. (2012). Experience of meaning in everyday occupations among unemployed people with severe mental illness. Scandinavian Journal of Occupational Therapy, 19(1), 49-58. https://doi.org/10.3109/11038128.2010.540038
Argentzell, E., Leufstadius, C., & Eklund, M. (2012). Factors influencing subjective perceptions of everyday occupations: Comparing day centre attendees with non-attendees. Scandinavian Journal of Occupational Therapy, 19, 68-77. https://doi.org/10.3109/11038128.2011.560963
Bachke, C. C., & Larsen, I. B. (2017). Fra behandling til recovery. En review-studie av forskning på dagsenter for mennesker med psykiske lidelser [From treatment to recovery. A literature review of research on day centers for people with mental health problems]. Nordisk Tidsskrift for Helseforskning, 13(2). https://dx.doi.org/10.7557/14.4213
Bergem, R., & Ekeland, T. J. (2006). Citizenship of people with mental illness [only in Norwegian]. Tidsskrift for Velferdsforskning, 9, 26-38.
Borg, M., & Kristiansen, K. (Eds.). (2009). Medforskning: Å forske sammen for kunnskap om psykisk helse [Service user involvement in research: Doing research together for knowledge about mental health]. Oslo, Norway: Universitetsforlaget.
Brandal, N., Bratberg, Ø., & Thorsen, D. E. (2013). The Nordic model of social democracy. London, UK: Palgrave Macmillan. https://doi.org/10.1057/9781137013279
Bryant, W. (2011). Mental Health Day services in the United Kingdom from 1946 to 1995: An 'untidy set of services'. The British Journal of Occupational Therapy, 74, 554-561. https://doi.org/10.4276/030802211X13232584581371
Bryant, W., Craik, C., & McKay, E. A. (2004). Living in a glasshouse: Exploring occupational alienation. Canadian Journal of Occupational Therapy, 71, 282-289. https://doi.org/10.1177/000841740407100507
Brydon-Miller, M., Kral, M., Maguire, P., Noffke, S., & Sabhlok, A. (2011). Jazz and the Banyan tree. Roots and riffs on participatory action research. In N. K. Denzin, & Y. S. Lincoln (Eds.), The Sage handbook of qualitative research (4th ed., pp. 387-400). Thousand Oaks, CA: Sage.
Catty, J. S., Burns, T., Comas, A., & Pool, Z. (2008). Day centres for severe mental illness (review). The Cochrane Library, 3, 1-16. https://doi.org/10.1002/14651858.CD001710.pub2
Chamberlin, J. (1990). The ex-patients' movement: Where we've been and where we're going. The Journal of Mind and Behavior, 11, 323-336.
Dencker-Larsen, S., & Lundberg, K. G. (2016). Depicted welfare-recipient stereotypes in Norway and Denmark: A photo-elicitation study. Nordic Journal of Social Research, 7. https://doi.org/10.7577/njsr.2098
Denzin, N. K., & Lincoln, Y. S. (2011). Introduction. In N. K. Denzin, & Y. S. Lincoln (Eds.), The Sage handbook of qualitative research (4th ed., pp. 1-19). Thousand Oaks, CA: Sage.
Ekeland, T. J., Stefansen, J., & Steinstø, N. O. (2011). Clinical autonomy in the era of evidence. Governmental challenges for clinical practice. Tidsskrift for Velferdsforskning, 14(1), 2-14.
Eklund, M., Hansson, L., & Ahlqvist, C. (2004). The importance of work as compared to other forms of daily occupations for wellbeing and functioning among persons with long-term mental illness. Community Mental Health Journal, 40(5), 465-477. https://doi.org/10.1023/B:COMH.0000040659.19844.c2
Eklund, M., & Sandlund, M. (2014). Predictors of valued everyday occupations, empowerment and satisfaction in day centres: Implications for services for persons with psychiatric disabilities. Scandinavian Journal of Caring Sciences, 28(3), 582-590. https://doi.org/10.1111/scs.12085
Eklund, M., & Tjörnstrand, C. (2013). Psychiatric rehabilitation in community-based day centres: Motivation and satisfaction. Scandinavian Journal of Occupational Therapy, 20(6), 438-445. https://doi.org/10.3109/11038128.2013.805428
Elstad, T. A., & Eide, A. H. (2009). User participation in community mental health services: Exploring the experiences of users and professionals. Scandinavian Journal of Caring Sciences, 23, 674–681.https://doi.org/10.1111/j.1471-6712.2008.00660.x
Evans-Lacko, S., Knapp, M., McCrone, P., Thornicroft, G., & Mojtabai, R. (2013). The mental health consequences of the recession: Economic hardship and employment of people with mental health problems in 27 European countries. PLoS One, 8, e69792. https://doi.org/10.1371/journal.pone.0069792
Fine, M. (2012). Troubling calls for evidence: A critical race, class and gender analysis of whose evidence counts. Feminism & Psychology, 22, 3-19. https://doi.org/10.1177/0959353511435475
Fjellfeldt, M., Eklund, M., Sandlund, M., & Markström, U. (2016). Implementation of choice from participants’ perspectives: A study of community mental healthcare reform in Sweden. Journal of Social Work in Disability & Rehabilitation, 15(2), 116-133. https://doi.org/10.1080/1536710X.2016.1162121
Foucault, M. (1988). Madness and civilization: A history of insanity in the age of reason (R. Howard, Trans.). New York, NY: Vintage Books. (Original work published 1961)
Hall, S., & Cheston, R. (2002). Mental health and identity: The evaluation of a drop-in centre. Journal of Community & Applied Social Psychology, 12, 30-43. https://doi.org/10.1002/casp.639
Hamre, B., Fristrup, T., & Christensen, G. (2016). The subject of exemption: Through discourses of normalization and individualization in Denmark. Nordic Journal of Social Research, 7. https://doi.org/10.15845/njsr.v7i0.899
Harvey, D. (2005). A brief history of neoliberalism. Oxford, UK: Oxford University Press.
Hedegaard, T. F. (2016). Neo-liberalism and the Nordic welfare model: A study of the liberal alliance and ideological adaptation in Denmark. Nordic Journal of Social Research, 7. https://doi.org/10.7577/njsr.2099
Horghagen, S., Fostvedt, B., & Alsaker, S. (2014). Craft activities in groups at meeting places: Supporting mental health users' everyday occupations. Scandinavian Journal of Occupational Therapy, 21, 145-152. https://doi.org/10.3109/11038128.2013.866691
Kalseth, J., Pettersen, I., & Kalseth, B. (2008). Psykisk helsearbeid i kommunene - tiltak og tjenester. Status 2007/2008 og utvikling i Opptrappingsplanperioden. [Community mental health care in municipalities - initiatives and services. Status 2007/2008 and developments in the Action Plan period] (SINTEF report A8823). Trondheim, Norway: SINTEF. Retrieved from http://www.sintef.no
Larsen, I. B. (2015). Dialogiske omgivelser som betydningsfulle for mennesker med psykiske problemer. ‘Vi blir friskere av å gå her’ [Dialogical environments as significant for people with psychological problems. ‘We become healthier from attending this place’]. In D. Ulland, A. B. Thorød, & E. Ulland (Eds.), Psykisk helse. Nye arenaer, aktører og tilnærminger (pp. 30-37). Oslo: Universitetsforlaget.
Larsen, I. B., & Topor, A. (2017). A place for the heart: A journey in the post-asylum landscape. Metaphors and materiality. Health and Place, 45, 145-151. https://doi.org/10.1016/j.healthplace.2017.03.015
LeFrancois, B. A., Menzies, R., & Reaume, G. (Eds.). (2013). Mad matters: A critical reader in Canadian mad studies. Toronto, Canada: Canadian Scholar's Press Inc.
Malterud, K. (2012). Fokusgrupper som forskningsmetode for medisin og helsefag [Focus groups as a research method for medicine and health sciences]. Oslo: Universitetsforlaget.
Mattheys, K. (2015). The coalition, austerity and mental health. Disability & Society, 30, 475-478. https://doi.org/10.1080/09687599.2014.1000513
Ministry of Health and Care Services. (1998). Om opptrappingsplan for psykisk helse 1999-2006. St.prp. nr. 63 (1997-98). [Report No. 63 to the Storting (1997–1998) on the Escalation plan for mental health 1999–2006]. Oslo, Norway: Ministry of Health and Care Services.
National Social Inclusion Programme. (2008). From segregation to inclusion: Where are we now? A review of progress towards the implementation of the Mental Health Day services commissioning guidance. London, UK: National Inclusion Programme.
Nelson, G., Prilleltensky, I., & MacGillivary, H. (2001). Building value-based partnerships: Toward solidarity with oppressed groups. American Journal of Community Psychology, 29, 649-677. https://doi.org/10.1023/A:1010406400101
Nilsson, I., Argentzell, E., Sandlund, M., Leufstadius, C., & Eklund, M. (2011). Measuring perceived meaningfulness in day centres for persons with mental illness. Scandinavian Journal of Occupational Therapy, 18(4), 312-320. https://doi.org/10.3109/11038128.2010.522592
Norwegian Council for Mental Health. (1995). Velferdsstatens forsømte gruppe [The neglected group of the welfare state]. Oslo: The Norwegian Council for Mental Health. Retrieved from http://www.nb.no/nbsok/nb/da967be511dbc872a612f7f5d3add109.nbdigital?lang=no#6
Norwegian Directorate of Health. (2005). Veileder. Psykisk helsearbeid for voksne i kommunene [Guidance. Community mental health care for adults in the municipality]. Oslo, Norway: Norwegian Directorate of Health.
O'Malley, P. (2009). Responsibilization. In A. Wakefield & J. Fleming (Eds.), The SAGE dictionary of policing (pp. 277-279). London, UK: SAGE Publications Ltd. https://doi.org/10.4135/9781446269053
Osborg Ose, S., & Slettebak, R. T. (2012). Kommunale tiltak i psykisk helsearbeid 2012. Årsverksstatistikk og analyser av kommunal variasjon [Municipal activity in community mental health care 2012. Statistics on full time equivalents and analyses of municipal variations]. (SINTEF report No 60H215/ 102001067). Trondheim, Norway: SINTEF. Retrieved from http://www.sintef.no
Parker, I. (2014). Discourse dynamics: Critical analysis for social and individual psychology. London: Routledge. (Original work published in 1992)
Pinford, V. (2000). 'Building up safe havens...all around the world': Users' experiences of living in the community with mental health problems. Health & Place, 6, 201-212. https://doi.org/10.1016/S1353-8292(00)00023-X
Rise, M. B., Westerlund, H., Bjørgen, D., & Steinbekk, A. (2013). Safely cared for or empowered in mental health care? Yes, please. International Journal of Social Psychiatry, 60, 134-138. https://doi.org/10.1177/0020764012471278
Social Exclusion Unit. (2004). Mental health and social exclusion. Social Exclusion Unit report. Retrieved from http://hdl.handle.net/10822/1039428
Tjörnstrand, C., Bejerholm, U., & Eklund, M. (2011). Participation in day centres for people with psychiatric disabilities: Characteristics of occupations. Scandinavian Journal of Occupational Therapy, 18, 243-253. https://doi.org/10.3109/11038128.2011.583938
Ynnesdal Haugen, L. S., Envy, A., Borg, M., Ekeland, T. J., & Anderssen, N. (2016). Discourses of service user involvement in meeting places in Norwegian community mental health care: A discourse analysis of staff accounts. Disability & Society, 31(1-2), 1-18. https://doi.org/10.1080/09687599.2016.1139489
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2018-03-21
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Ynnesdal Haugen, L. S., Andreas Envy, A., Ekeland, T.-J., Borg, M., & Anderssen, N. (2018). A participatory discourse analysis of service users’ accounts of meeting places in Norwegian community mental health care. Nordic Journal of Social Research, 9. https://doi.org/10.7577/njsr.2149
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