Conceptualizing the outcomes of involving people who use mental health services in policy development.

CONTEXT: Inclusion of people who use mental health services in policymaking is a goal of many mental health systems. However, the outcomes of such involvement have not been well articulated or researched.
OBJECTIVES: The objectives of this research were to explore how the social and personal outcomes of citizen-user involvement in mental health policymaking were conceptualized by policy actors and to create a conceptual framework to guide the development and evaluation of citizen-user involvement.
DESIGN: This qualitative instrumental case study explored the phenomenon of citizen-user involvement using the policy field of mental health and social housing policy in the Province of Manitoba, Canada, as the focal case. PARTICIPANTS: A total of 21 informants from four policy actor groups, citizen-users, representatives of advocacy organizations, government officials and service providers, participated in key informant interviews. Data also included policy documents relevant to the policy field. ANALYSIS: Data collected from interviews and policy documents were analysed using an inductive qualitative paradigm.
RESULTS: Participants identified multiple outcomes of citizen-user involvement in policymaking. The resulting conceptual framework illustrated how outcomes in personal, substantive, instrumental and normative dimensions influence micro-, meso- and macrosocial structures. The results also provided a cautionary tale by suggesting how attention needs to be paid to managing the risks as well as optimizing the rewards of involvement.
CONCLUSIONS: The framework has application in guiding the development and evaluation of mechanisms that aim to involve citizen-users in policymaking. The framework encourages an approach that takes into account the complexity and multidimensional nature of engaging citizen-users.