A discourse analysis of talk about service users in early intervention in psychosis teams

Talk is a social action, used to reflect and construct versions of reality upon which future action is based (Austin, 1962; Fairclough, 1995). Constructions of psychological distress have been seen to reflect wider cultural discourses and affect the treatment of sufferers. Medical discourse has been found to be dominant in inpatient psychiatric settings (Platts, 2006) and interviews with CPNs demonstrated that they perceive organizational, legal and medical barriers to working in an empowering way with clients (Tilley, Pollock & Tait, 1999). EIP services were developed to provide community-based mental health services run on recovery principles of client empowerment and collaborative working, however they operate in a wider discursive context of risk-aversion and public protection.
The aim of this research was to investigate the ways in which EIP staff teams used different discourses to make sense of their clients’ presentations and make decisions regarding their care. EIP staff team meetings were analysed using a combined Discursive Psychology and Foucauldian Discourse Analysis approach.
Staff used three core discourses – medical, psychological and recovery – along with others to achieve particular outcomes and position themselves in relation to other stakeholders. EIP teams appeared to negotiate a number of sometimes conflicting institutional, clinical and societal pressures. They appeared to have particular difficulty in resolving the conflict arising from clients holding different recovery goals to those stipulated in EIP policy guidance, which centre on seeking employment or education. The dissonance of these conflicting pressures generated anxiety that was managed in various ways including locating problems within clients. As a result, staff were seen to neglect potential environmental contributors to clients’ difficulties and the inherent contradictions in their own roles. I proposed Open Dialogue as an alternative service delivery model which has the potential to address some of the difficulties EIP currently experience.