Building in dialogue between consumers and staff in acute mental health services

This paper describes some aspects of the methodology, material, and findings from a lengthy participatory action research engagement by a consumer organization in Australia, which was undertaken in collaboration with staff at a major public psychiatric hospital and then went on to involve "players" throughout the local and national mental health services system. A small first phase established a dialogic methodology for the exchange of experiences and thinking between staff and consumers. The purpose of the second phase of the research was to explore how consumers' voices might be heard, and how staff-consumer communication about that feedback, might be "built in" to ongoing organizational structure and culture. Systems thinking about defensive routines, silences, and voice-as-discourse is reported as offering a possible way of cracking the puzzle of the closed-loop cycle of claim/blame-defense-and-counter-claimiblame-defense that has been characteristic to date.