Involving Disadvantaged People in Dialogue: Arguments and Examples from Mental Health Care

Abstract

This paper examines the theoretical and practical basis for engaging in dialogue with very disadvantaged people. Using a selective literature review, conceptual analysis, and clinical examples, we explore the reasonable limits of dialogue with disadvantaged populations in order to better understand dialogue, as well as to explore ways to effectively involve disadvantaged people in dialogue. Although people with serious mental illness represent only one very disadvantaged population, we suggest that examining dialogue with this population can serve as a test case for dialogue with disadvantaged people more generally. A recovery-oriented approach can support dialogue processes with people who have mental illness, as their recovery may require, or at least benefit from, dialogue. The inclusion of two clinical scenarios serves to highlight differences in clinical and personal recovery outcomes when dialogue is and is not present in mental health care. Furthermore, although it is not required from a standard principles-based bioethical approach, involving people with mental health issues in dialogue can complement a standard bioethics approach, through dialogical bioethics. A dialogical approach goes beyond the standard principles of bioethics by means of a process that allows relevant bioethical principles to be prioritised, based in part on the person’s informed choice. Overall, our findings suggest that involving very disadvantaged people in dialogue – in this case, people with serious mental illness – is not only possible, it is plausible and can be constructive in relation to a variety of dialogical aims that range from informing to supporting to decision-making processes.