Towards a Radical Methodology of Mental Health: The Case of Participatory Action Research (PAR)

Mark Bertram, Vocational Service Manager, South London and Maudsley Trust (Lambeth), UK Mark.Bertram@slam.nhs.uk

Jason L. Powell, Lecturer in Social Policy and Social Gerontology, School of Community, Health Sciences and Social Care, University of Salford, UK jasonpwll@aol.com

Key words: Mental Health; Oppression; Research Epistemology; Participatory Action Research

‘The scientific look is no act of communion. The very idea of a sacrament of the present moment is, scientifically worthless nonsense. It has no objective existence, therefore it has no epistemological value. Whatever shadowy existence it may guardedly be granted has no real existence in objective time and space. That is as much to say: we have been abolished, and can only wait to be demolished. We need to find a proper balance between the claims on our judgement from our raw, wild, untamed experience, and the claims of objective rationality’ (Laing, R.D., 1982, p26).

‘[The] experiential encounter with the presence of the world is the ground of our being and knowing…our experience cannot be confused with symbolic construct’ (Heron and Reason, 1997, p2).

The nature of research "inside" the ‘field’ of mental health has predominantly taken on a privileged ‘scientific’ foundation and ethos which does not allow for sentient or existential reflection to which Heron and Reason (1997) point to, and much to the passionate disdain of R.D Laing (1982). Indeed, the scientific ‘medical model’ is literally a global influence that perceives mental illness, in particular, as related to physical, psychological and biological 'problems'. Such 'problems' are tied to very narrow individualistic explanations that centre on the pathologisation of minds and bodies. Such a perspective has held dominant ideas that helped shape and legitimise policies of mental health and subsequent inequality (Sim, 1990; Wahidin and Powell, 2001). Indeed, ‘mental illness’ throughout the past hundred years has been seen as a ‘medical problem’ and this predominant perspective is evident through the language used by researchers, policy makers, mass media and the general public (Sim, 1990). The master narrative of mental illness still begins and ends with the thorny problem of physical decline. In western culture, the ideological myths about the mind and body are the 'bottom line' - subject to rise and consolidation of ‘metaphors of pathology’ such as ‘abnormality’ and ‘madness’ (Sim, 1990; Powell and Biggs, 2000). Insofar as there is a history of mental illness, there is also a history of governmental efforts to control and regulate classified ‘mentally ill’ subjects (Foucault, 1966). The grand medical narratives of the body and mind hides the location of complex intersections of negative ideas about mental illness and ‘madness’ in western culture (Foucault, 1966; Powell and Biggs, 2000).

Henceforth, within the mental health field there are considerable challenges because of power imbalances and the desire for knowledge construction to be ‘certain’ and ‘expert’ due to the ‘inspecting gaze’ (Foucault, 1977, 77) on the part of professionals. It is important to recognise then that research is always a power process which takes place in a particular political and socio-economic context. This paper faces up to the challenge of traditional research methodology and stresses the importance of a radically new approach entitled ‘participatory action research’ (PAR) to both applied research and inter-relationships between service users and providers.

Nevertheless, before we embark on the methodological journey relating to insights from PAR, we need to assess the relevance of ‘traditional’ methodology and epistemology to mental health and research in general.

Traditional research methods on mental health have been increasingly criticised in relation to anti-oppressive research, because they fail to recognise and deal with the political context in which social research takes place, and they detach from societal processes those who are exploited and ruled over such as professional power and those labelled as ‘mentally ill’ (Powell, 2001). Despite this, the current UK government is attempting to deliver a programme of modernising mental health services informed by research (DoH., 1999, 2001). The National Institute for Mental Health in England states "The institute will bring together the research…and ensure the development of evidence based mental health services" (DoH., 2001, p4). The core assumption is that evidence drawn from very positivist randomised controlled trials (R.C.T.) or meta-analyses generally form an ‘objective’ and ‘value free’ basis for determining the shape and function of future services (Reynolds, 2000). Indeed, funding by R&D Department of Health still is contingent on using positivist methodology and less emphasis on ethnography. Precedence given to this positivist method is made explicit in the National Service Framework for mental health (DoH, 1999) (which grades the evidence from (R.C.T.) as type 1 to service user views/expert opinion as type 5).

Thus, contemporary Department of Health (2001) research guidance with its emphasis placed on random trial models can be criticised as assuming that reality consists of a world of 'objectively defined facts' (Jupp, 1994), and for not exploring underlying values, assumptions and theories informing the research process. As Jupp (1994, 74-8) claims data that is selected, collected and then presented as facts does not derive from a neutral stance of scientific objectivity. It originates from pragmatism as well as from a value base, the social construction of ideas and propositions belonging to the practitioner researcher, and if there is one, the funding body or supervisor.

Such critiques of a positivist methodology have led researchers such as Dale Spender (1983, 28 quoted in Powell, 2002, in press) to argue that:

'I do not subscribe to a static theory of society or knowledge. I believe everything to be in a state of flux and that any theory or conceptualisation is drilling a sample at an arbitrary point - try again tommorrow or in another place and you will get a different result. This has meant I tolerate ambiguity and contradiction. I find it 'logical' to acdept that women have different life experiences and that this gives rise to different interpretations and that all are equally valid'.

Spender's contention that all interpretations are equally valid has been reflected in some recent postmodern methodologies. It represents a version of what Fiona Williams (1994, 61) has termed 'pure relativist postmodernism'. However, this perspective is open to criticism. If all interpretations of the world are equally valid then the openly oppressive and the anti-oppressive perspectives are equivalent. The broad enlightenment project, that assumes it is possible to understand, interpret and change the world is discarded, and from this perspective, notions of structured inequality and the prospects for overcoming this are lost. Rather, it is important to recognise oppression as a socially constructed phenomena that arose with the capitalist mode of production. Thus as well as recognising the importance of human agency or subjects' understanding and interpretations of the world it is equally important to have recognition of structural manifestations of oppression. This is a phenomenon which affects, restricts, oppresses the lives of people defined as ‘mentally ill’ as well as, on occasions, promoting collective responses and anti-oppressive action. Thus, an empowering research methodology...must be grounded in the struggle against structured oppression.

We also believe that anti-oppressive methodology such as PAR should incorporate an understanding of social life which regards social divisions as basic phenomena which condition our lives and thought and that it is therefore important to explore the alternative ways of conducting research which are not constrained by the dominant conventions.

As a result of such concerns, anti-oppressive research methodologies have begun to emerge over the past decade or so to offer constructive alternatives to mainstream research which arguably tends to perpetuate rather than challenge social divisions by accepting taken-for-granted premises about social relationships (Powell, 2001). It is also crucial in carrying out anti-discriminatory research to move away from pathological perspectives, to an understanding of mental health and power in professions being determined by discriminatory institutional processes, procedures and attitudes.

Another factor to take into account when carrying out social research is the relationship between the researcher and the research process, and the relevance of the researcher's personal experience. This approach is critical of the notion of scholarly detachment which involves 'removing' ourselves from the events and processes which we describe, and which does not consider how researchers cope with the actual experiences of the research process. As such, it challenges the view amongst the ‘traditional’ research community that personal experience typically is irrelevant to mainstream research, or is thought to contaminate a project's objectivity. As Powell (2001) points out, acknowledging an emotional terrain contradicts positivist approaches where the investigator disembodies objective recorders of truth.

The introduction of PAR ‘plugs firmly into’ feminist scholars’ belief that the ‘personal’ is the crucial variable which is present in each and every attempt to 'do research', and that consciousness and experience should be made explicit within the research, rather than being disguised through claims of 'objectivity' and 'science'. That is, the kind of person we are, our involvement and our knowledge, influence how we experience the research, and have a crucial impact on what we see and what we do (Powell, in press). By doing participatory work where we have a personal commitment, our academic and professional contributions are more likely to come out of a personal, creative, politically engaged self, one that has a social, and not just an academic purpose. Clearly the value position we hold as researchers influences the topics we seek to research, the kind of knowledge we seek to generate and the way we go about actually doing the research.

Faulkner (2000) claims research findings from R.C.T are limited as they do not take into account the concerns of service users as an experiential source or reflect truly the complexity and participation of individuals and social contexts. Recently, there has been an ambivalence within research and development (R&D) narratives spoken by the British Department of Health: one the hand, is the presumption that random trial testing is the cornerstone of ‘objective’ research; on the other hand, the Department of Health concede "scientific basis for many interventions is uncertain" and collaboration with service users in research implementation will be a priority (DoH 2001, p1). Central to this agenda would be enabling individuals and groups to gain some control of research studies (Sample, 1996).

Now, we have reviewed the epistemological issues of research, the next section reviews the policy context of mental health. From that we seek to contextualise PAR in more depth and its emancipatory potential for researching mental health.

A spectrum of possible participation and involvement between service users and providers in the health field has emerged and is described as a ladder of power sharing Kemshall and Littlechild (2000) cite Arnsteins (1969) model: citizen control, delegated power, partnership, placation, consultation, informing, therapy, manipulation. Currently, the driving forces which determine the level of participation stem from legal and professional mandates. However, these have been criticized as partial, ineffective and generally reflect the ideologies of welfare marketisation and consumerist models of participation where knowledge, power and resources remain with providers (Kemshall and Littlechild, 2000).

Within the disability research field there is evidence of a small shift toward greater partnership and equality within the research process and reports of a first step toward an emerging emancipatory paradigm through genuine, albeit limited progress made in changing the social relations of research production (Zarb, 1992). In contrast, the mental health field is dominated heavily by positivist methods conducted solely by professionals. A handful of user led research initiatives exist but little appears in the way of research collaboration in between (Faulkner, 2000, Rose et al, 1998).

A strategic way forward with research was recently suggested by Faulkner and Thomas (2002, p3): ‘A marriage of two types of expertise is the essential ingredient of the best mental health care: expertise by experience and expertise by profession’. These authors assert that qualitative research conducted with service users examines issues that are relevant in establishing meanings behind people’s actions. In contrast, quantitative findings (R.C.T.) may not take into account aspects of service users lives which could be vital in understanding an "individual’s decision to continue treatment, remain in contact with services or indeed survive" (Faulkner and Thomas, 2002 p2).

Arguably, the nature of Participant Action Research (PAR) and its associated approaches could form the basis for the fertilisation of a research alliance based on experiential and existential understanding. This approach has been described as a style of research rather than a specific method, with a particular strength in both generating solutions to practical problems, and in its ability to empower. Biggs and Powell (1999) suggests that such an approach has three important elements: its democratic impulse; its participatory character; its simultaneous contribution to social science and social change. This approach therefore is concerned with action-oriented activity in which ordinary people address common needs concerning their lives and through this process generate knowledge and communicate (Habermas, 1992). Using this approach provides the opportunity to legitimise the knowledge generated by people, thus challenging other (hegemonic) knowledge about mental health that has often been based on ‘deficiency’ and ‘deficit’, or abnormality (Faulkner)

Further, participatory action research is compatible with health promotion principles, which can be summarised as: participation, partnership and empowerment. A central tenet of health promotion is that individuals have the capacity to define their issues, concerns and solutions. If research is going to fulfil its commitments to mental health then there needs to be a continuing dialogue between all stakeholders about the principles of democracy, participation and preferred knowledge. An interpretative approach to research will invariably produce differing perspectives that may lead to complexity and contradiction. PAR research therefore strives towards to: achieve mutual respect; be honest about our own objectives; be honest about what is in it for people; be clear that the research findings will be disseminated to policy makers to try to influence policy, which should have an impact at a community level; and be able to acknowledge that some of the expected changes cannot be guaranteed

Henceforth, participatory action research is inherently more subjective than many other forms of research but this does not mean that the research will not be rigorously undertaken. In this research rigour will be achieved through the fostering of a sense of responsibility, accountability, partiality and subjectivity rather than standard application of rules as in more traditional research (Davis and Dodd, 2002).

In practical terms this will mean, in part, working hard to achieve the trust of participants by understanding the vulnerability of some and the sensitivity of the topic. Informed consent, privacy and confidentiality are principles that will underpin the research as will the need not to mislead participants. Boundaries will also be established and constantly reviewed and approaches to debriefing participants will be developed.

Although Fals Borda (1996) identified thirty five varieties, a basic tenet of (P.R.) is the facilitation of research processes which can lead to transformative changes at a personal and structural level. The principles of Whytes (1991) hybrid, Participatory Action Research (P.A.R.) a fusion of qualitative philosophies and action research, describes how this is achieved through an exploration of the knowledge and experience of participants (co-researchers) who actively engage in all phases of the research, defining and investigating problems and collectively designing required action.

Critical within the (P.A.R.) process is the belief that through reflection, action and further reflection people within all dimensions of race, gender and class can transform and gain a critical understanding of the forces of their own oppression and act (Dockery, 1996). Traditionally, research is conducted on people "without attempting to alleviate identified problematic situations" (Sample, 1996, p317). In contrast, Rogers and Palmer-Erb (1994) highlight that (P.A.R.) is a means not an end in a developmental change process.

A further guiding principle is that PAR is orientated toward cultural, ethnic and diverse lifestyle pluralisms which, in theory, would allow issues of gender and race to be addressed. The implicit value claimed is the possibility of getting to what Butt (1991) called the `nitty gritty` of framing the right questions that are culturally specific to promote understanding based on experiences with a view to genuinely addressing emerging needs as part of the research process.

This assertion of the ontological primacy of being is derived from the principles of the Husserlian line of phenomenologists. Merleau Ponty (1962, p11) in his classic preface, argues "We must begin by re-awakening the basic experience of being in the world of which science is the second order expression". Underpinning Heron and Reasons (1997) framework is the phenomenological theory that essences of lived experience can best be understood without imposing preconception.

In describing the philosophical basis for new paradigm inquiry Heron also argues from the moral and political angle, " Knowledge fuels power…and the moral principle of respect for persons is most fully honoured when power is shared not only in the application of knowledge…but also in the generation of such knowledge" (Heron and Reason, 1981, p35). A step further is that the accumulation of knowledge, as an element of power, may become an instrument for change through what Stavenhagen ( 1971) described as a creative critical conscience to question and then modify social systems.

However, in sharp contrast, to this ideal liberationist strategy, the reality of the research context in the mental health field is summed up by Beresford and Wallcraft (1997) who argue that service users are still seen as a source of empirical data rather than creators of their own theories. They attribute this to the continued dominance of psychiatric professions and service users/survivors unequal relations with them.

The dynamics of (P.A.R.) are designed to examine and change the social relations of research collaboration and specifically allow for transformation at a very personal and politicized level. As such the nature of collaborative research would seem suitable to potentially address these inequalities, bringing up dilemmas with role function and anonymity (De Kooning and Martin, 1996, Smith and O Flynn, 2000).

Consequently, (P.A.R.) within the disability research field has been described as a fairly revolutionary change process and as a precursor toward emancipation (Zarb, 1992, Sample, 1996). Although it has been advocated as a useful partnership approach within the mental health field there are considerable challenges in attempting to change the power distribution toward service users (Rogers and Palmer-Erbs, 1994).

The crucial question is how possible is it to implement PAR approaches? Dockery (1996, p169) asserts, "We face an impossible task within the N.H.S.". Current evidence in the UK mental health field of the pure application of PAR is non existent with attempts ranging from tokenism to attempts at partnership (Smith and O Flynn, 2000).

Whykes (2002 p4) recently described the benefits of the service user research enterprise (S.U.R.E.) which was designed to "redress this power imbalance by providing training to service users in how to become collaborators". The early benefits reported are that research questions and outcomes have been altered based on users expertise. However, the aim is not to train service users in research but to train "service users and clinical academics in how to negotiate during a research programme". We would argue that this is not going far enough with a clear distinction still being made between users and clinical academics.

Smith and O Flynn (2000) describe the use of participatory and emancipatory approaches in researching perspectives of different stakeholders (service users, staff) within a network of vocational initiatives for people diagnosed with mental illness. Personal gains reported include a range of communication skills, increased confidence, reciprocity and co-researchers feeling empowered "I know a vast amount more than I did before…it’s given me the power I wouldn’t have had otherwise"

(Smith and O Flynn, 2000, p 522).

However, to gain funding and ethical approval a proposal had to be drawn up prior to the recruitment of co-researchers this was seen later as having a negative impact on breaking down power relations as research questions had already been formulated. Role confusion from participants was also highlighted. "Were they co-researchers, research subjects or service user representatives" (Smith and O Flynn, 2000, p522). The level of training and support required was underestimated which meant that the research skills of co-researchers enabled them to be only partially equipped to influence the study. These important findings raise implications for the future use of qualitative strategies such as what constitutes effective research training, how much time does it take and who decides which `representative` service users will get it? Importantly, will funders accept research proposals from mental health service users?

In addition, Dachler (2000) commented that the gains and difficulties for participants were constructed from these authors’ perspectives who gained political reality while alternative understandings from participants remain muted. This tends to be typical of research publications and raises the issue of the control of authorship.

These developments highlight a small step in an empowering direction but are a long way from the implementation of processes which may change the social and material relations of the research production or lead to any collective action to change systems as suggested by Oliver, (1992). Evidence for this possibility through using (PAR) approaches has to be drawn from areas outside of the mental health field.

Bernhard described a PAR approach as emancipatory method to explore positive strategies for community survival with black men in the U.K. and Canada. Control of the research design, analysis, writing up and dissemination of the results remained with participants. Consequently, self understanding and importantly self determination was achieved through participants reporting a sense of individual and collective empowerment " I’ve been encouraged to do and act…thank you for the opportunity to talk about black men in a positive light" (Bernhard, 2000, p181). The author identified full participation as the key to facilitating changes. This occurred through the reflective processes of many members of the black community and allies coming together to create real strategies that enabled survival and success through social inclusion opportunities such as higher education and jobs.

This evidence clearly demonstrates the direct benefits of research collaboration to a marginalised community through enhancing knowledge, drawing on lived experiences and enhancing their power base to act. These positive outcomes arguably answer the fundamental axiological question of the value of research inquiry paradigms in terms of human flourishing. Heron and Reason (1997, p10) highlight that human association is "authentic when it seeks the developmental emergence of autonomy and co-operation".

A primary obstacle to participation emerges in relation to the imbalance of power differentials between mental health service users, interprofessional systems and structures. The power and status of professional cultures are based on the assumptions that staff know what’s best (Braye and Preston-Shoot, 1995). Role security, financial and social rewards that `expert` health care status can bring are highly defended within the mental health industry (Linnett, 2001).

Therefore the integration of PAR approaches would require "systematic, philosophic, programmatic and role shifts that are substantial" (Rogers and Palmer-Erbs, 1994, p11). These authors also highlight that service users who chose to participate would require substantial training and resources to acquire the knowledge to carry out research.

What is essential is a `commitment` to a full collaborative process from power holders which, at present, is arguably lacking. Participation as conceived originally by Friere (1972) would mean the bold step of "acknowledging political structures and practices which disempower marginalised groups in society". Despite repeated calls and mandates for partnerships with service users, in reality the opposite appears to be happening with recent mental health policy advocating a greater control role for psychiatric services (Rogers and Pilgrim, 2001).

Political assumptions and precedence that `the best scientific evidence` can only be derived from positivistic methods also indicate a desire for knowledge construction of assumed `certainty` from the expert side. The psychodynamics of this social role position have been defined as `anxiety reduction` on the part of power holders with research becoming `elastic`to suit dominant interests (Menzies, 1959, Huxley, 2002)

The paper has attempted to highlight problems of traditional methodology in researching mental health as well as to point to the nature of PAR as a forward looking and qualitative methodology. We agree with Faulkner (2000 p1) who states we need a "broader understanding of what constitutes evidence...in order that service providers and policy makers can respond to the needs and views of service users". However, given the policy emphasis on positivistic paradigm driven methods it is arguable if we have reached the crucial stage of acknowledging the need to integrate (PAR) user centred approaches as legitimate inquiry.

The participatory principles of PAR which emphasise research processes that may have a transformatory affect in addressing power and social inequalities appear to be congruent with service users calls for changes in research practice (Faulkner and Thomas, 2002). However, the powerful forces resisting change are arguably considerable and include resistance from professionals with uncertainty and fear being cited as dynamic factors that activate resistance (Hornby, 1988, Kemshall and Littlechild, 2000). There is also political resistance to seeing psychiatric patients as experts or partners in setting research agendas (Beresford and Wallcraft, 1997).

Given these constraints and dynamic problems, ethically it will be necessary to "look for entry points to develop a next step, rather than demand the ideal is put in place tomorrow" (De Koning and Martin, 2000, p 169). A research synthesis or (marriage) as suggested by Faulkner and Thomas (2002) will require enormous shifts in thinking, power sharing and research practice before researchers, service users and providers could potentially exist in ‘healthy’ collaborative research relationships.

Beresford, P. and Wallcraft, J. (1997) Psychiatric system Survivors and Emancipatory research: Issues, overlaps and differences, in C. Barnes and G. Mercer, Doing Disability Research. Leeds: The Disability Press.

Bernhard, W. (2000) Participatory Research as Emancipatory Method: Challenges and Opportunities, in D. Burton (ed), Research Training for Social Scientists. London: Sage Publications

Braye, S. and Preston-Shoot, M. (1995) Empowering Practice in Social Care. Great Britain: Open University Press.

Butt, J. (1994) Exploring and Using the Black Resource in Research. Race Equality Unit, National Institute for Social Work, 9-12

Dachler, P. (2000) Commentary- Taking qualitative methods a (radical) step forward? European Journal of Work and Organisational Psychology, 9, 4, 575-583.

De Koning, K. and Martin, M. (1996) Participatory Research in Health: Issues and Experiences. London: Zed Books.

Department of Health (1999) National Service Frameworks, Mental Health: Modern Standards and Service Models, London: HMSO.

Department of Health (2001) The National Institute for Mental Health in England-Role and Function, London: HMSO

Dockery, G. (1996) Rhetoric or Reality? Participatory Research in the National Health Service UK, in K. De Koning and M. Martin, Participatory Research in Health: Issues and Experiences. London: Zed Books

Faulkner, A. (2000) Evidence from the grassroots. Mental Health Foundation. Available from: http://www.mentalhealth.org.uk/html/content/article9mhp.cfm

Faulkner, A. and Thomas, P. (2002) User-Led research and evidence based medicine. British Journal of Psychiatry, 180, 1-3.

Foucault, M (1966) Madness and Civilization, London: Tavistock

Foucault, M (1977) Discipline and Punish, London: Tavistock

Friere, P. (1972) Pedagogy of the Oppressed. England: Penguin

Habermas, J (1992) Postmetaphysical Thinking, Cambridge: Polity

Heron, J. and Reason, P. (1997) A participatory inquiry paradigm. Qualitative Inquiry. 3,3, 274-294.

Hornby, S. (1988) The Application of Psychodynamic Understanding to Organisations in the Helping Services. Conference Paper: Jungian Training Committee of the British Association of Psychotherapists, 3-13.

Jupp, V (1994) Methods of Criminological Research, London: Routledge

Kemshall, H. and Littlechild, R. (2000) User Involvement and Participation in Social Care: Research Informing Practice. London: Jessica Kingsley.

Laing, R.D. (1982) The Voice of Experience: Experience, Science and Psychiatry. Harmondsworth: Penguin

Linnett, P. (2002) Letter to a Mental Health Professional. Asylum: Magazine for Democratic Psychiatry, 13, 2, 18-20.

Menzies, I. (1959) The Functioning of Social Systems as a Defence against Anxiety, in Containing Anxiety in Institutions-Selected Essays. London: Free Association Books.

Merleau-Ponty, M. (1962) Phenomenology of Perception. Trans, Colin Smith. London: Routledge and Kegan Paul.

Powell, J.L and Biggs, S (2000) ‘Managing Old Age: The Disciplinary Web of Power, Surveillance and Normalization’, Journal of Aging & Identity, 5 (1), 3-13.

Powell, J.L (in press 2002) review essay of Bradbury, V (Ed.) (2000) ‘Handbook of Action Research’, European Journal of Social Work

Oliver, M. (1992) Changing the Social Relations of Research Production. Disability, Handicap and Society, 7, 2, 101-114.

Rogers, A. and Pilgrim, D. (2001) 2^nd Ed Mental Health Policy in Britain. Basingstoke: Palgrave.

Rogers, S. and Palmers-Erb, V. (1994) Participatory Action Research: Implications for Research and Evaluation in Psychiatric Rehabilitation. Psychosocial Rehabilitation Journal, 18, 2, 2-12.

Rose, D., Ford, R., Lindley, P., Gawith, L. and The KCW Mental Health Monitoring Users Group (1998) In our Experience: User Focused Monitoring of Mental Health Services. Sainsburys Centre for Mental Health: London.

Sample, P. (1996) Beginnings: participatory action research and adults with developmental difficulties. Disability and Society, 11, 3, 317-332.

Sim, J (1990) Medical Power, OUP: Milton Keynes

Smith, B. and O`Flynn, D. (2000) The use of qualitative strategies in participant and emancipatory research to evaluate disability service organisations. European Journal of Work and Organisational Psychology, 9, 4, 515-526.

Stavenhagen, R. (1993) Decolonising Applied Social Sciences, in M. Hammersley Social Research: Philosophy, Politics and Practice. London: Sage

Whykes, T. (2002) Conference Abstract. Citizenship and Community: Social Inclusion and Mental Health. British Psychological Society in association with Sainsburys Centre for Mental Health and the Department of Health

Whyte, W, (1991) Participatory Action Research. Newbury Park, CA: Sage Publications

Williams, F. (1996) Social Policy, London: Macmillan

Zarb, G. (1992) On the Road to Damascus: first steps towards changing the relations of disability research production. Disability, Handicap and Society, 7, 2, 125-138.

Sincronía Fall 2002

Sincronía General Index