Introduction

Face-to-face interactions between professionals and service users are central to mental health services. Participants jointly seek, gather, produce and assess knowledge about concerns, risks and troubles that need to be addressed, for example, mental health, financial and interpersonal issues. Social work and health care are often conducted in multi-agency settings and meetings where professionals from different disciplines and service users address each other. In multi-agency meetings, mental health service users are both talked to and talked about, and they also describe their own situations and experiences. This creates a sensitive interactional task for professionals. Professionals need to express such knowledge about the service users that they deem relevant to tackle the issues at hand and make judgements in situations where service users are co-present as listeners, yet also co-producers of knowledge. Producing and using knowledge is bound to epistemic rights, to the ‘distribution of rights and responsibilities regarding what participants can accountably know, how they know it, whether they have rights to describe it, and in what terms’ (Heritage and Raymond, 2005, p 15).

This chapter studies how knowledge of service users’ recent histories and their experiences is produced, presented and used in statutory Care Programme Approach (CPA) meetings in England. The participants in the meetings are service users, their care coordinators, housing support workers and psychiatrists. The analysis displays which participants in this multi-agency interaction epistemically own knowledge about the service users’ recent past. What makes the ownership of this knowledge interesting is that despite dealing with service users’ personal histories, at times it is the professionals who hold this knowledge based on their previous interactions with a particular service user. Thus, in analysing the meetings, we are interested in how professionals present themselves as knowledgeable about the service user's history, and how service user participation is realised or not on these occasions.

The Care Programme Approach

The Care Programme Approach (CPA) was introduced in 1991 as a statutory framework for people requiring support in the community for more severe and enduring mental health problems (Department of Health, 1990). The framework has four main requirements:

• • a systematic assessment of the service user's health and social care needs;

• • the formulation of a care plan to address these identified needs;

• • a named key worker (now called a care coordinator) to coordinate the care plan;