Introduction

Since the 1980s, service user participation has been a widely discussed ideal among politicians, health and social care professionals and service users themselves (for example, Velasco, 2001; Kvarnström et al, 2012; Finset, 2017). Service user movements have highlighted participation as an issue of freedom of choice, human rights and self-determination (for example, Cook and Jonikas, 2002; Raitakari et al, 2015; Lakhani et al, 2018; see also Chapter 1). In general, the concept signifies that service users play an important role in directing health and social care service systems as well as their personal service pathways. Additionally, service users are portrayed as evaluators, informants, consumers, decision makers, experts-by-experience or collaborators in professional encounters.

Western policies emphasise that services and multi-agency collaboration should be pursued in a way that strengthens service user participation (for example, Thomas, 2010; Fox and Reeves, 2015; see also Chapter 1). However, there is conflicting knowledge on how this aim is actually realised in frontline practices of health and social care (for example, Kortteisto et al, 2018; see also Chapter 1). Multi-agency collaboration is a challenging way to realise participation because it requires various competencies, such as the capacity to express oneself, to consider the stances of other parties and to cross potential barriers, such as poor communication and lack of respect (Hopwood and Edwards, 2017; Naldemirci et al, 2018).

In this chapter, service user participation is examined through interprofessional interactions in multi-agency meetings in Finnish lowthreshold substance use services. The aim is to scrutinise interactional practices that strive to collaboratively strengthen the service user participation of vulnerable groups. Hence, our approach differs from previous studies that have constructed various conceptualisations of service user participation (Arnstein, 1969; Hickey and Kipping, 1998) or barriers in service pathways that service users experience (for example, Borg et al, 2009). Some studies have examined service user participation in multi-agency working exclusively in theoretical terms (Fox and Reeves, 2015), in conjunction with service user interviews (Thomas, 2010; Kvarnström et al, 2012) or through analysing interactional data from multi-agency meetings (Juhila et al, 2015; Koprowska, 2016), as is done in this chapter.

Collaboration requires sufficient sharing of institutional agendas and decisions, and aligning with one another's views and aspirations in interactions. Collaborative participation can thus be distinguished from participation that is based on acting as an individual consumer or advocate within services.