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Education intervention as a part of mental health service users’ rehabilitation: A practice theory



MScN Irja Nieminen defended her doctoral dissertation at University of Tampere on 20th of January 2017. Irja’s dissertation is important for ENTER Mental Health when the data for it were collected as part of the EMILIA Project. The dissertation includes an overview written in Finnish and four scientific articles:


1. Nieminen, I. & Kaunonen, M. 2011. Mielenterveyskuntoutujien osallistuminen EMILIA-

projektin koulutusinterventioihin –kuntoutujien ja henkilökunnan kokemukset 10 kk:n seurannan jälkeen (In Finnish). Hoitotiede 23, 57-71.


2. Nieminen, I., Ramon, S., Dawson, I., Flores, P., Leahy, E., Pedersen, ML. & Kaunonen, M. 2012. Experiences of social inclusion and employment of mental health service users in a European Union project. International Journal of Mental Health 41, 3-23.


3. Nieminen, I., Kylmä, J., Åstedt-Kurki, P., Kulmala, A. & Kaunonen, M. 2016. Mental health service users’ experiences of training focused on empowerment: Training environment and the benefits of training. Archives of Psychiatric Nursing 30, 309-315.


4. Nieminen, I. & Kaunonen, M. 2017. Professionals’ views on mental health service users’ education: challenges and support. Journal of Psychiatric and Mental Health Nursing, 24(1),

The dissertation can be read from:


In the Abstract of the thesis Irja Nieminen writes: Due to their mental illness, mental health service users often face difficulties when it comes to educating themselves, whether it is elementary, vocational, higher level or non-vocational training. However, education improves their employability and integration to society. Understanding mental health service users’ experiences on education will help identify factors, which can be used to help them achieve their educational goals. In her research mental health service users’ education was observed by focusing on the participation in an education intervention in the context of mental health rehabilitation. The purpose was to develop a practice theory on the education intervention as a part of mental health service users’ rehabilitation. The aim was to obtain data on what factors have to be taken into account when organizing the education intervention so that they would support mental health service users’ coping in the education. Another goal was to find out ways for the mental health service users to cope in the education intervention by using means of mental health rehabilitation.


The education intervention used in the study was developed in the international research project called EMILIA, which was funded by the European Union. The goal of the education intervention was to enhance the rehabilitation and social integration of mental health service users. The participants of the study were mental health service users (n=47) and staff members of mental health service units (n=59) from nine European countries. The countries participated in the research were Bosnia-Herzegovina, Denmark, Finland, France, Great Britain, Greece, Norway, Poland and Spain. The data were collected from the mental health service users by one-by-one interviews before the education intervention and 10 and 20 months after the beginning of the intervention. Data collection from the staff was conducted by observations and focus group interviews. The observations were carried out 10 months after the beginning of the intervention by observing staff meetings where the education intervention was discussed. The observations were carried out in all countries except for Finland, where the data from the staff members were collected by the focus group interviews. All data were analyzed by inductive content analysis. Metasynthesis was used as an analysis method to conclude the results of the original studies (Nieminen 2017).


The results showed that the education intervention as a part of mental health service users’ rehabilitation is a multidimensional process. It consisted of factors which are associated with the educational preparedness of the mental health service users, dimensions of the education event, consequences of the education and the forms of support of mental health rehabilitation that contribute to the mental health service users’ education. Factors that made the mental health service users’ education easier included taking into account the rehabilitation level when starting the education, treatment balance, goal-orientation of the education, motivation of the learner and intentional commitment to the education. Factors that hindered the mental health service users’ education included isolation, dominance of the illness and the values and attitudes of society. The education event was described by the research participants through its dimensions, which were social interaction, inner resources of the learner, the pedagogical implementation and student-based cooperation between the mental health service user, rehabilitation organization and education organization. The education was experienced to support theme mental health service users’ personal growth and to prepare them for social integration. Nevertheless, there were experiences of failed education. Forms of support of mental health rehabilitation that contribute to the mental health service users’ education were strengthening the mental health service users’ inner resources and creation of an environment that provides support and professional expertise.


As the outcome of the research a practice theory  was developed, which produced new knowledge and reinforced previous knowledge of the education intervention as a part of mental health rehabilitation. With the help of the practice theory, education interventions for mental health service users can be developed further to correspond to their needs and develop the education so that it supports better service users’ participation and follow-through in the education. The practice theory has yet to be tested and developed so that it can be used in different environments.

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