The significance of reflexive negotiation in networks - Networks and meaning in people with mental health and/or substance-use challenges

People with mental health or substance abuse problems often face social difficulties. At the same time, research highlights the importance of social factors as determinants of mental health. These phenomena are distinct yet intertwined. Looking for explanations in health and social factors may seem complex but raises questions about linkages between actor and structure. In this study we aim to circumvent what we believe to be simplifications when understanding networks as “structural effects” by maintaining a grounded approach. We critically examine perceptions of networks in an attempt to bridge a gap between the individual and structural level by asking two questions: “What are the characteristics of the networks of users of community mental health services, and what aspects of their network do users highlight as important?”. The findings show some variation in network structures, but as expected, several participants reported small and/or homogeneous networks. A conscious attitude toward different but contradictory relational and personal perspectives seems to be significant. For example, maintaining a sufficient number of relationships conflicted with evaluations of one's own health and assessments of relationship qualities. We argue that this evokes a negotiating way of being and suggest that reflexivity might serve as a missing mechanism challenging structural perspectives yet simultaneously representing new structures.