ORIGINAL ARTICLE ‘The right thing to do’: Fostering social inclusion for mental health service users through acts of citizenship Helen Paris Hamer, 1 Michael Rowe 2 and Carol Ann Seymour 3 1 Helen Hamer & Associates Ltd, Auckland, New Zealand, 2 Department of Psychiatry, Yale University, New Haven, Connecticut, USA, and 3 Waitemata District Health Board, Auckland, New Zealand ABSTRACT: The theoretical framework of citizenship is increasingly being used in mental health settings to inform practice. This exploratory qualitative study describes in more detail the acts of citizenship embedded in the everyday practices of mental health workers that promote the social inclusion of people in their care. Acts make a claim for justice when one’s rights and responsibilities of citizenship are denied. Semistructured interviews were conducted with 12 participants, seven mental health clinicians and five peer support workers, recruited from a mental health facility in Connecticut, USA. Two themes are presented, breaking the rules and the right thing to do, a rights- based practice that fosters inclusion for service users. Results suggest that staff undertake hidden acts of citizenship to promote inclusion and rights of service users by responsibly subverting the rules and norms of the organization. Changes to organizational practices to make visible such inclusionary acts are required. Implications for practice and considerations of organizational change through the development of a citizenship framework to underpin practice are recommended. KEY WORDS: acts of citizenship, rights, service users, social inclusion, subversive humanitarian- ism. INTRODUCTION The theoretical framework of citizenship is increasingly being used in mental health settings to inform how current service delivery can be a means to increase the social inclusion and participation in society for people with mental health problems (Hamer et al. 2017; Har- per et al. 2017). In this study, we explore the practices of inclusion that mental health staff undertake to pro- mote the social inclusion and citizenship of people in their care. As reported by Hamer et al. (2014), service users regarded mental health workers as champions of social inclusion, enhancing their status as citizens and full and equal participants. Such inclusive actions were often undertaken by bending, or breaking, the existing rules and norms of clinical practice. Rule breaking as a concept is not new and increasingly of interest to health professionals, described as responsible subver- sion (Davidson et al. 2009; Hutchinson 1990; Topor & Denhov 2015) or positive deviance (Gary 2013, 2014). This exploratory qualitative study describes in more detail how the theory of the acts of citizenship (Isin 2008) can bring a rights-based focus to these often-hid- den, inclusive acts embedded in the everyday practices of mental health workers. BACKGROUND Historical theories of citizenship have been criticized for their gendered, ethnocentric perspectives (Lister 2007; Turner 2016; Walby 1994) and exclusive of Correspondence: Helen Paris Hamer, Helen Hamer & Associates Ltd, PO Box 34832 Birkenhead, Auckland 0741, New Zealand. Email: helen@helenhamer.co.nz Helen Paris Hamer, RN, PhD, FNZCMHN. Michael Rowe, PhD. Carol Ann Seymour, RN, MN. Accepted July 31 2018. © 2018 Australian College of Mental Health Nurses Inc. International Journal of Mental Health Nursing (2019) 28, 297–305 doi: 10.1111/inm.12533