Empowerment in Mental Health

1. Empowerment in Mental Health Empowerment in Mental Health: The English Case Shulamit Ramon, Anglia Ruskin University, Cambridge 11th World Congress on Public Health, Rio de Janeiro, August 2006

2. Empowerment in Mental Health • Empowerment is usually defined as “a process, or a mechanism, by which people, organisations and communities gain mastery over their affairs” (Wolff, 1987) • It is therefore similar to the concept of conscientisation, coined by Freire (1972). • However, when a group of English mental health service users were asked to define it they came up with the following (Schafer, 2003, 99): • Becoming “empowered” is an ongoing progressive process whereby individuals develop greater control and responsibility over important aspects of their lives • It is characterised by a desire to learn and develop that is grounded in a developing appetite to experience the richness and diversity of life • It involves movement from victim towards victor, helpless recipient towards valued giver, from isolation towards integration, and from unhelpful towards helpful dependencies • In the users’ own definition empowerment is personal, all encompassing, and vital to a better quality of living.

3. Empowerment in Mental Health • For many English mental health professionals empowerment is an empty word, yet another slogan without cover. • They view service users as people who have an incurable illness which has made them unable to function normally, and who therefore rely on professional and family support forever. • Given such an approach empowerment is meaningless, for it is based on very different assumptions. • Empowerment can be also misused at a lip service approach (Humphries, 1996)

4. Empowerment in Mental Health • For those English mental health professionals and service users who believe in the value of empowerment the view of people experiencing mental illness is quite different. • It entails: • Experiencing mental ill health can be shuttering for one’s identity, self esteem and social standing. • With support, the user can rediscover his/her strengths and use these to re-build their lives; • Disturbing symptoms may be controlled by a variety of methods, the most effective of which are those which the person controls and activates; • The example of Hearing Voices (Romme and Ascher, 1993) highlights the value of users’ own devised coping strategies for mastering what can be otherwise a very negative and debilitating symptom; • Moreover, focusing on what a person can do for themselves and on establishing the support they want from others can be a major tool in one’s recovery (Wallcraft, 2005, Copeland, 1997); • Employment projects which place users in ordinary workplaces with support are proving to be successful (Grove, Secker and Seebohm, 2005), and many more users are expressing their wish to work. • User-led services have become possible, and a number of these are successful (e.g. LifeLine, a telephone helpline in Cambridge, managed and run only by service users for the whole county).

5. Empowerment in Mental Health • The rediscovery of the concept of recovery has highlighted that: • The rate of social recovery and of complete recovery has been always much higher than the psychiatric literature let us believe (Warner, 1994, Ramon, Healy and Renouf, 2006); • The new meaning of recovery focuses on achieving control over one’s own life, a meaning very close to that of empowerment; • Control over one’s life implies making choices, but also taking responsibility for one’s life and being supported by others; • Appropriate support and belief of others comes at the top of the list of variables enabling recovery;

6. Empowerment in Mental Health • The insufficiency of empowerment work only at the individual level • Stigma, lack of belief in users’ ability, an inappropriate benefit system barriers have been identified as key social barriers to recovery; • The stigma includes fear of people who have experienced mental illness by the general public and the media; • Mental health service users are perceived as unpredictable and as highly likely to harm others, whereas the evidence demonstrates that, if any, they are more likely to harm themselves and that we can predict when this may happen (Taylor and Gunn, 1999) • It is therefore recognised that there is a need for action at the collective level of empowerment and at the social structural level to facilitate recovery and the reintegration of mental health service users in our societies.

7. Empowerment in Mental Health • Collective measures introduced in England in the last ten years include: • A more vocal user movement with representatives on local and national mental health planning bodies • Involving users in research (Fetterman et al, 1996, Ramon, 2003); • Involving users in training future and current professionals; • Training users to be recovery mentors (Allot, 2004) • SHIFT, a campaign to reduce stigma, run by service users with public funding; • Introducing Experts in Experience at every mental health regional development centre, as part of the National Institute for Mental Health (NIMHE)

8. Empowerment in Mental Health • Changes in the delivery system • The above mentioned developments have led to some changes in the pattern of services. For Example: • The Haven is a resource centre for people with personality disorder, who are even more stigmatised in the UK than people with schizophrenia; • The Haven is run by a management committee in which the majority are users; • It offers many activities, all proposed and largely managed by users; • There is four crisis beds facility at the top of the beautiful building of the centre, which is run by professionals; • Thus far – after two years – the project has managed to reduce by 40% hospital admissions and self harm of its membership; • Many members are working in the centre as part-time volunteers, and can become paid workers after a period of being volunteers for six months.

9. Empowerment in Mental Health • The role of universities • Universities can support the social inclusion of service users • for example, my university has run a project on encouraging women experiencing mental health problems to come for “taster” courses in any field, including basic computer skills. Participants found this very useful as a first step towards volunteering, looking for work, or study.; • Another project titled Mind the Gap worked on reducing stereotypes about mental ill health among both staff and students; • It also constructed a mentorship system for students experiencing mental ill health aimed at enabling them to continue with their studies; • It encourages flexibility among staff members towards the demands from such students • Involve users in creating new knowledge through research and in training; • when preparing professionals ensure they get the right message about users’ abilities and real needs • they can work in partnership with user-led organisation • influence policy making