Exploring the social conditions for recovery with capabilities approach

1. Exploring the social conditions for recovery with capabilities approach A case study of Chinese mental health service users in the UK

2. Today’s focus: • Why exploring the social conditions for recovery is important • How to do it?

3. Starting point……a thick description of the experience of Chinese mh service users in the UK. • What are their experience of using mental health services? • What is it like living as an ethnic minority in the UK, having to deal with mental distress or ill-health?

4. Recovery approach • Recognising the nature of a recovery journey: • Non-linear journey (e.g. Deegan 1998: 15) • Some key words/principles: • Self-determination/ control over one’s own life (e.g. Davidson and Roe; Deegan, 1992; Jacobson and Greenley 2001) • “dignity of risk” and the “right to failure” (Deegan, 1996) • Choices • Hope ( e.g. Anthony,2004; Allott et al 2002) • Empowerment (e.g. Jacobson and Greenley 2001; Kwok 2009 • Resilience (e.g. Deegan, 2005) • ‘Personhood’ (e.g. Anthony, 2004) • Citizenship and human rights (e.g. Davidson and Roe 2007; Hopper 2007; Jacobson and Greenley 2001 )

5. Something is lacking… • So far it seems to focus: • individual empowerment • changes need to happen within mental health services While they are crucial, something is lacking….

6. Whose recovery? (SPN 2007) What recovery? • Barriers to recovery exist beyond ‘pathway to care’. • Challenges in different areas of life are beyond mh/disability discrimination • Social determinants of (mental) health and health inequalities (Marmot and Wilkinson, 1999) • A complex interplay of different power relations and social factors (Williams, 2003) • E.g. Karlsen and Nazroo (2002): strong relationships between health and experiences of racism, perceived discrimination and class. • gender, sexuality, ageism etc (SPN 2007)

7. what is lacking: changes in social structure • Sociological concepts: structure and agency (e.g. see Williams, 2003) and their dialectic relationship

8. intersectionality • Social structure: intersection of class, gender, ethnic relations (and others) results in a particular social location that a person situate in • To take agency seriously, we need to look at what structural changes is necessarily (within AND beyond mh services) (Hopper, 2007, Pilgrim 2008)  Empirically I start with finding out the social location that person is situated in.

9. Empirical focus (1) In-depth interview of mental distress and recovery history in the context of life history…. • What do they recover from, and in? • How do they make sense of their recovery? • What are the social locations they situated in? • What does social inclusion and recovery mean and entail for people in different social locations?

10. In a word… • Through the interview, I want to find out Social conditions for recovery

11. Heuristic framework for analysis: • Capabilities approach (CA)

12. What is Capabilities Approach (CA)? • Assessing one’s quality of life • As opposed to a utilitarian approach which uses resources and subjective satisfaction to access standard of living, it uses what a person is capable to ‘do and be’ as the evaluative spaces • Emphasis on freedom and agency • To truly realise agency, what is needed is….

13. ……Process and opportunities • Process aspect and opportunity aspect of freedom ‘processes that allow freedom of actions and decision, and the actual opportunities that people have, given their personal and social circumstance’ (Sen 1999: 17) • ‘What one chooses is less important than the range of valued options actually entertained, developmentally available and socially sanctioned.’ (Hopper 2007: 874) • Opportunities  possibilities

14. Using Ca to assess the social conditions for recovery How are the different capabilities of service user increase or decrease throughout the recovery journey ?

15. Empirical focus (II- a): Process • Going through the mh system: Does the process increase their capabilities (i.e. get the help they need and want, learning the skills on how to help themselves or seek help)…or decrease (i.e. becoming distrustful of services and being more isolated)? • Decision making: To what extent one’s choice is out of self-determination? To what extent one’s choice is an adapted preference due to impairment, unjust treatment or disadvantaged of opportunities? (e.g. perceived disability or racial discrimination) • Hope: how is hope/life goal changed over life history and the recovery journey, due to different social opportunities ?

16. Empirical focus (II-b): Possibilities • mh system: What are the existing choices presented to the service user? e.g. alternatives of treatments/therapy, different medical models (e.g. chinese herbal treatment, acupuntucture), peer-support groups • In the wider society: What are their opportunities due to their social locations? • Domestic life: e.g. availability of childcare, housework arrangement ) • Work: e.g. ‘what jobs are not for us?’ • Education and training • etc

17. An example of findings (Work in progress!) • Overseas brides (n=9, out of 21) • E.g. Lee et al, 2002 • From Mainland China or Hong Kong • social location: interplay of ethnicity, gender and class, with a particular migration history

18. Full-time carer of a disabled husband • Not knowing benefits for carers albeit having been taking care of husband for more than 10 years, until she reached crisis points outreached by chinese centre (lack of knowledge of welfare entitlement and different welfare ideologies from home countries, assumption of gender roles) • ‘recover from’ the strain of being a full-time carer: through counselling learnt to put herself first, anger management and learnt communications skills) • But still not using carer’s leave, as husband emotionally dependent on her • Putting children first: carer’s allowance is used to improve the living standard of the children, instead on herself, as children constantly comparing themselves with more well-off schoolmates • Language capability: Have tried to learn English but the demand of caring makes attending classes regularly difficult.

19. End…..

20. Developing and Adapting CA in policy analysis • Potential to transcend the discussion of citizenship rights and address the issues of ‘differences and pluralism’ with a theory of normative justice) Mick Carpenter ,2009) • Health capability and inequality and justice Ruger(2010: 5) • ‘Adapted preferences’ and gender (Nussbaum, 2001) • Disability and mental health (e.g. Hopper) • Social model of disability • To evaluate outcome of recovery (see also Wallcraft) • Explanatory framework and alternatives • (out-take)