Empowerment in Health and Social Care

SH4003

Week 10

Dr Alya Khan

Empowerment

• The term ‘empowerment’ is nowadays familiar & frequently used in health & social care
• It’s used across relevant disciplines: sociology, psychology, politics, health promotion, public administration (Barnes & Bowl, 2001)
• It’s applied to diverse groups of people: women, ethnic minorities, gay communities, nurses, students, older adults, etc
• Some claim that it’s so overused; it has become meaningless (Marland & Marland, 2000)
• How should the concept of ‘empowerment’ be understood?
• It has mainly been interpreted in 2 different ways:

1. Collectivist social action
2. Individualistic consumerism

1. History: the term originally developed out of US socialist theories of collective consciousness in the 1960s, & then in the UK 1970s progressive social movements around ideas of social action, group unity, & developing a collective ‘voice’ (Kendall, 1998).

Collectivism & Empowerment

• USA 1970s movement against mainstream mental health care argued for service-user rights & autonomy
• This drew on ideas of power, oppression, collective action & rights, from American civil rights movements (women’s rights, African-Americans, gay liberation)
• Carol Gilligan (1993) – feminist psychology
• Promote rights of the oppressed; ideas of self-help, community participation, development (Skelton, 1994)

2. 1980s/90s: ‘empowerment’ was appropriated by ‘new Right’ politics; i.e. an ideology of consumerism in health & social care (Skelton, 1994)

• This meant seeing ‘empowerment’ as devolving power from professionals & service managers to individual “consumers”.
• ‘Patient choice’ – government policy
• Self-care & self-responsibility – individualistic ‘empowerment’ NHS: part-privatization, competitive tendering, internal markets

Empowerment in Mental Health

• The concept of empowerment is especially important in mental health & social care, since those experiencing poor mental health have relatively powerlessness
• Sufferers often have concurrent poverty & social exclusion (Gomm, 1996)
• & experience barriers to access to housing, education, employment, social networks, etc (Dunn, 1999)
• Can principles of empowerment help them?
• Ideally, policies built on the ideal of ‘empowerment’ will have concrete positive effects on the lives of those experiencing mental ill health
• However, in practice the provision has been patchy
• This is because interpretations of ‘empowerment’ within theories and policies differ & are debated
• There’s no firm agreement on what ‘empowerment’ is exactly & how it should be implemented

Different Theories of Power

• To understand ‘empowerment’, the idea of POWER must be understood
• Healthcare professionals need a grasp of theories of power, but historically have not addressed this much
• “Without a clear conceptualization of the concept of power it is difficult to convincingly argue that one form of practice is more or less empowering than another.”

(Gilbert, 1999)

• In social theory there are different models of power:

Max Weber’s theory: power can be possessed, so it can be grabbed or given. In health & social care, service providers must give over some of their power to service users.

Steven Lukes theory: power has different ‘faces’, & can be hidden. In health & social care, hidden forms of power in relationships must be uncovered. E.g. roles of “expert” in relation to “patient”

Foucault’s theory: certain ‘discourses’ of what is ‘true’ dominate society. These ‘normalise’ certain ‘disciplining’ practices, which control & order society. In health & social care, people who deviate from norms are subject to disempowering forms of control (e.g. psychiatric practices). The discourses must be challenged.

Social Inequalities

• What about social inequalities? How are these related to empowerment practices?
• “But how can mentally ill people living in severe and perpetual poverty or homelessness be empowered in reality?” (Morrall, 1996)
• Fair distribution of resources. Reducing poverty & wealth inequality to result in a reduction of mental ill health
• Health Promotion ideals (Rogers & Pilgrim, 2003)
• WHO & OECD – a focus on poverty reduction

The ‘Empowerment’ Debate

• The debate about interpretation of the concept continues
• How you understand ‘empowerment’ directly affects the policies & practices you will develop & promote

You decide:

Should we focus on empowering individuals?

OR

The collective empowerment of groups

• Empowering individuals: usually understood at the psychological level

e.g. foster positive relationships between doctor & patient; have more individual ‘patients’ rights’; communication

• Empowering collectives: usually understood at the socio-structural level

e.g. allocate resources in a fair way; anti-discrimination laws; grassroots communal action (patients’ groups)

References:

Barnes & Bowl (2001), Taking over the Asylum: Empowerment & Mental Health, Macmillan Press

Dunn (1996), Creating Accepting Communities: Report of the Mind Enquiry into Mental Health & Social Exclusion, London: Mind

Gilligan, C. (1993), In a Different Voice: Psychological Theory & Women’s Development, Harvard University Press

Marland & Marland (2000), Power dressing…empowerment, Nursing Times, 96, pp2-8

Kendall (1998), Health & Empowerment: Research & Practice, (pp. 1 – 7) London: Arnold

Skelton (1994), Nursing & Empowerment: Concepts & Strategies, Journal of Advanced Nursing, 19 (pp. 415—423)

Gilbert (1999), Nursing: Empowerment & the Problem of Power

Gomm (1999), Mental Health Matters: A Reader, Ch14 (pp.110-120), Macmillan Press

Weber, M., various works – e.g. (2010), “The distribution of power within the community: classes, stande, parties” ,(trans. Waters, D., et el), Journal of Classical Sociology, 137

Lukes, S. (1974), Power: A Radical View, Macmillan Press

Foucault, M. (1981), The History of Sexuality, Harmondswoth (pp. 92-102)

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