Empowerment in Health and Social Care
Dr Alya Khan
- 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:
- Collectivist social action
- Individualistic consumerism
- 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)
- 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.”
- 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.
- 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
Should we focus on empowering individuals?
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)
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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