Academic journal article Social Work

Empowerment and Self-Help Agency Practice for People with Mental Disabilities

Academic journal article Social Work

Empowerment and Self-Help Agency Practice for People with Mental Disabilities

Article excerpt

Self-help is an attempt by people with a mutual problem to take control over the circumstances of their lives. Founded on the principle that people who share a disability have something to offer each other that professionals cannot provide, self-help efforts take many forms. Formal self-help efforts involve participation in organized groups for individuals with similar problems or in more differentiated and structured multiservice agencies. Over the past several decades, there has been tremendous growth in the number of such self-help agencies and groups for people with mental disabilities.

Self-helpers and traditional mental health service providers share the primary goal of enabling people to live better lives. However, self-helpers, particularly those in multifunction service agencies, argue there are fundamental differences between their practices, which they believe empower people, and those of traditional helpers, which they regard as disempowering.

In this article, we take the self-help perspective and place it within the social sciences literature to more precisely spell out the mechanisms by which self-help practice might work. This article must be read as a theory of self-help rather than a validation of it. It is intended to serve as the theoretical statement for necessary empirical work. The article is based on readings in the self-help literature and two years of observations, interviews, and meetings with self-help agencies and personnel. In addition, one of the authors has been active in the patients' rights movement for 15 years.

Client Critiques of Traditional Models of Care

The client-run movement has focused its critique on existing models of mental illness, on the practices of professionals who use these models, and on the lack of responsiveness of the larger environment to the needs of people with disabilities. The critique is directly indebted to the independent living movement.

Independent Living Paradigm

The independent living movement is based on a belief in severely disabled people's potential for self-determination, provided that they have access to support services, barrier-free environments, and appropriate information and skills (Frieden, 1978). It is also grounded on a commitment to major consumer involvement in planning and delivering these services. DeJong (1979) maintained that the independent living movement constitutes an analytic paradigm that has redirected the course of disability policy, practice, and research away from the rehabilitation paradigm.

DeJong (1979) noted that whereas the rehabilitation paradigm defines the physically disabled individual's problem in terms of impairment and lack of vocational skills, the independent living paradigm finds the rehabilitation process itself to be problematic. The focus of the problem, according to the rehabilitation paradigm, is in the individual; the solution rests with professionals; the proper role of the disabled individual is as a patient or client deferring to the control of the professional; and the desired outcome is maximum activities of daily living or gainful employment.

In contrast, the independent living paradigm locates the problem in the environment and the rehabilitation process. The solution to the problem is in peer counseling, advocacy, self-help, consumer control, and removal of environmental barriers. The social role of the disabled person is as consumer, with consumer control of services, and the desired outcome is independent living.

The mental health client movement draws from the independent living movement in finding the services of many professionals to be problematic rather than helpful but expands the critique to deal with special difficulties that the mental health client movement perceives to accompany mental health care. The critique parallels that of others such as Rosehan (1973) or Goffman (1961) and in some cases draws explicitly from them. …

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