Research Strategies for Consumer Empowerment of People with Severe Mental Illness

By Rapp, Charles A.; Shera, Wes et al. | Social Work, November 1993 | Go to article overview

Research Strategies for Consumer Empowerment of People with Severe Mental Illness


Rapp, Charles A., Shera, Wes, Kisthardt, Walter, Social Work


As if responding to Wintersteen's (1986) call to accept a leadership role, social work is increasingly becoming the dominant profession in the community care and rehabilitation of people with severe mental illness. There are more social workers employed by community support programs than any other profession. The past decade has witnessed a substantial growth in social work research in this area (Rubin, 1984; Videka-Sherman, 1988) and in specialized course work in master of social work curricula (Ewalt & Rapp, 1987). Coupled with this level of activity has been social work's historical concern with the empowerment of a variety of consumer groups.

The National Institute on Disability and Rehabilitation Research (NIDRR) and the National Institute of Mental Health (NIMH) are the federal government agencies devoted to improving the lives of people suffering from severe mental illness and are the principal funders of research in this area. Through their national leadership in research, training, and service, much has been accomplished in reducing stigma, creating opportunities, and enhancing the quality of these citizens' lives. Increasingly, both organizations have seen the empowerment of severely mentally ill people as central to achieving their mission. Consumer participation in services, planning and administration, self-help initiatives, and concern for consumer rights have been dominant concerns as reflected in administrative rules and regulations, speeches, conference presentations, and testimony before Congress (Reissman, 1990; Rose, 1991). However, the research conducted in mental health and rehabilitation often does not reflect this empowerment agenda and in many ways undermines it. This article describes research strategies that are more consonant with the professed values of social work and the empowerment social agenda.

Empowerment Paradigm

Empowerment has been described as a multilevel construct that emphasizes health promotion, self-and mutual help, and multiple definitions of competence (Zimmerman, in press). Gutierrez (1990) defined empowerment as a process of increasing personal, interpersonal, or political power so that individuals can take action to improve their life situation. Others have defined it as "an intentional, ongoing process centered in the local community, involving mutual respect, critical reflection, caring and group participation, through which people lacking an equal share of valued resources gain greater access to and control over those resources" (Cornell Empowerment Group, 1989). Although a systematic operationalization of this construct in social work practice is still emerging, there has been a significant growth in the literature that uses empowerment in various phases or fields of practice. For example, this literature discusses how empowerment can be used in child welfare (Hegar & Hunzeker, 1988), with women of color (Gutierrez, 1990) and Asian immigrants (Hirayama & Cetingok, 1988), with families (Dunst, Trivette, & Deal, 1988), and with people with severe and persistent mental illness (Rose, 1992).

Reissman (1990) described a consumer-centered model of human services for the 1990s that calls for the restructuring of help so that those who ordinarily receive help will function as producers of help. Self-help groups, peer helping, and self-care are prime illustrations of this model. Some of the central features of the emerging empowerment paradigm include treating clients as subjects rather than as objects; focusing on clients' strengths rather than on pathology; clients actively participating throughout the helping process; seeing resources as the total community rather than just as formal services; emphasizing the rejuvenation of informal social networks; and monitoring, evaluating, and advocating in a collaborative fashion.

The literature in the field of psychosocial rehabilitation and longitudinal investigations, such as that by Harding, Zubin, and Strauss (1987), suggests that social workers' professional attitudes and their provider-driven approaches to the delivery of mental health care may not be meeting the needs of clients who, in the long run, do return to acceptable levels of social functioning. …

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