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EMPOWERMENT AND RECOVERY
by Sally ClayEmpowerment is a strong word. Webster's New Collegiate Dictionary defines it as "to give official authority or legal power to." In this sense, the right of a citizen to vote is an example of empowerment.
In recent years, empowerment has acquired a wider application and a more personal, even spiritual, meaning. In this sense, empowerment is the means by which an individual acquires the inner authority to act as a free and useful person. Qualities of inner empowerment include self-esteem, confidence, and respect for others.
Mental patients have long been morally disenfranchised, not only within mental institutions, but also in their communities and even their families. Now mental health systems in this country are undergoing a quiet revolution. Ex-mental patients and other advocates are working with mental health providers and with government agencies to establish mental health care based on a philosophy of patient empowerment.
To understand what this means, we need to look at the three factors that allow a person to benefit from mental health care and to achieve optimal recovery. These are personal empowerment, social empowerment, and civil empowerment.
PERSONAL EMPOWERMENT
When we talk about "optimal recovery," we mean the ability to live in harmony with oneself and others. To experience an extreme mental state, and then to be forcibly confined to a mental institution, is a radical disruption of this harmony. Under these circumstances, recovery first means restoring the inner composure necessary to return to the community. But composure alone may be superficial; it is not recovery.
True recovery occurs when a person learns to recognize his or her basic goodness, and can see a similar goodness in others. Personal empowerment means that a person uses this inner potential in daily life. With the awareness of one's own potential, it is possible to reach a lasting mental stability, as well as a sense of well-being and usefulness. Empowerment goes beyond what we call "mental health" to actual sanity.
There are many ways to develop inner potential, and they always involve one's own good motivation and effort. Tried and true methods include work, exercise, art, giving, and meditation--the list could go on and on. But sometimes personal empowerment needs nurturing, and this is especially true in mental health settings, where patients have undergone experiences that shatter their lives and their identities.
Mental patients-like everyone else-need respect and loving kindness, and they especially need these human qualities from those who treat them. It is a universal complaint that, under the medical model, psychiatric treatment addresses only outward symptoms and ignores inner experience. But when mental health workers and professionals, especially psychiatrists, are trained to understand the inner experiences of themselves and others, they naturally develop a greater tolerance and compassion. This is what facilitates true recovery, in contrast to simple and sometimes mechanical composure. One of the best resources to train mental health professionals are ex-patients who have experienced extreme mental states as well as some degree of recovery.
Recovery can be nurtured on a personal level by those who provide direct services to mental patients. But full recovery, or personal empowerment, in most cases takes place only within an environment that also provides both social and civil empowerment.
SOCIAL EMPOWERMENT
Today the effects of social "dis-empowerment" are all around us. The phenomenon of homelessness reveals the miseries that result from joblessness and lack of housing. Anybody who works in mental health knows that this is only the tip of the iceberg-millions more ex-mental patients live in inappropriate housing and receive only meager public assistance. When mental patients are given jobs, they are often forced to perform demeaning work for menial wages. Community programs for support and rehabilitation are inadequate, and even when state institutions are scaled down to more human levels, savings in institutional funding are not transferred back to the community. Sometimes poverty and social disenfranchisement are the most devastating effects of mental affliction, and these, in turn, become the cause for recurring hospitalizations.
The American Dream is based on the foundation of home, work, and family. Most of us depend on all three of these for any happiness we can claim. Certainly it is hard to imagine how anyone could even think of personal empowerment if they are not only fighting the fears of their own mind, but also living alone among strangers, unable to get a job, and not sure whether the food stamps will last another week. Mental patients, like everybody else, need decent, affordable housing. They need the spectrum of housing, from structured residences to reasonably priced independent apartments. They need jobs that are meaningful to them and that pay decent wages, and sometimes they need job training programs and educational subsidies.
Most of all, of course, ex-mental patients need a network of friends and supporters. Although this aspect of social empowerment cannot be legislated, structured, or bought, it can be fostered by the moral and financial support of programs such as drop-in centers, peer advocacy, and other consumer-run programs.
CIVIL EMPOWERMENT
Most adult mental patients are citizens of the United States and have the right to vote. As citizens they are also entitled to full protection under the Bill of Rights and other human rights legislation under the United States Constitution. In the past the human rights of mental patients have been frequently ignored and often violated.
Some rights of mental patients were stated in the federal Protection and Advocacy for Mentally Ill Individuals Act of 1986. These include the rights to informed consent in treatment, to refuse medication, to least restrictive setting, to information about treatment, to participation in one's treatment plan, and to assert grievances. As citizens, mental patients are also entitled to due process, especially regarding commitment and forced treatment.
In other areas of medical care it is now widely acknowledged that a patient's free will and positive motivation are often critical factors in recovery. The person most likely to get well-to become empowered-is the person who feels free to question, to accept or reject treatment, and to communicate with and care for the people who are caring for him.
Because mental patients are stigmatized and ignored in their communities, legislation and funding for community mental health and public assistance programs is woefully inadequate, both on the national and local levels. In addition, the public bureaucracies stifle and degrade the people they are supposed to help. Mental health professionals can join with mental health survivors in raising the awareness level of government officials and the general public on these issues.
CONCLUSION
Ultimately, patient empowerment is a matter of self-determination; it occurs when a patient freely chooses his or her own path to recovery and well-being. It is the job of mental health services to provide an environment of personal respect, material support, and social justice that encourages the individual patient in this process.