OPPORTUNITIES AND LIMITATIONS The preceding seven chapters illustrate the diverse opportunities for empowering people with severe mental illness, including those living in the community and those residing in long-term public psychiatric hospitals. Some of the opportunities were associated with subjective empowerment, that is, feelings of increased power, control, or inuence. This occurred through the process of participation itself, through mechanisms such as having a meaningful voice in the operation of a mental health organization through serving on its board of directors or helping other people and being helped by others through participation in a mutual support group. Other opportunities were empowering because of the objective, or tangible, short-term outcomes that resulted from participation, such as getting a college degree or learning the skills required to engage in legislative advocacy. Still other opportunities were empowering because they led to objective long-term outcome s, for example , obtaining a job of one’ s choice and raising oneself out of poverty or moving to safe, affordable housing in on e’s community of choice. Table 12.1 lists the opportunities for empowering people with severe mental illness described in chapters 5 through 11. Table 12.1 Opportunities for Empowering People With Severe Mental Illness l Meaningful participation in treatment planning l Selection and maintenance of one’s housing of choice l Meaningful participation in the control of one’s housing l Meaningful participation in decision making regarding service development and pragmatic aspects of program operation within the organizations from which one receives services through mechanisms such as boards of directors, task forces, committees, open forums, consumer councils, and program evaluation l Meaningful participation in service planning and policy making at the local, state, or federal levels through mechanisms such as state and regional planning boards, task forces, advocacy groups, ofces of consumer affairs within state mental health authorities, consumer groups, mental health agencies, and voting l Employment that provides a livable wage and offers benets including comprehensive health and mental health insurance coverage l Meaningful participation in research, evaluation, and performance improvement activities in multiple stages of the research process l Meaningful participation in mutual support groups l Meaningful participation in consumer-run organizations as members or as paid staff l Employment as service providers in traditional mental health organizations The preceding chapters also identify substantial limitations to empowerment. Chapter 2, A History of Powerlessness , highlighted the long-term nature of many limitations to empowerment; chapter 3, Individual Rights, Coercion, and Empowerment,??2000, identies the coercive use of power as a limitation to empowerment; and chapters 5 through 11 describe limitations to empowerment associate d with particular empowerment opportunities. One of the most prominent limitations affecting all empowerment opportunities is the enduring stigmatized views of people with mental illness as being violent, irresponsible, incapable of making meaningful decisions, or unable to care for themselves. These views are held by many people within society, including some policy makers, mental health professionals, family members, and even people with mental illness themselves. A second prominent limitation is insufcient nancial resource s. Such funding limitations extend to needed mental health treatment, rehabilitation, and support services, including the new psychotropic medications that have greater efcacy and fewer side effect s, safe and affordable housing,????, and supported employment, to name a few. A third prominent limitation to empowerment is unmanaged psychiatric symptoms. Despite recent advances in mental health treatment and rehabilitation, including the new psychotropic medication s and supported employ-men t, for example, some people with mental illness are incapable of being empowered, that is, taking full control over their own lives, because of ongoing or periodic unmanaged psychiatric symptoms. Table 12.2 includes these three and other potential limitations to empowering people with severe mental illness Table 12.2 Potential Limitations to Empowering People With Severe Mental Illness l Stigmatized views of people with severe mental illness l Insufcient nancial resources to fund quality mental health treatment, rehabilitation, and support services l Unmanaged psychiatric symptoms l People with mental illness lacking participation skills and the access to needed skill training l People with mental illness lacking condence, motivation, or willingness to meaningfully participate l Cultural, racial, or ethnic differences inhibiting communication and under-standing needed for meaningful participation l Lack of concrete incentives, or the presence of concrete disincentives, for people with mental illness to participate, or for others to meaningfully involve people with mental illness l Lack of choices that are meaningful l Lack of information needed to make informed choices l Choice limitations placed on people with mental illness by criminal justice agencies, legal guardians, or other potentially coercive bodies l Lack of knowledge about the legal rights of people with mental illness or how to seek redress if their rights are violated l Lack of structures and processes for meaningful participation l Lack of access to advocates to provide support, or to mediators to resolve disputes l People with mental illness lacking knowledge of the benets to them for meaningful participation l Parties participating with people with mental illness lacking knowledge of the benets to people with mental illness and to themselves for meaningfully involving people with mental illness l Lack of logistical resources needed for participation, such as transportation or child care l Parties interacting with people with mental illness lacking the skills to meaningfully involve them l Insufcient time to meaningfully participate together l People with mental illness lacking knowledge of the successes of other people with mental illness that could inspire them to participate l Organizational leaders not providing the time, training, or resources to support meaningful participation, nor modeling meaningful participation in their own interactions with people with mental illness l Culture surrounding the potentially empowering activity lacking support for meaningful participation by people with mental illness CREATING THE CONDITIONS FOR EMPOWERMENT Chapter 4 identies nine conditions that typically are necessary for empowering people with severe mental illness and for this empower-men t to be sustained long-term. These conditions then are applied in chapters 5 through 11 to various opportunities for empowerment. Many parties can contribute to creating the conditions for empowerment that address limitations to, and maximize opportunities for, empowerment. The parties and their role in empowerment will vary by the specic opportunity for empowerment. There are, however, at least six par ties that are in posit ions to contribute to creating the conditions for empowerment opportunities. The parties and their general contributions follow. Table 12.2 Potential Limitations to Empowering People With Severe Mental Illness l Stigmatized views of people with severe mental illness l Insufcient nancial resources to fund quality mental health treatment, l rehabilitation, and support services l Unmanaged psychiatric symptoms l People with mental illness lacking participation skills and the access to needed skill training l People with mental illness lacking condence, motivation, or willingness to meaningfully participate l Cultural, racial, or ethnic differences inhibiting communication and under-standing needed for meaningful participation l Lack of concrete incentives, or the presence of concrete disincentives, for people with mental illness to participate, or for others to meaningfully involve people with mental illness l Lack of choices that are meaningful l Lack of information needed to make informed choices l Choice limitations placed on people with mental illness by criminal justice agencies, legal guardians, or other potentially coercive bodies l Lack of knowledge about the legal rights of people with mental illness or how to seek redress if their rights are violated l Lack of structures and processes for meaningful participation l Lack of access to advocates to provide support, or to mediators to resolve disputes l People with mental illness lacking knowledge of the benets to them for meaningful participation l Parties participating with people with mental illness lacking knowledge of the benets to people with mental illness and to themselves for meaningfully involving people with mental illness l Lack of logistical resources needed for participation, such as transportation or child care l Parties interacting with people with mental illness lacking the skills to meaningfully involve them l Insufcient time to meaningfully participate together l People with mental illness lacking knowledge of the successes of other people with mental illness that could inspire them to participate l Organizational leaders not providing the time, training, or resources to support meaningful participation, nor modeling meaningful participation in their own interactions with people with mental illness l Culture surrounding the potentially empowering activity lacking support for meaningful participation by people with mental illness People With Severe Mental Illness As identied in the conceptualization of empowerment in chapter 1, one person cannot empower another. People with severe mental illness must act to empower themselves. They are, of course, more likely to take such actions when conditions for empowerment are met. Yet, there are actions people with mental illness can take to empower themselves, or at least to create the conditions over which they have at least some control. The following are a sample of these actions: l Seek out ways to manage psychiatric symptoms, such as taking psychotropic medication, learning stress reduction and symptom management techniques , or a combination of the two. l Improve skills through training, rehabilitation, or formal educational activities, and request assistance to improve skills when skill decits exist in specic empowerment opportunities. l Take advantage of those opportunities for empowerment that already may exist through treatment planning, ho using, organizational decision making , planning and policy making, employment, rese arch, service provision,??? ??, or other opportunities not addressed in this book, and request , and in some instance s insist upon, these opportunities when they currently do not exist. l Request, and in some instances insist upon, meaningful choices that promote empowerment, whether the y be, for example, policy alternatives while engaged in organizational decision making or choices of housing . l Identify, and carefully weigh , concrete incentives and disincentives for part-time and full -time employment . l Volunteer to participate in boa ds of directors , task forces, committees, open forum s, consumer councils, or program evaluations in order to inuence service development and pragmatic aspects of program operation within the organizations from which one receives services. l Volunteer to participate in state and regional planning boards, task forces, advocacy groups, state ofces of consumer affairs, consumer groups, or mental health agencies in order to inuence service planning and policy making at the local, state, or federal levels. l Exercise one’s right to vote, if eligible, and participate in the political process. l Request, and in some instances insist up on, opportunities to participate in all stages of the research, evaluation, or performance improvement processes. l Request, and in some instance s insist upon, the resource s needed for meaningful participation, which, depending on the situation, may include training, transportation, the presence of an advocate, peer support, or other resources. l Consider participating in mutual support and consumer-run organizations, both to receive assistance and to help others. l Value short-term empowerment outcomes that can lead to greater empowerment in the future, such as completing a training program in order to sit on the board of directors of a mental health agency or working part-time before seeking full-time employment. l Selectively disclose one’s mental illness to help dispel the stigma of mental illness. l Share experiences of recovery to serve as role models and to offer hope to others with mental illness.
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