Community and Mental Health
Contemporary mental health policy and practice has been based on two basic principles – the need for an evidence-based approach to practice and a recognition of the importance of understanding the lived experience of mental illness. Beyond the symptoms of the various disorders is the range of personal and social consequences of illness. These include disruptions to a sense of self, relationships, economic security, work, and housing. The social context and social consequences of mental disorder are central to social work practice in the mental health area. This chapter has explored a number of theoretical perspectives including the concept of lived experience, recovery theory, stigma, shame, and empowerment. A practice focusing on these social dimensions of mental illness demands an engagement both with the broader evidence base shared by all disciplines, and a specific concern for individuals and their families, and the experience of mental illness and its consequences in their lives.
KeywordsRecovery Community Empowerment Social work Mental health
While the experience of mental distress is acutely personal, we acknowledge that people experience that distress within a network of intimate and other social relationships. Social work has traditionally sought to apply a broad focus to understanding mental health problems. We see an individual within a family, within a community. We understand the importance of life stage; of schooling and work; of physical health; of gender, ethnicity, and culture; of sexuality, disability, and spirituality; and of housing and income security. A broad social work perspective on mental illness seeks to understand how each of these dimensions of social life shapes the experience of mental distress.
In this chapter we will explore a number of important theoretical aspects of social work practice, specifically the concept of “lived experience” of mental illness, the concept of community, and the potential for recovery theory to provide a coherent theoretical basis for organizing social work practice. We will consider the nature of social inclusion, stigma, and shame. Empowerment is often identified as a goal for social work practice, and we will consider this concept and examples of empowerment in group and community settings.
In this chapter, we have chosen to use the term consumer to describe individuals who have a lived experience of mental illness and treatment. This is the term preferred by individuals with a lived experience in the Australian context. In other countries the term service user is commonly used.
The Domain of Social Work Practice in Mental Health
In their review of the various ways of understanding the domain of social work in mental health, Bland et al. (2015) identify different approaches to practice in different national contexts. For example, many social workers in North America work as private practice therapists on a fee for service basis. In Britain and Australia, this is less common, and social workers are generally employed in public mental health settings as part of multidisciplinary teams or in community-based recovery-oriented services. Mental health legislation and differences in policy and funding of services in various countries shape the way that social work is practiced. In New Zealand, for example, mental health services have been strongly influenced by multicultural principles so that Maori culture is acknowledged and broader community approaches are incorporated to complement more individual treatments.
In Australia over the last 20 years, there has been a significant effort within the social work profession, to articulate the role of social work in mental health and to lift the practice competence of mental health social workers (Bland et al. 2015). The Australian Association of Social Workers (AASW) has specified core knowledge and skills that all schools of social work have to teach in social work programs as a condition of accreditation (AASW 2017). The AASW has established a specific category of membership that recognizes advanced competence in mental health that qualifies accredited members for private practice work in the national health insurance scheme.
The domain of social work in mental health is that of the social context and social consequences of mental illness. The purpose of practice is to promote recovery, restore individual, family, and community wellbeing, to enhance development of each individual’s power and control over their lives, and to advance principles of social justice. Social work practice occurs at the interface between the individual and the environment: social work activity begins with the individual, and extends to the contexts of family, social networks, community, and the broader society.
At the level of ‘social context’, social work is concerned with the way each individual’s social environment shapes their experience of mental illness and mental health problems. Its concerns include issues of individual personality, vulnerability and resilience, family functioning, strengths and stressors, support networks, culture, community, class, disability, ethnicity and gender. In addition to the intrapsychic aspects of ego functioning, self-esteem, spirituality, and interpersonal aspects of family functioning and personal relationships, its concerns include broader social issues of economic wellbeing, employment and housing.
At the level of ‘social consequences’, social work is concerned with the impact of mental illness and mental health problems on the individual, the family and personal relationships, and the broader community, including the impact on sense of self, on life chances, on family wellbeing, and on economic security, employment, and housing. Social work is concerned with the interface between mental illness and broader health and welfare issues such as child protection and domestic violence.
At the level of ‘social justice’, social work is concerned with issues of stigma and discrimination, of political freedoms and civil rights, of promoting access to necessary treatment and support services, and of promoting consumer and carer rights to participation and choice in mental health services. It is concerned with making all human services more accessible and responsive to the specific needs and wishes of people with mental illness, and their family and other carers. (AASW 2008, pp. 8–9)
The statement reflects the familiar social work concept of understanding the “person in environment” and provides a basis for understanding a community approach to practice in the mental health area that is distinctly social work in focus – with an emphasis on social justice and social consequences of mental illness in areas such as housing, employment, economic security, and family welfare.
Lived Experience as an Organizing Principle
In the mental health field, the dominant research narrative is that of the scientific delineation of diagnostic categories and the search for evidence to inform practice. These positivist approaches underpin broad areas of policy and practice, including psychiatric assessment, epidemiology, the development of targeted medications, the assessment and management of risk, and the articulation and evaluation of psychosocial interventions. All mental health disciplines share this knowledge base, and social workers in mental health settings will absorb and contribute to the evidence base for practice (Victorian Government Department of Health 2013). We would, for example, endorse the principle of careful assessment and rigor in psychiatric diagnosis, together with the search for effective interventions for mental health disorders. This positive embrace of evidence-based practice as an underpinning principle for social work practice is strongly and cogently argued by academics such as Thyer, both in this book (e.g., see chapter “Medical Perspective on Mental Health”) and elsewhere (Thyer and Myers 2011).
Alongside this principle, and central to the definition of the domain of social work described in the previous section, is a recognition of the broader social context in which both disorder and treatment are experienced. This is an important dimension of mental health consumer advocacy over the last 20 years, an insistence that people are not defined by their diagnostic label and that the labels themselves do not effectively describe the experience of mental illness (Bland and Tullgren 2015). This principle encourages us to focus not on a set of symptoms but on the realities of life with a mental illness. When we do this, we discover that people describe problems of isolation and loneliness, poverty, disrupted family relationships, housing, and income security – social problems that are at the heart of social work practice. Lived experience becomes a starting point for understanding the impact of mental illness, not just for individuals but for their families as well (Bland and Renouf 2017).
The practice principle for social work here is the need to start not with a diagnostic label but with a concern for the lived experience of the client and their family and friends. The experience of loneliness, powerlessness, poverty, stigma, and discrimination provides a focus for social work activity and indeed for research and knowledge building consistent with Thyer and Myers’ (2011) demand for a strong evidence base for practice. In the next section, we set out the principles of recovery theory that build on a focus on lived experience and provide a theoretical basis for social work practice.
The Nature of Community
A community approach to mental health practice is based on a recognition of the community as a potential site of intervention, both in health promotion and prevention and in moderating the impact of mental illness on individuals and families. It is consistent with the broad definition of the domain of social work in mental health described earlier in this chapter. We can touch only briefly on the very diverse literature on prevention and health promotion, but we will offer some useful definitions that help to frame the discussion of examples of empowerment that we will develop later in the chapter.
Mental health promotion is any action taken to maximize mental health and well-being among populations and individuals (Commonwealth of Australia 2000). It aims to protect, support, and sustain the emotional and social well-being of the population by promoting the factors that enhance mental health. It is a relevant concept across the spectrum of interventions – before, during, and after the onset of mental health problems and mental disorders. Prevention is defined as “interventions that occur before the initial onset of a disorder to prevent the development of disorder” (Mrazek and Haggerty 1994, p. 23).
In her overview of the scope of mental health promotion, Barry (2007) argues that promotion relies on three key determinants of mental health – social inclusion, freedom from discrimination and violence, and economic participation. This assertion connects broader promotion and prevention activities with the social justice themes of social work practice. Other relevant concepts familiar to social work practice include risk, resilience, protective factors, resources, and vulnerability. The Commonwealth of Australia monograph Promotion, Prevention and Early Intervention (Commonwealth of Australia 2000) identifies the creation of supportive social, cultural, and physical environments as a key strategy for encouraging positive mental health in communities.
Understanding Recovery Theory
The concept of recovery has emerged as a consistent unifying principle in contemporary mental health policies and services in many different cultural and political contexts. Despite unanimous endorsement of the principle and the enthusiasm of service providers and policy-makers to describe their services as recovery based, considerable difficulties remain in its definition and application. The principle is essentially radical, challenging a preoccupation with illness and symptoms, diagnosis, and standardized treatments, in favor of a concern for the individually based lived experience of illness (Bland and Tullgren 2015).
Recovery as a philosophy emerged partly from the rehabilitation movement based in Boston (Anthony 1993) but mainly from the published first-person accounts of the consumer empowerment movement (Deegan 1988).
A deeply personal, unique process of changing one’s attitudes, values, feelings and goals, skills and/or roles. It is a way of living a satisfying, hopeful and contributing life even with the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life. (p. 3)
Recovery is living well in the presence or absence of one’s mental illness.
Onken (2014) and Slade (2009) emphasize the dual nature of the recovery experience. It can be understood both as the management and moderation of distressing symptoms, what Slade calls clinical recovery, and the personal journey of restoring a positive sense of self and meaningful sense of belonging. Onken insists that this journey of recovery is about building a life in the community (Onken 2014). Jacobson and Greenley (2001) emphasize the community dimensions of recovery including a sense of connection with others and external conditions such as human rights, a positive culture of healing, and recovery-oriented services (Jacobson and Greenley 2001).
Overall, proponents of a recovery approach seek to reverse some priorities. People with mental illness don’t need treatment---they need a life. Treatment may contribute to the process of striving for a life worth living, but it is a means, not an end...The overarching principle of recovery is that the impoverished expectations, clinical preoccupations, and stigmatizing beliefs sometimes held by mental health workers should not preclude everyday ways of addressing common human problems. (Slade 2009, p. 704)
In recent years, there has been extensive work in conceptualizing and theorizing the nature of recovery, and there is an emerging consensus among the different writers about the dimensions of recovery (Onken 2014; Davidson et al. 2005; Topor et al. 2011; Leamy et al. 2011). In the following section, we use a recovery framework developed by Wyder and Bland (2014) and emphasize those dimensions of recovery most relevant to our analysis of the place of community in social work practice.
Element 1: Connectedness
Being connected is a cornerstone of recovery from a mental illness. Indeed, recovery from a mental illness is not done in isolation, and relationships and support from others play a crucial role in this journey. Consumers as part of their journey will need to have supportive others and role models, whether they are family members, friends, professionals, community members, or peers, who will provide them encouragement through the difficult times and help celebrate the good. There is now also mounting evidence of the importance of peer support in the consumer’s recovery journey (Craze 2013). Being connected also means being connected to their community. In this, consumers need to have the opportunity to expand and start occupying functional social roles such as partner, worker, student, taxpayer, or friend and to be able to make worthwhile contributions to a community of their choice. In summary, social support serves as a protective factor both for consumers and families, and good support will facilitate coping and family functioning.
Element 2: Hope and Optimism About the Future
Hope and optimism have consistently been identified as being at the center of the recovery journey of consumers. People with the lived experience of mental illness need to have a sense of hope that recovery is possible (Davidson et al. 2005; Leamy et al. 2011). While this is true for consumers, hope plays a central part in the recovery journeys of families and indeed the mental health workers themselves (Bland and Darlington 2009; Tweedell et al. 2004). There is emerging evidence of a connection between the family’s hopefulness and its capacity to sustain the hopefulness of the consumer. Both consumers and family members identify the hopefulness of mental health workers as central to their capacity to sustain the recovery journey (Bland and Darlington 2009). Hope is a complex concept, a part of the worker’s being rather than necessarily anything that they do. Valuing hope in mental health practice is an acknowledgment of the humanity of working with others.
Element 3: Identity
As part of their journey, consumers redefine themselves and start viewing their mental illness as only one aspect of a multidimensional identity rather than the mental illness being their primary identity. Many consumers, over time, have been able to rebuild and redefine a more positive sense of self. This task of rebuilding identity is invariably done through relationships with others. People recovering from a mental illness need to recover not only from the effects of the illness itself but also from social consequences and societal stigma associated with this (Davidson et al. 2005; Leamy et al. 2011). Many with lived experience of mental illness felt that they had struggled to overcome the stigma associated with mental illness and the impact this had on their sense of self.
As we will show later in this chapter, peer-based programs offer both consumers and families opportunities to challenge stigmatizing and limiting illness identities. A second strategy for identity change is the careful use of language, preferring strengths-based words and concepts over the pathology-saturated labels and language of psychiatry (Sartorius 2002).
Element 4: Meaning in Life
Throughout their illness consumers start to make meaning of the experiences of mental illness and incorporate these into their lives. As part of this, many with lived experience learn to accept the limitation imposed by their illness and discover talents, gifts, and possibilities that allow them to pursue and achieve new life goals despite the presence of the disability. This can involve pursuing and achieving new life goals and/or increasing their quality of life. Those with lived experience will start to resume ordinary community roles such as partner, worker, student, taxpayer, and friend. This represents a turning away from community of their choice (Davidson et al. 2005; Leamy et al. 2011). This journey of re-engagement with friends, family, and community is often shared with the family, who have often been isolated by caring responsibilities and the shame and stigma that they feel in response to the mental illness. Families moved from “fixing” and “doing for” to “being with” and “journeying alongside” (Tew et al. 2012).
Element 5: Agency and Empowerment
As part of their recovery journey, consumers learn to assume primary responsibility for their transformation to a person in recovery. The important concept here is a sense of agency. This process involves gaining control over one’s life and treatment. Consumers often talk about having the opportunities to make choices and being given the dignity of risk, where they are allowed to make decisions that allow them to succeed and fail (Davidson et al. 2005; Leamy et al. 2011). Assuming control over their lives is complex and involves the ability to resume control of a life that has been controlled not only by an illness but also by a treatment system and possibly family. As part of this process, consumers learn to manage their own levels of distress, stress, or depression. While complete symptom remission is not necessary, being able to manage symptoms in some way is essential for recovery (Davidson et al. 2005). Recovery always involves periods of good and difficult times, setbacks and accomplishments, and times when symptoms may be more or less controlled. A shift happens when consumers move away from simply receiving services to actively participating in and using treatments of their choice to bring symptoms under some degree of control and having their own coping strategies rather than being merely a recipient of other people’s interventions (Davidson et al. 2005; Deegan 1988).
A sense of empowerment and control over one’s life also emerges when people in recovery begin to demand the same rights and take on the same responsibilities as other citizens (Davidson et al. 2005; Leamy et al. 2011).
These citizen rights include the right to decide where to live, whom to love, and how to spend one’s time. Responsibilities include paying taxes and voting.
Becoming empowered is also linked to the concept of social inclusion, which has both a component of active citizenship and a sense of connection.
Empowerment happens through accessing resources such as housing and employment and confronting stigma and discrimination (Tew et al. 2012).
Empowerment involves holding power, control, and influence over one’s life and treatment.
Resources are critical to empowerment. Obtaining resources gives increased control over one’s life.
Empowerment can refer to both a process and an outcome. Participation is central to the process of empowerment.
Empowerment involves an interconnection between the individual and their environment.
Empowerment is situational – what is happening in a specific context at a specific point in time.
One cannot empower another – people empower themselves (Linhorst 2006, p. 10).
Onken builds on these and the familiar recovery concepts in arguing for the importance of building community capacity as a distinct and important dimension of recovery (Onken 2014). Recovery depends on system change, not just personal change. He identifies the need for basic material supports in housing, employment, and health care. He emphasizes the importance of citizenship, stewardship of the environment, and the development of social capital. We look at these aspects of community development in the next section of this chapter.
Stigma, Shame, and Discrimination
Goffman’s (1963) early definition of stigma as “spoiled identity” is still a useful starting point for our understanding of the nature of stigma. Stigma is typically defined as a visible mark of disgrace or infamy, while shame is seen as the painful feeling arising from the consciousness of something dishonorable, improper, and ridiculous that is done by oneself or another (Johnson 2015). Within the psychiatric literature, there is an awareness of the nature and impact of stigma in mental health (Horsfall and Cleary 2010), yet the nature of shame is less frequently acknowledged. Both stigma and shame are relevant to the analysis of the community dimensions of social work practice, because they are both fundamentally socially constructed and operate in a social and community context.
Bakshi et al. (1999) suggest that stigma in mental illness denotes an unjust and involuntary labeling process that misconstrues the character and personalities of individuals affected by mental disorder. The effect of stigma is to “other” and dehumanize. The identity of the individual is “spoiled,” lost in the power of the label. Corrigan and Watson (37) distinguish between public stigma and self-stigma. Public stigma is the reaction that the general population has to people with mental illness. Self-stigma is the prejudice which people with mental illness turn against themselves. Both public and self-stigma may be understood in terms of three components: stereotypes, prejudice, and discrimination (Corrigan and Watson 2002, p.16).
In their analysis of the concept of stigma, Epstein et al. (2012) provide a consumer perspective on the lived experience of stigma. They argue that the label conveys expectations that people with mental illness are peculiar, dangerous, and incompetent but that the concept of stigma does not place sufficient responsibility with those who discriminate on the basis of such thinking. The expectations and actions of others compound the very real difficulties already imposed by the illness. The impact of stigma and discrimination can be profound.
I think that the price of shame surrounding having or even knowing someone with mental health problems is too high a price to pay. Shame is why symptoms escalate, shame is why people don’t go to therapy, it’s the reason why people don’t tell their family and friends, shame costs lives, it leads to suicide and strange behaviours that others don’t or won’t understand, shame is what causes isolation and keeps a person harbouring a secret that should not be their sole burden to bear when professional help is available.
It has taken me so long to realise that the shame isn’t worth it. (Remi’s Blog 2017)
Research by Wyder et al. (2015) found high levels of shame among the families of inpatients detained under mental health laws. Confronting that sense of shame was identified as part of the family’s recovery journey and involved developing a new identity, sense of self, and sense of control over their situation. This study identified the treatment service as a source of stigma for the families and argued for a more “family-centered” approach to inpatient care.
An analysis of the connection between social inclusion and mental illness (Leff and Warner 2006) develops the ideas of stigma and discrimination as fundamental to social exclusion. Reviewing the international research literature on community approaches to challenging stigma and discrimination, Sartorius (37) argues that we need to work on a number of different social sectors, for example, health ministries, social welfare services, labor ministries, nongovernment organizations, and the media. Each of these sites provides multiple opportunities to challenge the negative impact of stigma.
Leff and Warner (2006) remind us that stigma can be imposed by a hostile or ignorant community but can be most effective in the form of “self-stigma,” the process of individuals and families absorbing negative stereotypes of mental illness and acting on these stereotypes. This results in low self-esteem, sense of shame, and low expectations – both of self and of service response. Other research, for example, the Anglicare Tasmania study of poverty and mental illness (Cameron and Flanagan 2004), has emphasized the power of the double stigma. People with mental illness often experience poverty, and their clothing, dental health, and physical appearance are visible signs of their status as poor and mentally ill. The two stigmas are mutually reinforcing.
One area of research has argued that the power of stigma is a barrier to help-seeking – that people suffering from mental distress avoid treatment services because of the stigma. Bathje and Pryor (2011) found that public stigma and self-stigma both worked to discourage people from seeking mental health care. A similar finding by Chronister et al. (2013) and research by Rüsch et al. (2009) recommended working at the community level to challenge stigma and facilitating social supports for people, in order to overcome the barrier of stigma to effective help-seeking. The research is significant because it locates the potential site for intervention not with the individual consumer but with the broader community.
Stigma is maintained through popular media. Advocacy groups in Australia such as ARAFMI, SANE, and beyondblue have worked hard to confront stigma and community ignorance about mental illness through community education and “media watch” activities. These programs appear to rely on the assumption that bad attitudes are based on ignorance and that change will happen when people better understand the nature of mental illness.
It is significant however that Australian research (Mental Health Council of Australia 2005, 2011) has found that a major site of stigma and oppression was the mental health system itself. Consumers reported that mental health workers often treated them with a lack of respect and were patronizing, dismissive, blaming, and judgmental. Research in the UK by Sartorius (37) reached similar conclusions. He argued that mental health professionals perpetuate stigma through the application of diagnostic labels and low expectations. These findings challenge the basis for an educational strategy to reduce stigma.
Consumers in these studies reported that health professionals were capable of the most disrespectful and dehumanizing response to people with mental illness. In recognition of this, the Australian National Mental Health Strategy includes a major priority of engaging consumers and family carers in the education and training of the mental health workforce. The National Practice Standards (Victorian Government Department of Health 2013) set out in detail the attitudes and values of workers that reflect a respectful relationship with consumers that must be the start of non-stigmatizing mental health practice.
The focus of anti-stigma campaigns remains difficult. Programs like beyondblue have been successful in promoting the simple idea that depression is common and that treatment is available and effective. Others, such as the Wesley Report Living with Mental Illness (Wesley Mission 2007), take a broader approach seeking to build awareness of mental illness and challenge misinformation in the community based on a concept of “mental health literacy.” This task of community education and attitude change continues to pose a long-term challenge. Many campaigns seem to have the problem of explaining two competing truths: firstly that people with mental health problems are not “others” but “us” and secondly that mental illness is serious and profoundly life changing (Bland et al. 2015). All this is made more difficult by the wide range of disorders grouped uncomfortably under the common tag of “mental illness.” In summarizing the UK approach to confronting stigma, the Sainsbury policy paper The Future of Mental Health: A Vision for 2015 concludes that it is debatable how far stigma can be challenged: “To achieve genuine change, increased investment in mental health promotion will be vital, but so will attitudinal change within services, among employers and in society as a whole” (Sainsbury Centre for Mental Health 2006, p. 15).
While stigma and discrimination are related concepts, it may be helpful to recognize that strategies to confront these issues may be different. Public education and marketing campaigns may be needed to present mental illness in a more positive light, but discrimination might be confronted more directly and with the weight of the law rather than the vagaries of public opinion.
Perhaps the most valuable challenge to stigma has come from advocacy groups within the consumer movement. Agencies such as Our Consumer Place provide a strong consumer voice to support advocacy and public education. For example, they have prepared very practical manuals for consumers engaged in public speaking or education work. They have challenged anti-stigma projects that promote positive views of some disorders such as depression while allowing stigma on other disorders to continue. Another challenge to stigma has come from the burgeoning information available to the public on the Internet where consumer voices can be easily accessed, along with good practical information about disorders and treatments by advocacy groups like SANE Australia (Bland et al. 2015).
Participation – people should be able to participate in society and decisions that affect them.
Accountability – those in authority should act justly and be answerable for their actions.
No discrimination – people should be treated fairly.
Empowerment – allowing people to use rights as a leverage for action.
Linking decision-making to agreed human rights norms.
Identification of all relevant human rights and balancing various rights (Mental Health Commission New Zealand 2007, p. 180).
This emphasis on human rights overtakes a concern for confronting stigma. If the law can deal effectively with the impact of stigma, there is less need to address the difficult challenge of changing community attitudes and values. A concern with social exclusion provides a natural focus for social work activity in multidisciplinary team settings, offering as it does an additional conceptual and practical paradigm for social work practice. It leads social work back to core business. It represents an additional focus for work, to complement more therapeutic definitions of practice (Bland et al. 2015).
Example: Our Consumer Place – Empowerment Through Collective Action
Our Consumer Place is a resource centre run entirely by people diagnosed with “mental illness” (we choose to call ourselves “consumers”). We provide information, training, support and advice to consumer-run groups and projects (or more specifically, “Consumer Developed Initiatives” (CDIs)). We also support what we call “consumer perspective,” recognising that the lived experience of “mental illness” provides a crucial source of insight that is of value and must be respected.
We believe that we are part of an important cultural shift, towards valuing and respecting the lived experience of “mental illness”. Our Consumer Place has been developed by consumers for consumers. (http://www.ourconsumerplace.com.au/consumer/aboutus)
The organization asserts that it is not a therapeutic resource or an advocacy group. Rather, the focus is on building the intellectual and skill base of the consumer movement and building a consumer community with the skills and resources to effect change for mental health consumers. The community building supported by Our Consumer Place is localized and contextualized. They run workshops and presentations for both professional workers and for consumers which focus on developing a distinct consumer perspective in mental health. One major activity has been the establishment of a clearinghouse of lectures, publications, and websites to resource consumers as they engage in training and contribute to the knowledge base for the mental health workforce. Leading intellectuals at Our Consumer Place such as Merinda Epstein and Flick Grey have given consumers a powerful voice in the mental health community.
One of the distinctive contributions of the organization has been that of challenging and reclaiming the language of mental illness. Merinda’s cartoon drawings and deeply insightful and irreverent text offer an engaging and accessible set of ideas relevant to both consumers and professionals. The word “mad” has been embraced and promoted, featuring in such publications as “Mad Workplaces” and the “Madquarry Dictionary.” Ann Tullgren, consumer and social worker and a regular contributor to the Our Consumer Place newsletters, has produced a helpful list of stigmatizing words and alternative ways of expressing these. Judgmental phrases such as “non-compliant” are reworked to become “choosing my own treatment.” A constant message of Our Consumer Place is that the language we use constructs the reality of that experience, and challenging the negative, disrespectful, and pessimistic language of psychiatry is an ongoing part of the struggle to defeat stigma.
Providing resources. Our Consumer Place develops the intellectual property that forms the basis of education and training and makes it available to the consumer community. Individual consumers are connected with very skilled and committed activists. The quality training provided supports the good efforts of mental health workers as well as consumer activists.
Reclaiming identity – a positive view of madness. In line with the recovery task of building a positive identity, Our Consumer Place can give isolated consumers and their families a language, role models, encouragement, and hope to be able to abandon the highly stigmatized and life-limiting role of mental health patient. There is another way to be mad, and there can be some pride, and indeed some joy, in that identity.
Asserting authority and sense of agency. This is achieved through training and publication, promoting the consumer voice as a valid and important alternative to the dominant voice of mental health clinicians and academics. Our Consumer Place has been able to challenge the power of stigma and the hidden oppression of the anti-stigma campaigns. There is specific training in consumers using their experience to train others, moving beyond telling their story, and using their experience to challenge beliefs and values. Consumers recognize that they are the experts in their own experience and that that expertise is powerful when shared with others.
Establishing a sense of community. Our Consumer Place is a community of like-minded individuals, drawn together for mutual support and education. The newsletters and website provide a point of connection, pride, and identity.
Empowerment Through Challenging Orthodoxy and Promoting an Alternative Voice
A movement of voice hearers, professionals and carers that operates hundreds of self-help groups all around the world. Together, we are united in our mission to promote recovery and reduce the stigma associated with voice hearing.
Although ‘auditory hallucinations’ are commonly understood as meaningless symptoms of biological illness, research suggests there are many explanations for hearing voices. Some people begin to hear voices as a result of extreme stress or trauma, while others find spiritual guidance in the form of their voices.
The Hearing Voices Network offer information, support, and understanding to people who hear voices and those who support them. The network highlights the limitations of a solely medical model in understanding and responding to hearing voices. It also provides self-help groups where voice hearers can discuss their experiences in a safe, nonjudgmental environment.
The Hearing Voices Network positions people with lived experience as experts and provides training to mental health professionals to help challenge the harmful paradigm of hopelessness and stigma that exists within the mental health system. The Network promotes hope that recovery and flourishing is possible. It also challenges stigma associated with hearing voices.
People with lived experience support, promote, and disseminate research findings into various approaches to hearing voices.
Working with consumer groups and with family carer organizations is an important part of the community work of social workers. Confronting stigma and discrimination, and promoting the welfare of disadvantaged groups, is core business for the profession. The consumer and career organizations challenge the professional community to work effectively together. When social workers are employed in clinical services, they work as part of the powerful service structures that consumers and family carers can find oppressive. Working in respectful partnership with consumers and family carers remains a challenge for all the mental health disciplines.
This chapter has explored a number of theoretical perspectives including the concept of lived experience, recovery theory, stigma, shame, and empowerment. We have worked from a definition of the domain of social work in mental health as being the social context and social consequences of mental illness. A practice focusing on these social dimensions of mental illness demands an engagement both with the broader evidence base shared by all disciplines, and a specific concern for individuals and their families, and the experience of mental illness and its consequences in their lives.
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