Seen But Not Heard: Can ‘User Involvement’ Become More than Empty Rhetoric?
| Date | 01 December 1996 |
| DOI | https://doi.org/10.1108/13619322199600038 |
| Published date | 01 December 1996 |
| Pages | 16-20 |
| Author | Rachel Perkins |
| Subject Matter | Health & social care |
16 The Mental Health Review 1:4 ©Pavilion Publishing (Brighton) 1996
Rachel Perkins, Clinical Director of
Rehabilitation and Continuing Care Services
PATHFINDER MENTAL HEALTH SERVICES NHS TRUST,
AND RECIPIENT OF MENTAL HEALTH SERVICES
Within mental health services, as in other
areas of life, ‘professionalism’ is deep-
rooted. ‘Thereis a pervasive societal belief
that trained professionals arethe only people who know
how to provide proper assistance. This attitude exists
whether our television needs to be fixed or we need help
dealing with personal issues. Wehave grown accustomed
to turning to professionals for help because we assume
they have special expertise’.1
However, amongst mental health service
users/survivors, recognition of the shortcomings
of such professionalism is increasingly widespread:
more and more people who experience mental
distress and disability are turning to sources of
expertise other than professionals.2, 3
‘Ex-patients…are beginning to turn to each other
rather than to mental health professionals for emotional
and instrumental support. They are finding that often
people with experiential knowledge (i.e., having learned
through personal experience) aremoreable to understand
their needs than are professionals who have learned
through education and training. Moreover, they are
finding the support and help they can give each other to
be as valuable — or sometimes morevaluable — than
the interventions of trained professionals’.1Such trends
can be seen in a variety of self-help and user run
services.4
This paper is based on the premise that
mainstream mental health services cannot survive
without the expertise of those who have themselves
experienced mental health problems. ‘User
involvement’ is not some act of altruism on the
part of mental health workers and service providers,
neither is it an ‘optional extra’: the ‘icing on the
cake’. If services are not to become irrelevant to
those who experience mental distress and disability,
then people who have experienced these things
must be the critical ingredient of the cake itself.
The balance of power
Many important gains have been won through the
efforts of users/survivors: ‘The growth of the user
movement and the active campaigning, advocacy and
development work of local and national groups, has
ensured that users arenow considered legitimate partici-
pants in planning, consultation and service delivery, at
least in some areas’.5However, it remains the case
that the majority of mainstream services have been
reluctant to change in any fundamental ways.
‘Token’ users may be involved on the periphery of
the planning process. Surveys of ‘users’ views’ may
be conducted. People may be given copies of their
care plans. But none of these fundamentally changes
the power relations that exist. Issues of power are
critical, but they are also very difficult.
In writing as someone who has experienced the
mental health system as both provider and recipient,
these power differentials are brought into sharp
relief. When I speak as a clinical director, I have
considerable power: people listen and take note of
my opinions. When I talk as someone who has mental
health problems, the position is very different: people
arekeen to interpret what I say in terms of their
own models and theories. T
ouse the words of Esso
Leete: ‘Ican talk, but I may not be heard. I can make
Seen But Not Heard:
Can ‘User Involvement’
Become More than Empty Rhetoric?
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