Mental health practice: Bonnyrigg
Mental health practice: Bonnyrigg

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Mental health practice: Bonnyrigg

2 Social work skills: empowerment and advocacy

Qualified social workers are expected to have the necessary skills to empower service users to participate in assessments and decision making and also to ensure that service users have access to advocacy services if they are unable to represent their own views. The requirement for these skills can be found in the key role ‘Support, representation and advocacy’. Both empowerment and advocacy are concerned with power and the ways in which it is distributed between people. Empowerment and advocacy are also concepts which can be difficult to define, as pointed out in the quotation below:

Empowerment and advocacy are both concerned with a shift of power or emphasis towards meeting the needs and rights of people who otherwise would be marginalised or oppressed. Beyond this generalisation, the concepts of empowerment and advocacy are not simple and as such are almost impossible to define. Where the term ‘empowerment’ is used it often covers a whole range of activities from consulting with service users to involvement in service planning.

Leadbetter, 2002, p.201

Empowerment lies at the very heart of what social work is all about, as demonstrated not only by its place in the key roles for social work, but also by the term's appearance in the definition of social work, as agreed by the International Association of Schools of Social Work (IASSW) and the International Federation of Social Work in 2001:

The social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being. Utilising theories of human behaviour and social systems, social work intervenes at points where people interact with their environments. Principles of human rights and social justice are fundamental to social work.

IASSW, 2001 (emphasis added)

However, while the term ‘empowerment’ is used frequently in social care and social work, there is seldom any detailed explanation of what empowerment actually means and how it can be achieved. In fact, some social workers would argue that empowerment is simply a ‘buzz-word’ that has become popular but which means very little in practice. Others would argue that it is not really possible for people to become ‘empowered’ and that the concept belies the true relationship between professionals and service users, where professionals basically still hold most of the power and are only prepared to share it under certain conditions. How can you measure something like ‘power’ anyway? And is it always possible to tell if someone has more power than somebody else? A major feature of the focus on empowerment in mental health services is the emphasis on service user involvement in services. This involvement can happen at many different levels, as you have seen from the experiences of service users at the Orchard Centre.

A good attempt at a clear definition of empowerment is as follows:

Empowerment aims to use specific strategies to reduce, eliminate, combat and reverse negative valuations by powerful groups in society affecting certain individuals and social groups.

Payne, 1997

Given the evidence of the discrimination experienced by many mental health service users – something you will be exploring in Section 3 – it is easy to see why empowerment should be an important goal for mental health practitioners. But what does good practice in relation to empowerment look like? Barnes and Walker identify one of the principles that should govern good practice as follows: ‘empowerment should enable personal development as well as increasing influence over services’ (1996, p.381). When service providers seek to involve service users, they often do so in order to gain feedback so that they can make changes and improvements to their services. What this principle asserts is that approaches to involvement should also be designed so that service users are personally empowered by the experience. In other words, there should be a two-way, rather than a one-way benefit. A good example of where things can go wrong in terms of involvement is when service users feel that their views have not been listened to or taken seriously, which can have the effect of making people feel disempowered rather than empowered.

If you refer back to your notes from Activity 5, you will see that advocacy was discussed by the service users from the Orchard Centre. One of the most powerful points about advocacy was made in the audio by Willie, who said:

I am actually quite bewildered that it has taken so long for advocacy to take the profile that it has taken on now. I don't see it as being a good idea: it is crucial. How do you expect somebody with a serious mental health issue – where maybe your brain is pickling in cider at the time – to put across clearly what you need? You need somebody that speaks to you, for you, when you are like that. It is essential.

So the essence of advocacy is the notion of someone who speaks for service users and represents their views. Beyond this essentially simple way of seeing advocacy, there are a number of different forms that it can take, as shown in the box below.

Self-advocacy seeks to empower service users to speak up for themselves by expressing their own needs and representing their own interests. This process can enable the service users to regain some control and power over their experience. Many advocacy projects have an explicit goal of consciousness-raising and power sharing for service users (Conlon and Lindow, 1994).

Peer advocacy is a process whereby one person advocates for another who has experienced, or is experiencing, similar difficulties or discrimination. Survivors of the mental health system may be more acceptable advocates for mental health users by being able to show empathy and understanding (Atkinson, 1999).

Citizen advocacy is usually a one-to-one and long-term partnership between a trained unpaid ‘citizen advocate’ and a service user (Brandon, 2001).

Professional or paid advocacy involves a trained paid worker responding to an identified problem, event or change in someone's life. The advocate's support is time-limited (Barnes, 2000).

Quoted in Rai-Atkins et al., 2002, p.5

This list of different forms of advocacy illustrates that it will frequently not be the social worker themselves who can act as an advocate. In fact, although social workers are expected to have the skills required to advocate on behalf of service users, they are frequently in a position which makes it impossible for them to be truly independent and represent only the service users' wishes. This can occur for many reasons, such as when:

  • They need to act on behalf of more than one family member who have conflicting wishes or interests.

  • The service user's wishes conflict with the social worker's assessment of what is in the best interests of the service user.

  • The wishes and needs of the service user are in conflict with the resources available to the social worker, who also has a responsibility to manage public funds and prioritise limited resources.

Consequently, although social workers need the skills of an advocate, they also need the knowledge of how to advise service users to find an independent advocate appropriate to their needs.

Given the discrimination experienced by many mental health service users and the racism experienced by many black mental health service users, advocacy has been seen as having a central role in ‘empowering’ people. The next section takes a closer look at stigma and discrimination and how these can be addressed.

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