Shifting the Paradigm in Community Mental Health

Shifting the Paradigm in Community Mental Health: Toward Empowerment and Community

GEOFFREY NELSON
JOHN LORD
JOANNA OCHOCKA
Copyright Date: 2001
Pages: 304
https://www.jstor.org/stable/10.3138/9781442679900
  • Cite this Item
  • Book Info
    Shifting the Paradigm in Community Mental Health
    Book Description:

    Examines changes in the values and practices within community mental health that occurred between 1984 and 1998 in the Kitchener-Waterloo area. A valuable guide for future research, and for consumers and administrators in the mental health field.

    eISBN: 978-1-4426-7990-0
    Subjects: Sociology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Preface
    (pp. ix-xii)
  4. Author Biographies
    (pp. xiii-xiv)
  5. Acknowledgments
    (pp. xv-xvi)
  6. PART ONE SETTING THE CONTEXT:: PARADIGMS, CHANGE, AND RESEARCH APPROACH

    • Chapter One Looking Back: The Traditional Paradigm in Mental Health
      (pp. 3-18)

      In this chapter we look back to clarify the underlying values and assumptions of the traditional paradigm in mental health. In so doing, we provide a historical perspective on how society has responded to people with serious mental illness. We begin by describing the community context for the study and some of our observations and personal motivations that prompted us to undertake this research.

      Kitchener-Waterloo is both typical and unique. The twin cities, with about 300,000 people, are rich in Mennonite history and surrounded by some of the best farmland in Ontario. About an hour west of Toronto, K-W, as...

    • Chapter Two Moving Ahead: Towards An Empowerment-Community Integration Paradigm in Community Mental Health
      (pp. 19-36)

      Larry Armitage considered himself lucky. Although he had been hospitalized several times for severe depression and anxiety, in recent years he had become part of a supportive community which enabled him to cope effectively with his mental health difficulties. Larry’s fortunes started to turn when he joined a self-help and mutual aid organization for psychiatric consumer/survivors. He began to write poetry for their newsletter, and soon he had a part-time job with the self-help organization. A local supported housing organization helped him find a small one-bedroom apartment and provided him with a support coordinator. The support coordinator, who took direction...

    • Chapter Three ‘Nothing about Me without Me’: Research Approach and Methodology
      (pp. 37-56)

      This statement, made by one of the consumer/survivor research assistants who worked on this project, points to the importance of consumer/survivor participation in research and evaluation. Since mental health organizations are intended to support consumer/survivors, those individuals who use those supports should have the right to evaluate them. A slogan originating from the South African disability movement, ‘nothing about me, without me,’ captures the essence of this point (Leff et al., 1997), which was a central theme in our research approach and methodology.

      The history of the study started in May 1995, when the three of us began to talk...

  7. PART TWO THE STATE AND THE COMMUNITY:: POLICY AND MENTAL HEALTH CHANGE

    • [PART TWO Introduction]
      (pp. 57-58)

      In the next three parts of the book, we present information gathered during our two-year community study. As the research began, it soon became apparent that provincial policy was very important in the process of mental health reform. We have learned that effective policy, while not sufficient by itself to facilitate community change, creates a vital context for the distribution of resources and the likelihood that communities will address significant issues. In Chapter 4 we summarize some of the historical lessons from earlier efforts at mental health change in Ontario and elsewhere. In Chapter 5 we describe the ‘time of...

    • Chapter Four The Sociopolitical and Policy Context: A Historical Review
      (pp. 59-75)

      The voices of people who have been directly involved in mental health policy and planning suggest that while reform is urgently needed, the process of change is discouragingly slow. In the period from 1980 to 1998 there was a great deal of activity related to mental health policy and planning in North America and in Ontario. We have examined whether there has been any substantive change in mental health policy over that time period or whether the policy and planning process echoes Sarason’s (1982: 116) observation about social policy that ‘the more things change, the more things remain the same.’...

    • Chapter Five A Time of Change: The Growth of Community Mental Health and the Emergence of an Alternative Paradigm, 1985–1994
      (pp. 76-98)

      As writer June Callwood noted in her introduction to Pat Capponi’s (1992) bookUpstairs in the Crazy House, Pat was a mover and a shaker in the mental health scene during the 1980s and early 1990s. Like other psychiatric survivor activists during this time, Pat was able to draw the attention of the public and politicians to the concrete living conditions that psychiatric consumer/survivors face in community life – poverty, poor housing, little support. She also was invited or invited herself to participate and speak out in a variety of different settings about how to address these issues. Pat identified...

  8. PART THREE ONE JOURNEY, THREE PATHWAYS:: CHANGE IN MENTAL HEALTH ORGANIZATIONS

    • Chapter Six Pathways towards Change: The Process of Organizational Change in Three Mental Health Organizations
      (pp. 101-124)

      While many organizations have been in the process of implementing new ideas that illustrate a shift in philosophy and practice, there has been little research that describes and analyses the process of change that organizations go through to move in this new direction. In this chapter we fill this gap by documenting the process of organizational change experienced by the three mental health organizations. As we mentioned in Chapter 2, we believe that Senge’s (1990) theory of the learning organization is useful in explaining these approaches to change.

      The purpose of this chapter is to develop an understanding of the...

    • Chapter Seven Organizational Change: Outcomes in the Three Community Mental Health Organizations
      (pp. 125-148)

      These statements not only illustrate particular changes that occurred in the three organizations, but also a more general transformation of the culture of these organizations. The purpose of this chapter is to describe the results of the process of change embarked on by the three Kitchener-Waterloo mental health organizations in the 1990s. The questions that we were interested in answering were: (a) How do these organizations look different now compared with before they initiated the change process? (b) What factors facilitated and inhibited the organizational changes that were experienced? To answer these questions, we used focus group data gathered from...

  9. PART FOUR IMPROVING INDIVIDUAL LIVES:: DEVELOPING ‘SELF IN COMMUNITY’

    • Chapter Eight Personal Empowerment
      (pp. 151-172)

      As we noted in Chapter 2, personal empowerment is often referred to as the process by which individuals participate with others while gaining increased control over their lives (Lord and Hutchison, 1993; Prilleltensky, 1994; Rappaport, 1987). This definition of personal empowerment suggests that empowerment is both a process that unfolds over time and the positive personal changes (outcomes) that follow from this process. Some of the positive outcomes that one might expect from the process of personal empowerment have recently been identified by consumer/survivors and include self-determination, decision-making, independence, perceptions of control, voice, skills, assertiveness, self-understanding, and self-esteem (Chamberlin, 1997;...

    • Chapter Nine Community Support and Integration
      (pp. 173-194)

      This quote from Jonathan, whose story is included later in this chapter, speaks to the importance of informal support and community for one’s mental health. Jonathan experienced strong feelings of community in the context of WRSH, a self-help and mutual aid organization. For us community support and integration means being a valued part of the community, not just being in the community (Lord and Pedlar, 1991; Nelson et al., 1998b). In the empowerment-community integration paradigm, people are seen as a part of community, and there is a focus on the whole person, including his or her strengths, capacity for growth,...

    • Chapter Ten Social Justice and Access to Valued Resources
      (pp. 195-214)

      This quote from Jan, a consumer/survivor who we interviewed for this research and whose story follows later in this chapter, brings home the grave issue of poverty, which many consumer/survivors face. The value of social justice and access to valued resources suggests that the other values already explored need to be accompanied by improvements in the concrete living conditions that contribute to consumer/survivors’ quality of life (Nelson et al., 1995). Examining the resources that consumer/survivors can access draws attention to the fair and equitable allocation of resources in society (Prilleltensky, 1994; Prilleltensky and Nelson, 1997).

      As we discussed in Chapter...

  10. PART FIVE CONCLUSIONS

    • Chapter Eleven Living with Change: Themes and Lessons from Shifting the Paradigm
      (pp. 217-240)

      In this chapter we reflect on what we have learned from our research on the paradigm shift in community mental health in the Kitchener-Waterloo community and the larger provincial context. In Chapter 1 we mentioned that we had noticed small changes in community mental health in our home community and had wondered whether these indicated a fundamental shift in the values and practice of community mental health. Our research has provided detailed information about change processes and outcomes at different levels of analysis. In this chapter we step back and consider the ‘big picture,’ returning to our original question about...

    • Chapter Twelve The Future: New Directions for the Empowerment-Community Integration Paradigm
      (pp. 241-254)

      In this chapter we address the following question: What are the future directions of the empowerment-community integration paradigm in community mental health? We consider the ideal qualities of this paradigm from the viewpoints of the diverse stakeholders who participated in this project and explore how treatment services might be provided within the framework of the paradigm.

      In this chapter we also consider what we believe is an important value that is currently not receiving a great deal of attention in the discourse on the empowerment-community integration paradigm in community mental health: diversity. We conclude with a discussion of the broader...

    • Chapter Thirteen Final Reflections on the Research Process
      (pp. 255-266)

      In this final chapter of the book we conclude with reflections on the research process. We begin with our own reflections, then we share the reflections of two members of the steering committee and three consumer/survivor research assistants who were members of the research team.

      During our research study we were not only learning about the organizations and the change in community mental health, but we were also constantly learning about new ways to conduct participatory action research. At the beginning of the project, for example, we had not expected that consumer/survivors would be participating in every aspect of the...

  11. References
    (pp. 267-284)
  12. Index
    (pp. 285-295)