journal of Psychiatric and Mental Health Nursing, 1994,

CI i n ical notice board Editor: Harry Wright

Getting a fair hearing: a small step towards client empowerment

Client empowerment has become a key concept, both as part of a therapeutic philosophy which can underpin psychiatric nursing practice and as a guiding principle in the management and develop- ment of mental health services. The concept implies direct client involvement not only in the planning and evaluation of individual care, but also in plan- ning and monitoring of local services. Paradoxi- cally there is a risk that some clients will be disempowered by such involvement, unless they can develop an understanding of the bureaucratic structures and processes with which they have been invited to engage. Managers and professional workers may rightly be accused of tokenism unless they recognize and address this paradox.

A group of mental health clients in Portsmouth welcomed the fact that they were regularly invited to join planning groups, to take part in service audits and to provide ‘the client’s perspective’ at local forums. However, in practice, their experience was that bureaucratic processes could be bewilder- ing and that professionals and managers frequently conducted business in jargon which was difficult to decipher. It could also be difficult to be appropri- ately assertive over a difference of views with pro- fessional workers like mental health nurses, some of whom would be privy to highly sensitive per- sonal information about clients. These barriers to involvement were often compounded by a lack of personal confidence. The group asked for support from the University of Portsmouth, an institution perceived as independent from the local statutory services. Together with this writer, the group identified their needs and planned a short course of six 1.5 h sessions entitled ‘Getting a Fair Hearing’.

1 Why do we have all these meetings? Themes for the six sessions were as follows:

Submissions address: 1

Llandrindod Wells, Powys LD1 SHF, Wales ’

2 Inside meetings and committees. 3 How people communicate and relate at meet- ings. 4 Getting the best out of meetings. 5 Making yourself heard. 6 Getting your views across effectively.

Course membership comprised nine clients some of whom were living independently, some in sup- ported accommodation and some who were in- patients a t the time. Whilst discussion and the sharing of ideas amongst the participants were very productive, the clients’ view was that their funda- mental need was for information. Accordingly sys- tematic information was presented via overhead projector and this functioned also as a trigger for clarification and discussion. The same information was provided on ‘hand-outs’ which could be taken home, read again and referred back to in the future. This writer functioned as the course facilitator and the course was funded by the Portsmouth District Health Authority. A University Certificate of Attendance was presented to all the course members.

Independent evaluation was undertaken by a non-participant observer who also elicited the par- ticipants’ views about the course by means of a simple questionnaire. Overall evaluation was very positive and also produced some clear indicators about ways in which the course might be improved. It would be desirable to extend the course to other service users, and to offer a follow-up focused more strongly on inter-personal skills to those who have undertaken the initial course. As one participant suggested, it may be equally important to provide a parallel course for managers and professionals aimed at enabling them to move beyond tokenism towards real collaborative working.

MARTIN GIDDEY Postgraduate Programme in Mental Health Studies,

University of Portsmouth, School of Social and Historical Studies, Portsmouth, England