Advocacy for the empowerment of people with mental disabilities

Why co-construction must be placed at the heart of the development of support policies.

Health and education are often the subject of debate in French society, particularly in recent times. The pandemic has highlighted the cruel lack of means of our public institutions, which have nevertheless been built on great ideals. 

At the same time, anxiety is increasingly affecting all sections of the population:

If we consider the general population aged between 18 and 65 years in one year, 15% of individuals will present an anxiety disorder during that year (prevalence over one year).

While 21% of 18-65 year olds will present an anxiety disorder at some point in their lives (lifetime prevalence).

And yet there is a subject that is very little discussed in the public (and private) sphere, which is common to all these subjects: mental health.

For example: we are only just beginning to hear about teaching about psychological well-being at school; the types of care available are rare and little known; and finally, it is often perceived as shameful to admit the serious consequences that anxiety and stress can have on us. 

Yet these two symptoms are often the tip of the iceberg. After all, we have been taught to be strong and to bury the rest in complete denial of its existence. But how do we identify what we don't know?

In this context, we are convinced that supporting people with mental illness can and must constantly be part of a process of improvement. Whether it concerns a minor pathology or a real disability, one of the pitfalls of care as it is currently practised in France often lies in its rigid, opaque nature ("we know how to care for you, do as we tell you").

In the majority of facilities, the procedures are regularly imposed on the people being treated. They then feel disarmed and passive, which reinforces their feeling of powerlessness in the face of the challenges that their pathology represents for them on a daily basis.

Co-construction: the key to personalised care

Among the existing solutions, we believe that professionals and supervisors benefit from being made aware of the notion of empowerment, in order to offer a care service that is best adapted to each person. The tools of this practice allow, among other things, to deconstruct blocking beliefs ("I'll never get out of this") and rebuild the (often damaged) self-confidence of the people being monitored.

In fact, empowerment methods set in motion a virtuous circle which boosts the power to act of both the carers and the cared-for, and thus makes it possible to envisage a co-constructed follow-up between the two parties.

Engaging oneself in one's own care journey, by moving from a passive role ("what can make things better?") to an active role ("what can I do with my carer to get better?") radically changes the situation.

Beware of generalisations! This is not to say that empowerment should be used in all treatments. Each case is different, and a proactive approach is not a universal solution. But for people who are sensitive to this approach, it can bring about lasting and life-saving changes. Unfortunately, it is too rarely proposed today.

All concerned

In France, one person in five suffers from a mental illness. Yet the taboo surrounding these pathologies is enormous in our country. Although urban populations are increasingly exposed to a normalisation of the phenomenon of therapy, drug treatment (whatever it is) remains demonised, and mental illnesses still only represent 2% of the bio-medical research budget, compared to 11% in the United States for example.

In terms of care, it is often a struggle, especially for the most disadvantaged. The CMPs (medico-psychological centres), life-saving institutions that provide care accessible to all, are little known by the general population. Yet, paradoxically, they are often overwhelmed, with waiting times of up to 18 months to obtain an appointment in some regions.

Even once supervision begins, obtaining a concrete diagnosis, delivered with kindness and without catastrophism, is extremely rare.

As for the practitioners' methods, they are too uniform, based on the ancient principles of Freudian psychology, which is far from being adapted for all cases.

Fortunately, some structures have already begun this shift towards personalisation through co-construction. Perhaps it is time to follow their example and to present to all those who wish to do so, a framework closer to a partnership, so that everyone can find his or her own voice.