Good Intentions Overruled: A Critique of Empowerment in the Routine Organization of Mental Health Services

You Can Take Care of People For A Day. Or, You Can Give Them The Power To take care of themselves for a lifetime. Unfortunately, people with mental health disorders are often excluded from the decision making processes that control their lives. Mental health institutions may encourage patient participation in principle, but organizational constraints overrule good intentions.Elizabeth Townsend examines what kinds of fundamental changes are needed to enable disadvantaged people to become empowered. She uses the theory and method of 'institutional ethnography' -- developed by Canadian sociologist Dorothy Smith -- to illustrate how people's knowledge of mental health services and their everyday experiences with them are organized. Focusing on the work of occupational therapists, Townsend demonstrates how attempts to enable empowerment in everyday practice are thwarted by the institutional processes of admission, accountability, decision making, budgeting, risk management, and discharge. She reveals that institutions promote dependency because professionals and managers still hold the reins of power and knowledge.Good Intentions OverRuled offers insight and practical guidance to health care providers, administrators, and advocates for the disabled. It is a major contribution not only to the field of human services but to adult education and management.