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

Good Intentions OverRuled is about empowerment; so it is also about power. This book shows how power is exerted in the routine organizational processes that determine what can be done in everyday life, since modern societies are controlled by regulations, policies, professional practice, legislation, budgets, and other forms of organization. Against the backdrop of an ideal vision of empowerment, this critique highlights both the Good Intentions of professionals and the organizational processes through which empowerment is OverRuled. Professionals who promote empowerment for those with little power, such as people with long-standing mental health problems, experience tension, a disjuncture between enabling participation in empowerment and engaging in caregiving processes that perpetuate dependence. Attempts to enable participation are undermined by processes of objectification, individualized accountability, hierarchical decision making, simulation-based education, risk management, and exclusion, which protect but also control people. The significance of this critique extends beyond mental health services because similar processes are used in the routine organization of power in education, employment insurance, transportation, and other sectors of society. Good Intentions OverRuled sparks debate about empowerment by using a method called institutional ethnography, developed by the Canadian sociologist Dorothy Smith. Mental health day programs are explored from the perspective of seven occupational therapists in Atlantic Canada. Described in this ethnography are the local, provincial, federal, and international processes used to organize power in Canada's mental health services. The aim is to inspire professional, lay, academic, and other persons (including those who use mental health services) to change the organization of power so that we promote rather than overrule empowerment.