How can we use power correctly – Creating trust, choice and equality in mental health services
As October marks both World Mental Health Day and Black History Month, we’ve decided to focus on a topic which lies at the heart of both: power. In mental health settings and wider society, power can affect who is listened to and who is overlooked, who can access support and how effective that support is. In this blog, we explore how power dynamics arise, and how mental health services can use power correctly.
Power dynamics play a role in almost all our relationships. With our brother or sister, a manager, the waiter in a café we frequent, and between a mental health support worker and the client they support.
Having power isn’t necessarily a bad thing. However, as people become more powerful, they may start to believe that their own values, ethics and opinions are objectively correct, and this can affect the way they act towards people with less power.
In mental health care, there has historically been a huge imbalance of power between client and care provider. The common belief was that a ‘doctor knows best’ approach was most effective – care often revolved around admitting patients to hospital, their treatment would be decided and controlled almost entirely by healthcare professionals, and there was often a preoccupation with reducing ‘risk’ (e.g. a perception that mental health patients are more likely to be violent).
Over the decades, this paternalistic approach has been discredited by most mental health professionals in favour of a person-centred approach where clients are supported more in the community and decisions about care are made with people instead of for them.
However, power dynamics still arise in mental health care. Imagine a person who has struggled with their mental health for a long time and turns to support from a mental health service. Through that support, they may not only improve their mental health but also see other changes in their life: better physical health, the chance to secure housing and employment, financial independence, and renewed confidence to socialise, make friends, and reconnect with family and community. With so much at stake, mental health providers hold significant power in their relationships with clients. We also know that when people are able to have more control over decision-making, the outcome of their support is more likely to be positive.
But it doesn’t always work like this. Unfortunately, negative power dynamics are still common in mental health care, such as:
- Complicated and disjointed systems which are difficult for clients to navigate, leaving them reliant on the knowledge and guidance of professionals.
- Use of exclusionary language and clinical terms to describe a person’s real feelings and behaviours, making them feel dehumanised or misunderstood. For example, describing a client who is struggling to connect with services as being ‘disengaged’ or ‘uncooperative’.
- The stigmatisation of mental health challenges which dismisses a person’s mental health challenges or decentres them from their care. For example, the belief that certain diagnoses cause people to be violent or commit crime.
- Discrimination, for example, Black people are four times more likely to be sectioned under the Mental Health Act than white people, and only 6% of Black adults receive mental health treatment, the lowest rate among all ethnic groups (compared with 13% of White British adults).
Negative power dynamics like these – or fear of encountering negative power dynamics – can affect access to mental health care and the effectiveness of mental health services.
So how do we use power correctly?
Jacqui’s story
When we think about using power the right way in mental health support, Jacqui’s story shows how it can be shared rather than imposed.
When Jacqui was first referred to us, she described herself as ‘barely managing’. Living with ADHD, PTSD and physical health issues, Jacqui struggled to trust others, especially men, which meant she found clinical settings and social situations challenging.
Because of these issues, Jacqui had found that traditional therapy wasn’t helping her as much as she needed. Instead of pushing her to continue working through methods that didn’t work for her, Jacqui was offered the chance to start working with Lottie, one of the Recovery and Wellbeing Workers from our Open Mental Health team in Somerset.
Over eight months, Jacqui and Lottie built a relationship based on trust and choice. Lottie worked side-by-side with Jacqui to help her develop emotional regulation skills, calming strategies and self-soothing techniques. These new tools had a ripple effect on Jacqui’s daily life – she now uses hearing loops which allow her to attend social gatherings without feeling upset, and she feels more confident advocating for herself in medical settings. Jacqui said:
“I’ve learned it’s okay to say ‘no’ when I’m not able or comfortable to do something without being consumed by guilt. These may sound like small changes, but for me they are huge steps toward living with more control, peace, and acceptance.”
Jacqui now feels ready to return to therapy to continue her progress, focusing on Cognitive Behavioural Therapy to help her PTSD.
Read Jacqui’s full story here.
Drew’s story
Drew’s story also shows how power can be shared in a way that puts clients and support workers on equal footing.
When Drew was referred to our Hope Project, he was experiencing suicidal feelings and was distrustful of services due to bad past experiences. Too often, he felt defined by his ADHD rather than seen as a whole person:
“My ADHD is a pain the butt. It’s so annoying. I get judged everywhere. It’s not fair. I’m also struggling with my mental health but I felt invisible, I felt the GPs weren’t listening to me.”
Meeting Ezra, his Hope Project worker, became a turning point. Their first encounter was at the Job Centre where Drew was meeting a housing officer about emergency accommodation. The first thing Ezra did was reassure Drew that he was in control of what happened next:
“Before meeting with the housing worker, I reassured Drew that this was about him, his situation and his needs, and that he could take his time to share why he needed their support. I shared that if he needed to take some time to go for a walk, with me or alone, that was okay. This alleviated the pressure he was feeling to say or do certain things to get the help he needed.”
In the past, Drew felt like he’d “lost himself” with no control over his emotions. With Ezra he finally felt like he was on an equal footing and had control over his own life. Because of past trauma of bullying, living in emergency accommodation was extremely difficult for Drew. Ezra introduced him to mindfulness exercises to help him manage his stress and eventually helped him secure his own flat and access benefits.
“Ezra showed me how to build back up and be confident again,” Drew said, “She made me feel safe and literally gave me back my life. No other support system has been like it, here I’ve found my confidence again. She’s inspired me to be the person I want to be.”
Using power correctly – A trauma-informed approach
In relationships between mental health providers and their clients, a psychological, adversity and trauma-informed (PAT-informed) approach can address and reduce negative power dynamics.
Following a PAT approach, we shift from a culture of asking “what is wrong?” to “what happened to you?” to help us understand a person’s past trauma and how this affects them now. This invites empathy, reduces judgment, and builds trust with our clients.
We recognise how past trauma and adversity can cause power imbalances to arise, for example, Drew’s past experiences of bullying which made it difficult for him to advocate for himself when placed in accommodation where he felt unsafe.
We also recognise how experiences of the world around us can cause power imbalances to arise, for example experiences of racism, sexism or inequality.
Find out more about our PAT work here.
World Mental Health Day 2025
The theme of this year’s World Mental Health Day is access to services – mental health in catastrophes and emergencies.
In times when it feels like the news cycle is nothing but negative, we can feel powerless. It’s one of the reasons we keep our own social media pages full of stories of hope and courage, to remind you that it’s ok to put your mental health and wellbeing first.
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