This paper examines the inequalities faced by women with mental illness, focusing on how moral exclusion and cultural imperialism create barriers to seeking help. Drawing on the theory of planned behavior and Maslow's hierarchy of needs, the paper analyzes how social workers can assess and support this population across individual, family, group, and community systems. It further discusses how the context for practice has evolved — particularly in light of COVID-19 lockdowns — and outlines an empowerment practice framework that incorporates trauma-informed care, participation models, and intersectional awareness of race, sex, and age to help women achieve self-actualization and reduce stigma.
The inequalities experienced by women with mental illness have been shaped by forms of oppression, such as moral exclusion (social stigmatization and marginalization) and cultural imperialism (gendered norms that prevent women from seeking help for mental illness). Moral exclusion occurs when a person is made to feel inferior to or separate from others. This happens with women experiencing mental illness because society condemns them as weak and imperfect (Boysen & Logan, 2017). In general, there is a stigma around seeking help for mental health because there is too little understanding about what mental illness is, its prevalence, and why it is important to approach it with empathy (Lopez, Sanchez, Killian & Eghaneyan, 2018). For women, there is the additional idea that if they have mental illness, they are not in control of themselves and may act out in ways that harm others (Taylor & Richards, 2019). Mainstream society holds cultural expectations for women, and those standards function as a form of cultural imperialism insofar as they prevent women from seeking mental health treatment because of the taboo associated with mental illness.
Social work professionals may have the opportunity to work toward empowerment with women dealing with mental illness in settings across multiple systems, including individuals, families, groups, organizations, and communities. They can do this by providing access to counselors and therapists who work with women and by applying various approaches and frameworks, such as trauma theory (Tseris, 2019). Family systems approaches and group approaches can also be utilized. According to Shooshtari, Abedi, Bahrami & Samouei (2018), women with mental health issues can also be empowered by ensuring their primary needs are met, including their need for food and shelter; after that, it is important that their social needs are met, such as having a support network of friends or family they can turn to for help.
All of this is in line with Maslow's (1943) theory of motivation and the hierarchy of needs: in order for a person to reach a state of self-actualization, their lower-level needs for shelter, security, love, and self-esteem must first be met. The same principle applies to a woman dealing with mental illness, except that these needs are more pronounced because of the disadvantage she faces given her mental health condition and the stigma associated with it. A social worker needs to help ensure that basic needs are being met — shelter, security, social support, and self-esteem. Additionally, Shooshtari et al. (2018) note that the social worker can further empower the woman with mental illness by providing access to facilities and services, knowledge about her rights, a way to participate in decision-making, and the opportunity to take control of her life. For example, a social worker could help empower a woman dealing with mental illness by connecting her with a clinic where services are provided, or by linking her with a church group or local organization that serves individuals with mental health issues so she can develop a support system.
The theory of planned behavior posits that individuals have — or perceive themselves to have — control over their own lives. One valuable study conducted by Rowe et al. (2016) showed that young drivers who believed themselves to be in control of their environment were more likely to take risks on the road than young drivers who were cautious and aware of the many factors that might cause an accident. The strength of planned behavior theory is that it allows one to predict behavior based on perceptions of control; it also enables the construction of control as a conceptual framework.
In the context of a social worker applying this theory with a woman dealing with mental illness, the important point to keep in mind is that the social worker would use the theory to forecast how the client would react given her perception of control. By applying the theory of planned behavior to this population, one can help predict how a woman with mental illness might respond to various situations depending on how in control she feels. The more helpless a woman feels, the more support she may need before she is able to begin making decisions on her own or to reach out and develop a support network without fear of stigmatization. A social worker can also assess whether the woman perceives herself to be in more control than she actually is; if so, she will likely be more willing to take risks that could be harmful to her health. The social worker can then provide advice, guidance, and recommendations based on that assessment.
"How social change and COVID reshaped practice context"
"Personal, family, and community-level contextual factors"
"Empowerment models, trauma awareness, and intersectionality"
"Systems-level strategies for participation and empowerment"
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