Tuesday, 19 March 2013

What does participation mean to you?

by Freda Lacey

The Powys teaching Health Board (PtHB) pays Powys Association of Voluntary Organisations (PAVO) to promote, enable and facilitate “participation” in the design, planning, delivery and evaluation of mental health services in Powys.  It is my role as the Participation Officer in the mental health team at PAVO to carry out this work. At the end of this past week, I’m questioning whether what I’m doing, after just over a year in my job, is effective.  I’m really not sure.  As I sit here today reflecting on my week, I’m really seeking to understand what is “participation” and more importantly, how we “do” this in relation to mental health.

Last Thursday, I attended a Mental Health Planning and Development Partnership meeting, chaired by the PtHB.  I had been asked to deliver a paper on “participation” at the meeting, as active participation by individuals and carers in this partnership is a requirement under the “Together for Mental Health” strategy and delivery plan for the Mental Health Measure.  This particular meeting has led me to question, “What is participation?” as people in the meeting grappled with and challenged the way I propose “participation”.  What is meant by true participation, what is understood by it?  In many ways, I’m being confronted to define what I understand it to mean, after all, I’m being paid to enable participation to happen.

While there are many organisations which promote and develop participation in Wales, I went online to see what came up when I searched “participation” as if I knew nothing about the subject.  The first link took me to Wikipedia, and says it may refer to, decision making, ownership, philosophy, finance and eparticipation.  I drilled down into decision making and it further says, “for well-informed participation to occur, it is argued that some version of transparency, e.g. radical transparency, is necessary, but not sufficient. It has also been argued that those most affected by a decision should have the most say while those that are least affected should have the least say in a topic”. 

I looked at the rest and “ownership” and “finance” are boringly “money” oriented so not helpful to me (or you) here.  The, “philosophy” link took me to a deep spacey place, I’m not sure I can explain it very well, but when I finally came to, I was thinking of passive vs active participation.  It made me reflect on what happens if we don’t participate, if we’re passive.  This can lead to decisions or action being taken that is “done to us”, rather than us being involved and feeling powerful in the decision making process affecting us.

A common “model” that is often used to define “participation” is that of Sherry Arnstein.  While there are others who’ve developed her model, I think hers is fairly easy to understand.  It looks like this.

I personally think there is a difference between engagement and participation.   For me, engagement means different ways of getting people involved in participating.  For example, you could use a blog to engage with people (hopefully).  There are innovative ways of engaging with people, through the use of eparticipation (electronic) mechanisms, such as Twitter, Facebook, email, websites, electronic surveys, YouTube, etc, but not everyone has access to these and more importantly, there are people in Powys who just don’t want to engage with services in this way.

True participation has to enable all ways of engaging with people, most especially, I feel, in face to face dialogue.  The more we rely on eparticipation as the only way of engaging with people, the more we remove ourselves from that face to face opportunity of conversing, listening, having open (transparent) dialogue with people.  For me, true, active participation, means personal (people) action.  If I look at Sherry Arnstein’s model, it’s the degree of “citizen power” that means true partnership, delegated power and ultimately, citizen control.

The more we enable links of personal contact between decision makers and those who are most affected by the decisions which are made, the more we move towards true partnership with delegated power and control in how mental health services are shaped.

After much reflection, I cannot enable participation without active people (citizen) power.  It is down to me to use the widest engagement tools possible to ensure this happens.  It’s down to me to ensure that I stand firm in promoting individual “participation”.  Who do I ultimately stand for?  It’s the people affected by mental health services in Powys.  If you want to start a movement, now is a good time, let me know?

"Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has." - Margaret Mead.

You can link to the National Principles for Public Engagement here.


  1. It is good to know that the people of Powys have such dedicated individuals as yourself to champion them. All voices should be heard and be encouraged to participate.

  2. Questioning where one is and where one is going is always an important and constructive thing to do, however within the context of participation the real challenge is not to define it. To define it is to put boundaries around it. Participation can so easily move from tokenism to supporting people who say what we want to hear or who fire the bullets we want to fire. True participation has to be anarchic, it is defined by the individual who wants to participate, however uncomfortable that may be. So questioning is good so long as it does not get in the way of active participation.

  3. I found your examination of what participation means, at all levels, really helpful (in terms of the groups i am involved with). Also, Derek Turner's comment urges me to pose the question - "Where are the dissenting voices?" as a way of remembering to make room for these.
    The main difficulty is always getting members to move from passive to vocal or active participation.
    Keep presenting a variety of options for participation (as you already suggest) and keep asking for input on new options. Which is I suppose a way of staying flexible and open to change in the area of participation by members of the access group.
    Good luck with this work, and thanks for the stimulation your blog gave me in this often problemmatic area.
    Leonie ~