The Capabilities Approach, Transformative Measurement, and Housing First

Transformative change to mental health systems involves transformation in how practices, policies, and research respond to the needs of individuals with psychiatric disabilities. This paper presents Amartya Sen’s capabilities approach as a promising framework for outcome measurement congruent with the aims of transformative change in mental health systems. In this paper, Sen’s capabilities approach is contrasted with therapeutic and citizenship values as well as the Housing First approach to housing. The capabilities approach is examined in detail with regard to outcome measurement. Finally, this paper shows the value added of the capabilities approach to transformative mental health. Keywords: Community mental health, Capabilities Approach, Housing First, Housing First, Citizenship Proponents for transformative change in mental health systems advocate for meaningful changes to social responses for individuals with psychiatric disabilities in terms of practices, policies, and research (Nelson, Kloos, & Ornelas, in press). In this paper I will present Amartya Sen’s (1999) Capabilities Approach, a perspective concerned with the measurement of welfare and global poverty reduction, as an important methodological tool for research that pursues transformative change in mental health systems. The goal of this paper will be to contribute to the nascent literature on capabilities and mental health by articulating how Sen’s capabilities approach frames measurement and in turn how this contributes to transformative mental health. In making this case I will use Housing First, with specific reference to the Canadian At Home/Chez Soi study (Goering et al., 2011), as a concrete example of transformative mental health (Nelson, 2010). Theoretically, two arguments will be advanced: (a) that the capabilities approach synthesizes citizenship and therapeutic values and connects these values with outcome measurement (Sylvestre, Nelson, Sabloff, & Peddle, 2007; Sylvestre, unpublished manuscript) and; (b) that the capabilities approach can make several important contributions to the Housing First literature. In advancing these arguments I will start by defining and discussing citizenship and therapeutic values and relate these values to outcome measurement. I will present Housing First as an example of transformative change in community mental health that synthesizes citizenship and therapeutic values in its outcome measurement and holds a strong congruence with the capabilities approach. I will briefly define the capabilities approach and review the existing literature on the capabilities approach and mental health. I will then present this approach as it relates to measurement. Finally, I will comment on the value added of the capabilities approach to transformative mental health. Citizenship and Therapeutic Values An important dimension of changing the status quo of mental health systems is the foregrounding of citizenship values in research, practice, and policy (Sylvestre, unpublished manuscript). In a content analysis of mental health and housing literature, Sylvestre et al. (2007) identify citizenship and therapeutic values as two dominant categories. Citizenship values encompass access and affordability, accountability, housing rights, and legal security of tenure. Therapeutic values encompass choice and control, quality, and community integration. In their review, the authors conclude that therapeutic values dominate the housing and mental health literature and that research focusing on how housing programs are actually delivered and experienced by tenants is needed to address this value discrepancy. Sylvestre (unpublished manuscript), drawing on the work of Hall and Williamson (1999), has extended the conception of citizenship presented by Sylvestre et al. (2007) and presented three conceptions of citizenship. The three orientations are: (a) legal citizenship (the nature of the relationship between individuals and the state); (b) normative citizenship (the interaction of citizens with civic, political, or social organization and processes); and (c) lived citizenship (the implications of citizenship in daily life). Legal citizenship denotes the relationship of the individual to the state primarily through rights and responsibilities. Rights ensure equal treatment and equal access to participation in political and civic life. Responsibilities are less well defined. Sylvestre (unpublished manuscript) draws on Marshall (1950) to articulate three dimensions of rights: (i) civil rights – rights that are necessary for individual freedom, (ii) political rights – the right to exercise political power, and (iii) social rights – the basic provisions offered by the state to ensure a base level of social welfare and the ability of all citizens to act on Global Journal of Community Psychology Practice Volume 5, Issue 1 June 2014