From Service User to Citizen

On Citizenship, Dignity, and the Right to Participate

There are words that describe people, and there are words that place them.

“Service user” is one such term.

At first, it appears neutral. A person uses a service, just as others use a bus, a library, or a public scheme. But when the verb becomes a noun, something changes. The person is no longer someone who uses something. The person becomes a user.

The word is no longer simply a description of an action. It becomes an identity.

In health and social services, “service user” has become a collective term for people who receive help, care, or support from public agencies. The term was introduced partly to replace older and more paternalistic labels such as client, dependent, or patient. It was meant to signal activity, rights, and influence. The person was not to be seen only as a passive recipient of help, but as someone who used a service.

Yet a new problem emerged. The person was still defined through their relationship to the service system.

A woman with an intellectual disability is not first and foremost a user of municipal services. She may be a daughter, sister, neighbour, friend, colleague, churchgoer, football supporter, or member of a local choir. She may be someone who enjoys walking in particular places, who looks forward to Saturdays, who misses someone who has died, or who becomes anxious when strangers enter her home.

None of this disappears because she receives services.

Even so, the service system may come to meet her as though the most important thing about her is that she receives municipal support. Her life is interpreted through decisions, staff schedules, case records, action plans, and budgets. Other people’s work is organised around her, yet her own life may paradoxically remain in the background.

The movement from service user to citizen therefore involves more than replacing one word with another. It requires a change of perspective.

The service user is seen from the system.

The citizen is seen as a member of society.

Whom Do We See When We See a Service User?

Language is never entirely innocent. The words we use shape what we notice. They bring certain aspects of reality into view and conceal others.

When a person is described as a service user, it becomes natural to ask which services they receive, whether the decision is being followed, whether resources are being used properly, and whether the service is efficient. These are necessary questions. But they are not sufficient.

When a person is described as a citizen, other questions come into view. Does this person have influence over their own life? Do they have access to the local community? Is their voice heard? Do they have opportunities to form relationships, develop interests, and influence the environment in which they live?

The service-user perspective can easily turn the person into an object of administration.

The citizenship perspective makes the person a participant in shared life.

This does not mean that the word “citizen” automatically creates justice. A person may be called a citizen and still be treated as an object. But the concept points in another direction. It reminds us that a person does not merely receive something from society. The person belongs to society.

This belonging does not depend on the ability to work, level of education, language, or cognitive capacity. It does not begin only when a person can speak at a meeting, vote in an election, or argue for their interests.

Citizenship must begin in the recognition that the person already belongs.

It is not something that must be earned.

From Institution to Community

The history of people with intellectual disabilities shows how decisive this distinction is.

For much of the twentieth century, many people with intellectual disabilities were placed in institutions, often far from their families and local communities. These institutions were intended to provide care, education, and protection. But they also created distance. They enabled the wider society to live without encountering the people who lived there.

Institutionalisation was not merely a way of organising services. It was also a way of organising visibility.

Some people occupied society’s ordinary spaces. Others were placed outside them.

When the Norwegian reform that closed the large institutions for people with intellectual disabilities was implemented, the aim was for people to move out of institutions and into municipalities. They were to live in ordinary communities, receive more individualised services, and lead lives that more closely resembled those of other citizens.

This was an important reform of justice. It recognised that people with intellectual disabilities should not live in separate worlds, isolated from the rest of society.

But physical relocation is not the same as social inclusion.

A person may live in a flat in the middle of a town and still remain outside social life. They may have an address in the community without belonging there. They may meet many employees but have few friends. They may be surrounded by people throughout the day and still be lonely.

The institution can disappear as a building while surviving as an organisational form.

When daily life is governed by shift changes, staff meetings, budgetary limits, and standardised routines, the person’s own life may still be subordinated to the needs of the service. When several flats are grouped around a staff room, the home may gradually acquire the character of a workplace. When the decisive question becomes what staff have the capacity to provide, the home may lose some of its meaning as the person’s own place.

It is therefore not enough to ask where a person lives.

We must also ask who decides there.

Citizenship as Belonging

Citizenship is often understood in legal and political terms. A citizen has certain rights and duties. Citizens may vote, speak freely, and participate in society’s institutions.

These are important dimensions of citizenship, but they do not fully capture the experience of belonging.

Citizenship also has a social and existential dimension. It is about being counted. About having a place in other people’s attention. About being missed when one does not arrive and welcomed when one returns.

A person may possess all formal rights and still lack this sense of belonging.

There are people who spend their entire lives within the care of the welfare state but rarely experience themselves as participants in a shared project. They are accompanied, activated, transported, and cared for. Yet they are not always given the opportunity to develop the relationships that make a place a home and a group a community.

Belonging cannot be created by administrative decision.

It must grow between people.

This does not mean that public services are unimportant. On the contrary, services can either open or close the space for belonging. They can help a person enter communities or make them even more dependent on professional relationships.

A staff member who accompanies a person to an activity can do more than provide transport and safety. She can support the person in getting to know others, finding a place, and gradually participating without the helper remaining at the centre.

But a service can also become so dominant that it overshadows the person. The professional helper may become the one who speaks, explains, and answers on behalf of the person. Then the helper becomes visible while the citizen remains in the background.

Good support should not only protect.

It should also make participation possible.

Nussbaum and Genuine Opportunities

Martha Nussbaum’s theory of justice helps us understand why formal equality is not enough.

She does not ask only which rights a person has on paper. She asks what the person is actually able to do and to be.

This distinction is crucial.

A person may have the right to participate in society but lack transport. They may have the right to express an opinion but not receive information in a form they can understand. They may have the right to self-determination but be surrounded by people who make decisions more quickly than the person can comprehend them.

The right exists.

The opportunity is missing.

Nussbaum’s Capabilities Approach directs attention towards these actual opportunities. She identifies ten central areas that a just society must ensure are available to every person. These include life, bodily health, bodily integrity, senses and thought, emotions, practical reason, affiliation, play, and control over one’s political and material environment.

The list is not a prescription for one particular kind of life. It does not say that everyone must live in the same way. It says that everyone should have genuine access to basic opportunities that make a dignified human life possible.

This also includes the right to refrain.

A person should have the opportunity to participate without being forced into activity. They should be able to seek community, but also to withdraw. They should be able to use their abilities, but also to live well without having to prove their usefulness.

Nussbaum’s thinking therefore protects both participation and individuality.

The citizen is not a project to be normalised. The citizen is a person who should be given real opportunities to live their own life.

The Right to Have a Voice

Citizenship is closely connected to voice. The person who has a voice can describe how the world appears from their own position. They can express wishes, resistance, joy, and disagreement.

But not everyone uses spoken language. Not everyone can formulate a coherent argument. Not everyone understands the complex documents produced by public authorities.

Does this mean that they have less to say?

A democratic society must be able to listen to more than the articulate voice.

Some people express themselves through simple words, pictures, body language, habits, or reactions. A person who withdraws from particular situations may be expressing something important. Someone who becomes anxious when new staff arrive may be showing that stability and familiarity are essential. Someone who repeatedly seeks the company of a particular person may be expressing attachment.

Listening therefore requires more than asking a question and writing down the answer.

It requires time, attention, and knowledge of the person.

This creates a particular responsibility for professionals and relatives. When a person needs support to express themselves, others must help their voice emerge without taking it over.

This is a difficult balance.

The person who knows someone well may understand signs that others overlook. At the same time, the same helper may become so confident in their interpretation that the person’s expressions are no longer examined.

“I know what she wants” may be an expression of deep familiarity.

But it may also be the beginning of her own voice disappearing.

Citizenship therefore requires a listening humility. We must be willing to interpret, but also willing to be wrong.

The Slow Time of Self-Determination

In modern services, time is often scarce. Tasks must be completed, shifts must end, and several people need support. Efficiency therefore becomes a necessary part of everyday life.

But self-determination takes time.

It takes time to explain alternatives. It takes time to wait for an answer. It takes time to allow a person to change their mind. It takes time to discover whether a yes is really a yes, or merely an answer given to please the person asking.

The professional can often complete the task more quickly alone.

It is faster to choose clothes, prepare food, tidy the room, and plan the day without involving the person. But what is gained in efficiency may be lost in agency.

When others continually act on our behalf, we may lose the opportunity to experience ourselves as acting human beings.

This also applies to small choices. Which cup should be used? When should the walk take place? Who should enter the home? Should the bedroom door be open or closed?

Seen from the outside, such choices may appear insignificant. But a life consists largely of such small decisions. If others take them over, the person may gradually lose ownership of their own everyday life.

The right to participate does not therefore necessarily begin at the town hall or the polling station.

It begins at the breakfast table.

When Care Becomes Direction

Care and control are not always clear opposites. They may be woven into one another.

The helper often has a responsibility to protect. A person may have difficulty understanding the consequences of their choices. There may be risks concerning health, finances, relationships, or safety. Professionals cannot always withdraw and say that every decision is solely the person’s own responsibility.

Nussbaum accepts that a weak form of paternalism may sometimes be necessary. Society also protects people without disabilities through laws, safety requirements, and restrictions. None of us lives with complete freedom.

But protection can easily expand.

A measure introduced to prevent a specific danger may become a permanent rule. A practical routine may gradually be presented as necessary. What actually protects the organisation from uncertainty may be described as care for the person.

We must then ask: For whom is this arrangement best?

Is it designed around the citizen’s needs, or around the service’s need for predictability?

Professional care must always include critical reflection on its own power. Good intentions do not release anyone from this responsibility. On the contrary, good intentions can make power more difficult to recognise.

“We are doing this for your own good” is one of care’s most understandable statements.

It is also one of its most dangerous.

The Home and the Right to Privacy

A clear example can be found in services provided in people’s homes.

For someone receiving extensive assistance, the home may also be the workplace of many staff members. They have keys, routines, documentation requirements, and responsibility for safety. Sometimes staff are present around the clock.

But the home still belongs to the person who lives there.

This can easily be forgotten.

When staff refer to the home as “the unit,” when shared spaces are organised according to staff working needs, or when residents must adapt to shift changes, a displacement takes place. The space of the service enters the space of private life.

The right to bodily integrity and control over one’s material environment is central to Nussbaum. This is not only about owning things or having an address. It is about being able to experience a place as one’s own.

In one’s own home, a person should in principle decide who may enter. There, one should be able to withdraw, be alone, and shape the surroundings according to personal wishes.

But what does this mean when the person cannot unlock the door, express whom they want to visit, or understand why new staff keep arriving?

Then just practice depends on helpers asking not only what they are entitled to do as employees, but what it means to be a guest in another person’s home.

The professional may work there.

But it is not her home.

Participation Is More Than Activity

In welfare services, activity is often used as a measure of a good life. People are expected to have daily plans, leisure opportunities, and meaningful occupations. This matters. Passivity, isolation, and lack of stimulation can make life poorer.

But activity is not the same as participation.

A person may take part in many activities without having any influence over them. She may be transported from place to place, follow a programme, and still remain more spectator than participant.

Participation means having a place that matters.

It may be a small place. One need not give speeches, lead meetings, or hold paid employment in order to participate. Setting the table in a shared space, greeting a neighbour, being known in the local shop, or having a regular task in an association can create an experience of contribution.

What matters is not the size of the achievement.

What matters is that the action is received as the person’s own action.

Citizenship arises in such reciprocal connections. I do something that others notice. Others expect something of me, but they also make room for me. I am not merely someone who receives help. I am someone who enters into the world of others.

This distinguishes participation from activation.

The person who is activated is set in motion by others.

The person who participates is part of something.

Work, Production, and Human Value

In modern societies, work is one of the most important routes into citizenship. Through work, people receive income, social status, colleagues, and structure in everyday life. The question “What do you do?” is often among the first we ask when meeting someone.

But this can make it difficult to recognise the value of lives not connected to ordinary employment.

People with intellectual disabilities often encounter low expectations. Some receive supported work or day activities, but without the wages, status, and development that others associate with employment. Others remain completely outside working life.

Nussbaum’s theory challenges the idea that human dignity must be proved through economic production.

The right to participate does not mean that everyone should be forced into the structures of working life. But it does mean that people should have genuine opportunities to use their interests and resources, to be recognised for what they do, and to belong to communities where their presence matters.

A person can contribute without that contribution being measurable in productivity.

They may create joy. They may keep relationships alive. They may remind others of slowness, presence, and care. They may be the person who always greets others, who knows all the songs, or who makes people laugh.

This is not a romanticisation of disability. Nor is it a claim that people exist to improve the lives of others.

It is a reminder that human contribution is broader than economic output.

A society that sees only productivity sees too little of the human being.

Participation and Power

Participation has become a central ideal in health and social services. Those who receive services should be able to influence how support is designed.

But participation can become an empty word unless power relations are examined.

The person receiving the service is one individual. On the other side stands an organisation with staff, management, rules, professional assessments, and financial limits. The relationship is therefore never entirely symmetrical.

The person may state what they want, but it is often others who decide whether the wish is realistic, professionally defensible, or financially possible.

This does not mean that participation is meaningless. But it does mean that participation does not arise merely because a question has been asked.

Genuine participation requires those with greater power to be willing to surrender some of it.

This may mean changing routines. Rewriting a plan. Not choosing the solution preferred by staff. Allowing a person to try something that involves a degree of risk.

Participation without the possibility of influence is merely consultation.

The citizen is asked, but the system decides.

The social basis of self-respect, which Nussbaum emphasises, develops when a person experiences that their wishes have consequences. I say something, and the world changes a little. My perspective matters.

When answers never have any effect, the person may learn the opposite.

My voice means nothing.

Supported Citizenship

Some people need extensive assistance in order to exercise citizenship. They may need support to understand information, express preferences, attend meetings, or safeguard their rights.

This does not make them lesser citizens.

It simply shows that citizenship, like so much else in human life, can be supported.

We like to imagine the citizen as an independent individual standing alone before the state. In reality, most of us exercise citizenship through relationships. We consult family members, read the assessments of others, allow someone to help us with digital systems, and seek support when trying to understand complicated rules.

The difference is not between those who need support and those who do not.

The difference lies in how visible the support is.

Supported citizenship means that another person can help a citizen to be heard without replacing her. The helper can explain, prepare, interpret, and be present. In some situations, the helper may also need to speak on the person’s behalf.

But representation must repeatedly return to the question: Whose perspective is being expressed?

Professional responsibility consists not only in knowing what is professionally correct.

It also consists in protecting the other person’s opportunity to be the author of their own life.

The Ordinary Right to a Distinctive Life

Normalisation has been an important ideal in the development of services for people with disabilities. People should have access to conditions of life similar to those available to others: a home of their own, work or activity, leisure, privacy, and participation in the local community.

But normalisation can be misunderstood.

It can become the belief that people must live as much like the majority as possible in order to be included. We then risk replacing the rules of the institution with the rules of normality.

A person may want a different life.

They may need more quiet, more predictability, or other forms of community. They may find joy in repetitions that others consider monotonous. They may prefer a few close relationships to many activities.

Justice does not mean that everyone must live the same life.

It means that everyone should have the opportunity to live a life that is both dignified and their own.

There is therefore a tension between the ordinary and the distinctive. The citizen should have access to society’s common goods, but should not be forced to become like everyone else.

Inclusion does not mean dissolving differences.

It means allowing differences a place in the shared world.

From Service to Society

Welfare services cannot create citizenship on their own.

They can support, adapt, and open doors. But a society in which people with disabilities have contact only with family members and paid staff is not fully inclusive.

Citizenship also requires the local community to take responsibility.

Neighbours, associations, workplaces, cultural institutions, and political organisations must be willing to make room. Not only physical room, but social room. It must be possible to participate without mastering all the unwritten codes upon which communities often depend.

This also asks something of those of us who do not work in services.

How do we meet the person who takes longer in the queue at the shop? Whom do we invite into our associations? Whom do we speak with, and whom do we only speak about? Are our communities open only to those who quickly understand how they are expected to behave?

An inclusive society is not defined primarily by its declarations.

It is defined by who is actually present.

From Service User to Citizen

The transition from service user to citizen is not completed because a public document has formulated it.

It must be made real again in every service, every community, and every encounter.

It happens when the person is not only asked whether the service works, but whether life has become the life they want. It happens when the dwelling is treated as a home. When support is provided without taking over the voice. When participation is understood as belonging, not merely activity.

It happens when we stop asking only what is wrong with a person and begin asking what prevents that person from living.

Nussbaum’s contribution is to show that justice cannot be measured only in resources, laws, or good intentions. It must be assessed through the real opportunities people have to do and to be what gives life value.

Does the person have the opportunity to form attachments?

To use their senses and imagination?

To play, grieve, love, and think?

To influence their own home and everyday life?

To be treated with respect?

These are not luxuries to be provided only when the economy allows. They are parts of a human life.

The citizen is not first and foremost someone who demands services.

The citizen is someone who already belongs to the community and therefore has a claim on society to make that belonging real.

This may be the deepest difference between service user and citizen.

The service user is administered by society.

The citizen helps to create it.

And a just society begins on the day when even the person who needs extensive support is met as a participant in the world we share. 

A just society begins on the day when even the person who needs extensive support 

is met as a participant in the world we share. 

This essay is based on my own notes and professional reflections and was developed in conversation with OpenAI/ChatGPT, which also created the illustration.