Psychopolitics in the twenty first century

This special issue was inspired by our long standing interest in Sedgwick's work and our own – individual and collective – struggle with the questions he posed for a left-inspired politics of mental health. Specifically, it arose out of a national conference we collectively organized in June 2015 at Liverpool Hope University - PsychoPolitics in the Twenty First Century: Peter Sedgwick and radical movements in mental health. We do not necessarily agree, even amongst ourselves, about what constitutes his enduring legacy for a mental health politics. However, we do share the belief that his work offers a crucial starting point for discussion and debate. In the rest of this editorial we summarise the contents of this issue, and then outline some key areas that we think require further attentio

Social protection and labour market policies for vulnerable groups from a social investment perspective. The case of welfare recipients with mental health needs in England (RE-InVEST working paper series D5.1)

This study examines the impact of welfare reform on claimants with mental health needs in England, in particular the effects of the recent introduction of two social protection measures: Employment and Support Allowance (ESA) and Personal Independence Payment (PIP). Our analysis indicates that reduced access to and adequacy of benefit coverage under these reforms, particularly the elements linked to increased conditionality, have led to diminished levels of social protection for people with mental health needs. We also identify how discriminatory processes in the benefits system have negatively impacted the sense of self- respect and security experienced by claimants. Overall our data suggest that ESA and PIP processes undermine claimants’ subjective wellbeing and exacerbate experiences of mental distress. We therefore propose the term ‘benefits distress’ to describe these forms of suffering that are being institutionally propagated by UK government agencies and the corporations to which state welfare functions are outsourced. The study is part of the wider European RE-InVEST project to investigate the impact of active labour market and social protection policy on marginalised social groups since the financial crisis of 2007

Towards inclusive service delivery through social investment in England. An analysis of five sectors, with a particular focus on mental health

This report examines trends in social investment in England following the financial crisis of 2007/8. The first section considers social investment in relation to four policy arenas: housing, financial services, early childhood education and care, and water. The second part of the report provides an overview of social investment and disinvestment trends in the healthcare system in England since the 1990s with a particular focus on mental health services. This section includes a detailed account of service users’ and professionals’ experiences of the impact of liberalisation and austerity measures on mental health service delivery drawing on qualitative data collection. Throughout the report we identify policy recommendations to address the effects and impacts of emergent trends towards social disinvestment and liberalisation of public services. This study is part of the wider pan-European RE-InVEST project to investigate the impact of the EU Social Investment package on marginalised groups since the 2007 crisis

Mental Health Beyond Austerity: A ‘Mental Wealth’ Approach to post-austerity policy-making

The proposals in this document arose out of preparatory work by the four authors for the TUC ‘Closing the Gap’ conference in Salford as well as contributions by participants at the event. The manifesto in Appendix I represents some very preliminary ideas and suggestions towards a mental w/health manifesto, but does not claim to be a comprehensive statement nor represent the position of any particular organization or campaign. However, if there is a wish amongst wider mental w/health campaigns to do so, the authors are open to further discussions to develop this in democratic, collaborative and inclusive ways into a post-austerity Mental Health/Wealth Manifesto to inform ongoing activism

Understanding Mental Distress: Knowledge, Practice and Neoliberal Reform in Community Mental Health Services

The book presents an ethnographic exploration of contemporary neoliberal reforms of community mental health services. The introduction of market-based delivery and performance mechanisms has restructured this setting and produced a shift from predominantly relational to informational forms of practice, within an organisational culture of defensive risk management. The time and space within services to develop trusting supportive practitioner-user relationships has been significantly constrained. The implementation of these organisational reforms was also accompanied by punitive forms of managerial control. Overall, these developments have generated tensions and stress for practitioners and service users alike. However, neoliberal reform processes are uneven and the sediments of earlier systems of mental health provision remain visible in the form of biomedical, custodial but also social-relational approaches. These diverse organisational features create a range of institutional tendencies (or situational logics). While situational logics in neoliberal services that tended to reinforce restrictive biomedical and custodial practices were predominant, sometimes countervailing practices that challenged the constraints of these informational, medically reductive and coercive tendencies also emerged. Discontent with currently dominant logics generated resistance in the form of micro-level attempts by practitioners to maintain social-relational and community approaches. This also included the development of nascent alliances between practitioners and service-user survivor activists to contest these restrictions. This book offers a case study both of the effects of neoliberal reform on mental health services, and of the way this restructured action environment shapes how practitioners, service users and carers understand and respond to lived experiences of mental distress

‘Diagnosis human’: Markets, targets and medicalisation in community mental health services

Jeremy Weinstein has argued that three processes: managerialism, marketisation and medicalisation are reshaping contemporary mental health practice. This chapter will seek to expand on their nature, dynamics and interaction within community mental health services in England. The discussion will begin with an overview of the form taken by managerialism and marketisation in mental health services. This is followed by an outline of the mechanisms through which front line practice is medicalised and its impact on social workers, other mental health practitioners and service users. The chapter will then go on to briefly examine risk, and conclude with consideration of the prospects for resistance to the neoliberal restructuring of the mental health field

‘The business end’: Neoliberal policy reforms and biomedical residualism in frontline community mental health practice in England

Mental health policy initiatives in England over the last three decades have led to significant restructuring of statutory service provision. One feature of this has been the reconfiguration of NHS mental health services to align with the requirements of internal and external markets. Based on findings from twelve months’ ethnographic fieldwork within one mainstay of NHS statutory services, the community mental health team (CMHT), this paper examines the effects of such neoliberal policy and service reforms on professional practice and conceptualisations of mental distress. The paper begins with an account of the restructuring of the labour process in mental health services. This utilises the notion of ‘strenuous welfarism’ (Mooney and Law, 2007) to describe an organisational context characterised by escalating performance management, deskilling of professional practice and the intensification of mental health work. Increasingly prominent aspects of managerialism and marketization disrupted attempts by mental health practitioners to sustain supportive and mutual structures with colleagues and engage with service users in therapeutic and relationship-based forms of practice. Moreover organisational processes increasingly recast service users as individual consumers ‘responsibilised’ to manage their own risk, or subject to increasingly coercive measures when perceived to have failed to do so. Consequently biomedical orientations were remobilised in practice in spite of a rhetorical shift in policy discourse towards socially inclusive approaches. The term ‘biomedical residualism’ is coined to describe this phenomenon. However instances of ethical professionalism that reflected resistance to these residualised modes of practice were also visible

Realising Sedgwick’s Vision: Theorising strategies of resistance to neoliberal mental health and welfare policy

There has recently been a re-emergence of interest in non-reductive historical materialist modes for analysing social movements. A precursor of this is found in the work of mental health activist and Marxist theorist Peter Sedgwick. We contend that Sedgwick’s work retains utility for theorising radical mental health movements in the twenty-first century, though we argue his framework needs extension in light of intervening debates regarding the interaction of material (distributive) and post-material (recognition) concerns. Having established this we will turn to an overview of recent neoliberal work, welfare and mental health policy reforms as a basis for consideration of strategic implications and challenges for resistance and coalition building amongst survivor and worker activists. We will propose a contemporary Sedgwickian strategy that identifies transitional organizing goals combining concrete material demands with imaginative, prefigurative means oriented towards ruptural change. In conclusion we argue that tools for promoting this strategy such as the Social Work Action Network’s (SWAN) Mental Health Charter may assist in binding together diverse constituencies to strengthen alliances of resistance and deepen a politics of solidarity

Crisis and resistance in mental health services in England

The last two years have seen a small but significant increase in the level of resistance by service users and practitioners to the coalition government’s policy of austerity and neoliberal restructuring of mental health services in England. This article provides an overview and analysis of these developments by examining four recent campaigns that feature alliances between service users, workers, trade unionists and anti-cuts activists. It considers both challenges faced and successes achieved by campaigners