Mental health care: Is changing policy changing minds?

MENTAL HEALTH CARE: IS CHANGING POLICY CHANGING MINDS? A question of direction: ‘How did we get here and are we going the right way?’

A critical analysis, written by Feleena Mason, Oxford Centre for Criminology You can find a downloadable version here.

Introduction

In this study I explore the contemporary mental health care treatment directive and the external factors that brought us to the current model of treatment. My question is:

‘How did we get here, and are we going the right way?

My interest in mental health care provision is longstanding but was recently stirred by interactions I had with a local mental health care. In January 2015 I needed to ask a community mental health team for their support in assisting a bi-polar family member, who for anonymity reasons will be referred to as [patient A] from this point forward. The response I received raised questions to me of the effectiveness and purpose of the current model of mental health care. A mother and carer of a vulnerable bipolar adult was unable to provide support, I directed the question to several treatment hubs within the local community mental health team, with the specific question being: “how can [patient A] access the help needed in order to continue to live independently?” The response I received was from a senior care co-ordinator; “unless [patient A] needs medicating, there is nothing that we can do”. This standard and typical response compelled me to investigate this treatment principle further. How and why has the apex of mental health care become, “if you don’t need medicating, there is nothing that can be done”?

To answer the question I will begin by tracing the historical model of mental health care. I adopt a socio-economic perspective and situate the discussion under headings of, ‘the Transition’ and ‘Evolution’ of mental health care which will discuss the move from institutional to community care. This will continue into a critical look at the decarceration process under the heading of ‘Scared in the community’, this section will explore the objective of ‘community’ as a method of treatment. The focus of the study then turns to ‘the policy of madness’ in which I look at neo-liberalism and debate its significance within the organisational restructuring of mental health care, purchase and treatment. The concluding section of, ‘right direction, wrong vehicle’, questions current treatment directives and explores the arguments raised alongside a user’s perspective. The study concludes with a summary of findings and suggests ways of improving the service user’s experience of contemporary mental health care.

The Transition

As a social scientist it is important to examine any contemporary phenomena within the context of its position in time and space. The significance of this, as part of an investigative procedure is the key to contextualising the ‘how and why’ attitudes and perceptions that have changed over time. Fawcett and Karban (2005) advocate this approach of historically ‘mapping’ when exploring social complexities when they write, “this will provide a backdrop for contemporary developments, recognising that the legacy of the past provides one route into an understanding of the complexities of the present” (2005, p26). Therefore to understand current mental health policy and practise, my exploration of the norms and values associated with mental health and caring for this mentally ill, are placed forthwith in a brief historical context.

From the mid-18th century, locking up and institutionalising those deemed to have mental or physical dysfunction was the norm until criticisms of the human rights of those incarcerated were brought into question. After two centuries of unreformed authoritarian institutionalisation, changes began to take place inside and out of the construct of asylum:

in the late 1950’s and 1960’s a number of notable changes were introduced […] The iron railings surrounding the parameter were dismantled, many of the wards were unlocked, patients were given individualised clothing, more recreation was provided and programs of occupational and industrial therapy were introduced, (Barham, 1992, p6).

The debate on the purpose of asylums began with the 1954 review into mental health legislation and treatment (Goodwin 1997, p10). The conditions of asylums, the scandals surrounding them in conjunction with a lack of funding to refurbish them, paved the way for change. However, around this time theoretical shifts in rethinking mental health treatment and provision also began to develop; the literary contribution of Goffman’s(1961) Asylums and the research of Tooth and Brook (1961) (cited in: Weller and Muijen 1993, p2) were paramount in this movement. Tooth and Brook’s (1961) conclusions were modified and presented to parliament as policy objectives by the Minister of Health, Enoch Powell in 1962, (Weller and Muijen 1993, p2). Whilst changes to mental health provision became a political objective in the 1950’s it manifested only in speech and suggestion, “it was argued that there had been ‘A substantial change in the general climate of public opinion’ (Ministry of Health, 1958, 22), and that ‘people are more ready to tolerate mental disorder’ (Chief Medical Officer, 1958, 121)”, (cited in: Goodwin, 1997, p41). This began the change of directive from asylum to community care, but was very slow to be fostered, “the gradual closure of long stay hospitals serving a variety of groups can be traced from 1960’s onwards. Although progress was initially slow, the pace gathered momentum – fuelled by a number of scandals over abuse and neglect”, (Fawcett and Karban, 2005, p35). The move from institution to community care was formally outlined by The Mental Health Act of 1959 confirming that, “The passing of this legislation reflects the fact that a clear policy position has been established … concerning the need to shift from an institutional to a community-based system of care and treatment” (Goodwin, 1997, p11), however it wasn’t until the 1962 Hospital plan that the official closure program was launched (Murphy, 1991, p59). I will now explore elements attributed to the demise of asylums.

The Evolution

This section of evaluation considers the changes to mental health care after the 1962 hospital closure plan. I will start with a discussion on approaches to treatment, consider the impact of alternative therapies and illustrate the effects of theoretical benchmarks in the move from custody to treatment.

The first element which facilitated change in the treatment of mental illness was the advancement of pharmaceuticals:

The introduction of ‘major tranquillizers’ and their widespread use […] the relaxation of institutional life, plus the success of earlier methods of rehabilitation and resettlement outside hospital, resulted in an open and optimistic attitude in British Psychiatry, (Weller and Muijen, 1993, p7).

The increased use of anti-psychotic drugs and tranquilizers (benzodiazepines, chlordiazepoxide (Librium), diazepam (Valium)), became commonly prescribed inside and out of asylums, “during the 1970’s the number of prescriptions for benzodiazepines continued to rise in Britain … in 1979 [when] 30.7 million scripts were dispensed”, (Taylor, 1987) (cited in; Heller, Reynolds, Gomm, Muston & Pattison, 1996, p197). However not all theorists agree on the significance of medicine when discussing the decline of asylums, “indeed many (Skull 1977; Treacher and Baruch 1980: 146) suggest that the so called drug revolution had only partial significance in the wider changes taking place at this time”, (Fawcett and Karban, 2005, p34), these wider changes being of an increased social awareness of civil rights as, “a marked shift occurred in the 1970’s towards support for acknowledging the civil rights of marginalised groups”, (Goodwin, 1997, p37). Consequently I am not arguing the significance of medication at this stage but, wish to outline its’ prevalence in the transformation of mental health treatment.

Another factor which developed at this time was a contention between mental health care inmates and psychiatrists. This resulted in a critical gaze becoming focused on psychiatry due to the authoritarian regimes associated with asylums. Authors such as Cooper, Laing, Szasz and Esterson offered critiques of conventional psychiatry, which were received with mixed reviews and soon became associated with the ‘antipsychiatry movement’ in the 1960’s (Goodwin, 1997, p36 ). These writers offered alternative perspectives on the treatment and social construction of mental health, “in the 1960’s a number of critical accounts of psychiatric theory and practise were developed. Szasz (1961) argued that mental illness was a ‘myth’ concocted as a result of the interest of therapists”, (Goodwin, 1997, p36). Although Szasz is one of the more extreme examples, the significance is found in the assimilation of an opposition to the status quo. This first wave of ‘anti psychiatric’ theory prompted the significance of the patients perspective and guided the inspiration of the Mental Patients Union, (early 1970’s). Some argue that this movement went on to influence The BNAP (British Network for Alternatives to Psychiatry) and CAPO (Campaign against Psychiatric Oppression), (Heller et al., 1996, p219), without which current mental health policy would have taken a very different direction thus emphasising the importance of these movements in considering contemporary mental health treatment.

In continuing the discussion on the transition from asylums to community care, it was around this time that literary critiques of institutions (as well as psychiatry) began to emerge. Goffman’s (1961) Asylums heavily criticised institutions and reiterated the question of their relevance and purpose in modern society. Goffman (1961) argues that resistance to authoritarian regimes of the institution is taken as justification for ones incarceration, thus questioning the purpose and treatment ethics within this societal structure;

In a psychiatric hospital, failure to be an easily manageable patient, […] tends to be taken that one is not ‘ready’ for liberty and that one has a need to submit to further treatment […] for the patient to express hatred of it is to give evidence that his place in it is justified and that he is not ready to leave it, (Goffman, 1961, p335).

Theoretical concepts, pharmaceuticals and user groups marked a definitive change in approaches to mental health care. These elements along with a change in government policy affected the rate at which asylums began to close; this ‘decarceration’ process significantly accelerated after the 1983 Mental Health Act.

Scared in the community

In this section I argue that the hospital closure program resulted in acute failings in the organisation and management to the provision and care of mental health patients. The effects of some of these difficulties are expressed by Weller and Muijen (1993), “The reduction of places in mental hospitals has not been matched by alternative provisions everywhere, which may have caused some neglect and suffering”, (1993, p44). It is my view that neglect and suffering in any form will affect a mental health patient in one way, and that is negative; this element alone would have perpetuated the demand for beds and services that was clearly not available. Conversely Murphy (1991) supports my argument and confirms adverse consequences to patients discharged at this time:

Some who were discharged mentally well had further breakdowns. Many left their original discharge address and drifted to large towns to live in lodging houses and cheap hotels, seeking isolation and anonymity […[ some ended up in prison. No doubt there were many successes too but similarly we know almost nothing about them, (1991, p61).

Similar concerns are reflected by Beardshaw and Morgan (1990) who provide a unique record of the success and short comings of community care in one locality:

Some hospitals are providing impoverished service plans are made to run them down, and the anticipated ‘transfer of services’ has not taken place […] patients have at times been discharged from long-stay hospital care without adequate preparation, while others who would once have been admitted to mental hospitals are instead living on the margins of society, (1990, p8).

Murphy (1991) and Bean and Mounser (1993) argue that the hospital closure programme was based on a strategy of, “everyone gets out, and some, it appears, whether they are ready or not; indeed, whether they are able to live in the community or not”, (1993, p12). Fragmented care and inadequate provision were common themes identified in the decarceration process however, others argue that the exodus was not completely without success, even if significantly precarious,

The picture is not, however, unmitigatedly bleak, for there are pockets of excellent services here and there […] though the overall picture is fragmented, uncoordinated, haphazard and extraordinarily variable from place to place, (Murphy, 1991, p63).

Similar sentiments are expressed by supporters pointing out that,

Even [within] the advocates of the decarceration movement fears exist that patients leaving hospital are being dumped in the community leaving them isolated and physically and socially worse off than before, (Scull, 1977 and 1983, cited in: Bean and Mounser, 1993, p18).

It is my view that an over enthusiastic confidence in the community treatment process also resulted in a significantly reduced number of beds for patients, Goodwin (1997) quantifies the results:

In England in 1950 there were a total of 60,266 mental hospital admissions and in 1989 there were 194, 0000 admissions; more than a threefold increase in the admission despite a two thirds reduction in bed space (Goodwin, 1997, p91).

The systematic push towards community care had detrimental effects on the mental health patient. The reduction of hospital beds during decarceration meant that hospitals could not accommodate long term treatment requirements,

By 1991 the Department of Health closed 60 of Britain’s psychiatric hospitals thereby reducing the 70 000 hospital beds to 43 000, (Cohen, 1988, cited in: Bean and Mounser, 1993, p18).

Therefore, it is my view that one of the fundamental causes of an increased demand for hospital beds was created by the system itself. The rushed hospital closure programme left gaps in services which were not adequately supporting patients. Rogers and Pilgrim (2010) describe the effects of greater service demand pitched against inadequate bed space,

despite a steady decline in the number of people occupying hospital beds since the 1960’s, short stay admissions rose dramatically, creating a ‘revolving door’ hospital care, rather than fully fledged care in the community”, (2010, p202).

The lack of preparation and support of discharged patients is a notion reflected by user groups thirty five years on. Marjorie Wallace of mental health charity SANE stated in 2013;

What is truly shocking and disappointing is that the same factors have been identified case after case. The same catalogue of blunders are happening, the same recommendations have been given. And yet the same tragedies are happening. The lack of provision of beds, together with the budget cuts means health care trusts are taking a gamble (Carter, 2013).

My argument is that the changes to mental health provision accelerated at a rate which exceeded adequate provision to support the needs of the most vulnerable sections of people in our society. The community care ethos was strictly guided by a notion of deinstitutionalisation and decarceration, yet I argue that it failed to recognise and address the fundamental needs of the mental health patient. These elements are as significant now as they were then, being that the same criticisms of contemporary mental health care are being argued today. The key point is one of demand for services exceeding provision; which I argue is the principle factor in sustaining the ‘revolving door’ treatment ethic as it has been accepted and normalised from the very beginning of the community based treatment strategy.

Community

In considering the direction and purpose of contemporary mental health care, my next line of investigation considers the objective of community. The social construction of ‘community’ within the context of mental health care has left me with a feeling of unease. The construction and purpose of the term leads me to an argument made by Murphy (1991), who identifies the problem of its construction as ‘a vessel of treatment’ due to the fact that, “the ‘community’ is not a real place, only a fictional ideal”, (1991, p3). The creation of care ‘in’ and ‘by’ the community serves purpose to perpetuate one ideal, which is reconsidered by Banton, Clifford, Frosh, Lousada and Rosenthall (1985):

the rhetoric of ‘the community’ hides another rhetoric, that of family life. In practice it is women who carry the burden of the implementation of community strategies. Ideologically, the romantic fantasy of the remembered community is identical with the romantic fantasy of the family, associated symbolically with security, warmth and continuous care, obscuring issues of class, race and gender, (1985, p176).

Asylums although not perfect, simulated an environment of ‘same’ best described in Durkheims (1897) ‘le suicide’ as ‘Anomie’. I argue that the hostile, clinical and impersonal void of asylums, protected inmates from the external realisms of class, race and gender disparities. These issues, among other differences were unaccounted for in the creation of the ‘community’ to which the mental health patient was fostered to upon release. Unprepared services, lack of support and inadequate accommodation, reflect a sentiment dominant in current literature, yet the irony is in the realisation that this argument is based on claims of inadequacies from 35 years ago. There are undoubtedly many success stories from patients of this time but such change in directive was inevitably going to be susceptible to logistical difficulties. I argue that the shift from asylum to community care gave optimism to the treatment of the long term mentally ill however, the execution of its implementation failed to deliver on the promise of dignity and independence from incarceration. The decarceration movement along with economic incentives and lack of a definitive plan, had irreversible repercussions on the mental health patient which I argue are still being felt today. Whatever the degree of negligence experienced by the ex-inmate of asylums; it cannot be disputed that at the time of decarceration, patients’ needs were not addressed or met adequately. The development of fragmented and ineffective community care has continued to wage unfavourably against the patient both then and now. I will now shift the perspective of evaluation to economics and look at the compatibility of mental health care and liberalised economics.

The Policy of Madness

This part of the evaluation considers the concept of neo-liberalism, examine government policy and evaluate implications on mental health care. In researching for this paper, I identified distinct changes with mental health care policy and al;igned them with the expansion of a neo-liberal economic directive. I will firstly outline key elements of neo-liberalism which will provide the boundaries of discussion. This is summarised by Harvey (2005) as, “Deregulation, privatisation, and withdrawal of the state from many areas of social provision”, (2005, p3). This is neo-liberalization in very simplistic terms. A definition appropriated by the most socially visible elements of its existence however, neo-liberalisation is not that straightforward. It is not just a set of economic principles, but is also a political philosophy as Harvey (2005) outlines:

The process of neo-liberalization has, however, entailed much ‘creative destruction’, not only of prior institutional frameworks and powers but also of divisions of labour, social relations, welfare provisions, […] neoliberalism values market exchange as ‘ an ethic in itself, capable of acting as a guide to all human action, and substituting for all previously held ethical beliefs’, […] it holds that the social good will be maximised by maximizing the reach and frequency of market transactions, and it seeks to bring all human action into the domain of the market (Harvey, 2005, p3).

By introducing free market principles into publicly funded arenas, neo-liberalised market economies envisage that ‘social good’ will be maximised. It was during the 1980’s that this principle became popularised by Prime Minister Margaret Thatcher. It was believed that state funded institutions were contrary to voter’s demands and it was also a time where government commitments to reducing state involvement in citizens’ lives gained momentum. Neo-liberalism’s commitment to radical individualisation shifted mental health care from collective institutional care to individualised, decentralised care, which meant,

In organisational terms the implementation of a community care strategy involves a major shift of resources from hospital to community services, and from health authority to local authority, (Beardshaw and Morgan, 1990, p5).

This illustrates a distinct shift of responsibility from government to local authority. Watkins et al (1996) add depth to this illustration when they describe the force behind the 1990 Mental Health Act, which I argue coincided with neo-liberal concepts:

the 1990 Act was simply the extension into the health and social care arenas of Mrs Thatcher’s Zeal for market reform … The final dimension is the explicit emphasis on further development of the mixed economy of care: the encouragement of greater pluralism in provision, especially with markedly greater roles for private and voluntary agencies […], (1996, p42-43).

This observation reflects a very neoliberal strategy, in that the state has started to distance itself from the direct care of mental health patients by shifting the funding and duty of care. It is my view that private sector involvement has increased as neoliberal policy has accelerated but to the detriment of the patient;

Financial incentives, developed to support a specific policy directive, have encouraged greater diversity in service provision than previously provided in the hospitals […] public sector agencies involved in mental health care purchase services directly from provider units (Watkins et al ., 1996, p52).

Neo-liberalised economic principles have had a paramount effect on the ways mental health treatments are purchased and appropriated. It is my view that the problem of cost containment within a multi-agency approach has proven to be problematic within mental health care and planning. I argue that this is down to principles of purchasing goods and services for an atypical industry. Contractual reviews, negotiating and management of services against needs is fine; if mental illness was like chicken pox and came and went within a predetermined period of time. The time line of mental illness is fluid unlike fixed term contracts, therefore I argue that mental health provision and care is neither logistically or physically compatible with free market economics, “Mental health care is quite different from other so-called service industries”, (Watkins et al ., 1996, p53) this argument is supported by Knapp (1994) cited in; (Watkins et al ., 1996),

There are numerous potential sources of difficulty – what the economist would call ‘market failure’ […] market structure, provider power and information difficulties ((Knapp et al. 1994) cited in Watkins et al., p 52).

It is my view that these aforementioned sources of market failure have resulted in service-user inadequacies. Brooker and Repper (1998) describe a consequence of this in providing mental health care,

People overwhelmingly find that they have to ‘fit in’ with what is offered to them. Stated needs go unrecognised or, at worst, are ignored, (1998, p45-46).

My argument here is that orthodox procurement models used to provide mental health care cannot be optimised with a ‘one size fits all’ approach. Watkins et al., (1996) support this argument when they explain that, “many users have long term care needs which must now be satisfied by shorter–term contracts or purchasing (funding) agreements”, (1996, p52). Objectifying mental illness and forcing it to fit into market structures presents a unanimous specificity as Brooker and Repper (1998) argues;

Although local services are beginning to define the client group they intend to focus on, they are adapting to SIDDD [safety, informal and formal care, diagnosis, duration and disability] criteria in different ways […] whatever the mechanism for arriving at a definition of serious mental health problems, there is unlikely to be universal agreement, (1998, p312).

To match criterions and directives which fit with departmental budgets and requirements, holes are left in the support network, “Strict adherence to fixed criteria will inevitably leave gaps through which people can fall”, (Brooker and Repper, 1998, p313). I argue that this had led to service ambiguities, Knapp (1995) illustrates:

A growing number of agencies and professions are actively involved in mental health care delivery, funded from a growing diversity of sources […] it is clear that many different services and funding arrangements come under the mental health banner, and there are many types of ‘transaction’ linking them. The need for a strategic approach to resource utilisation and management is as pressing today as it has ever been (1995, p6).

Organisational restructuring which was introduced to bring about competition and choice has resulted in eluded responsibilities and ambiguous definitions of care. It is my view that this has affected the patient’s ability to access appropriate mental health care.

Another problem of orthodox economics in mental health treatment procurement are the indeterminate considerations which make calculating overall costs of caring for the mentally ill, fallible. This is within the structures of analysis whereby e.g; family members/carers time, loss of earnings etc., are evaluated with quantifiable cost procedures (ie; medicine, staffing, alternative therapies). This gives a false representation of the economic benefits of types of care and therapies available:

Quantitative benefit-cost analysis can influence judgements about the efficiency of [alternative] therapies by showing whether programmes that appear to bring most cost reductions are actually doing so or are merely shifting costs to other people, (Jonsson and Rosenbaum, 1993, p33).

These typical methods of analysis has resulted in shifting the cost and burden of treatment from government, to local authority and then onto family members and other agencies. Jonsson and Rosenbaum (1993) support this theory in having investigated the social costs of mental illness. They examine obscured costs attributed to caring for the mentally ill in the community and argue that unaccounted costs have been shifted to relatives, carers, law enforcement and other voluntary agencies, (1993, p19-20).

Another aspect of cost and care ‘shifting’ is one that has replicated itself systematically. As the government relinquished responsibility to local health authorities, these authorities then fostered their responsibilities to families, hostels, care homes and other agencies as Murphy (1991) illustrates,

Health and local authorities faced with strict budgetary constraints quickly came to realise that, if they discharged patients into the community, the funding responsibility would pass elsewhere, (1991, p68).

I argue that the cost benefit ethos has become paramount in executing mental health treatment. As a result; policy, planning, departmental ambiguities and a lack of funding has left mental health care at the mercy of pharmaceuticals with limited alternatives;

Treatment of the mentally ill is also falling prey to cost containment pressures; in the process, low-cost technologies, such as embodied in relatively inexpensive pharmaceuticals, will seem to be attractive, while labour-intensive long-term regimes involving hospitalization or individual psychotherapies will be restricted, (Jonsson and Rosenbaum ,1993, p33).

A statement made twelve years ago, yet has paramount significance today. It is my view that the foundations set in the decarceration process, together with neoliberalised economic policy, has turned contemporary mental health care into a medication focused treatment directive with restricted access to both conventional and alternative therapies for service users. Neo-liberalised individualisation policy and the adoption of a generic procurement procedure has defined, categorised and quantified mental illness; resulting in market failures and service deficits. Preventative measures and alternative therapies do not balance against cost benefit analysis and competing agencies in this schema.

Right direction, wrong vehicle

The focus on treatment has navigated positive intervention out of mental health care. Treatment is limited and time constricted; in my opinion has developed into a crisis management service. The disregard for mental health maintenance and preventative measures is a point discussed by Jonsson & Rosenbaum (1993),

Incentives operating in mental health, […] have implicitly encouraged the development and utilization of resources for treating the ill rather than preventing the illness, (1993, p33).

I argue that to ‘care’ is to provide asylum, safety, respite and compassion; in order to prevent and manage further illness. We need support in the community before a crisis of the existing patient, and before an individual has become the patient. Treatment and not prevention under pin economic incentives in contemporary mental health care which I argue perpetuate the ‘revolving door’ cycle,

Prevention of illness – mental or physical – is preferred to treatment. It does not follow, however, that prevention is more efficient once the differential costs of treatment and prevention are taken into account, (Jonsson and Rosenbaum, 1993, p20).

Preventative treatment methods do not show financial rewards in cost benefit analysis; therefore crisis management is seen to be cheap and effective. It is my view that costs incurred by families, alongside damaging effects on patients are longstanding and detrimental to, the long term mental health and wellbeing for all involved.

To expand on my experience with mental health care I will refer back to ‘Patient A’ mentioned at the beginning of this paper. The story started with an example of the difficulties faced when trying to access support for a mental health patient. To recap, my request for help for [Patient A] was received with contempt as I was told, “Unless [Patient A] needs medicating, there is nothing that we can do”. Twelve weeks after I contacted the local mental health team, [patient A] was restrained in handcuffs, placed in the back of a police van and detained under Section 136 of the Mental Health Act. [Patient A] was detained for 72 hours in a ‘safe place’ (an area providing an alternative to a police cell when available). In the 69th hour [patient A] was found a hospital bed some 200 miles away and eventually put on a 28 day section. [Patient A] is now nearer home and on a six month treatment order. I feel that all of this could have been avoided if the patient had been given support before relapse and crisis. Banton et al., (1985) acknowledge the systemic creation of a mental health crisis when they illustrate the cycle, “the community strategy [away] from a traditional responsive role, operating only when breakdowns in well-being are recognised and ‘clients’ created”, (1985, p188). It is hard for me to put these events onto paper because the ‘revolving door’ cycle is not just an identified phenomenon, it is a social fact that has consequences; it is degrading, painful and a haunting experience for all involved. Treatment in the form of crisis management is mental health care as I know it, and this is where my analogy with the wrong vehicle surmises; the right direction is in moving policy away from long term institutional care however, the wrong vehicle is the treatment ethic; a crisis management strategy is not a suitable catalyst for appropriate and effective mental health care.

Conclusion

In examining the history of mental health and looking at the processes of deinstitutionalisation, the closure of asylums has led to the start of a greater awareness of mental health through a public presence. Patients are no longer locked away, forgotten and forced to pay the price for an illness that they didn’t ask for. Social and political factors have acted as a catalyst for mental health care albeit with variable negative consequences yet nonetheless, a beneficial move towards increased awareness and understanding of mental health. Government spending (or lack thereof), local budget restrictions, NHS restructuring and expenditure reviews have resulted in a significant lack of treatment options for the mental health patient. The recurrent conflict between psychiatrists, therapists and patients lie within the realms of a treatment ethic dictated by neo-liberalised decentralised individualised care where cost benefit analysis is the definitive factor in appropriating treatment. The indoctrinated virtues of cheap pharmaceutical has manifested itself in the epitome of my contention; “If you don’t need medicating, there is nothing that can be done”. In conclusion, if progress in mental health care is to be made, policy and ethics need to change. A focus on prevention and a devolvement from a crisis management ethic needs to take place. The politicians and government officials who developed contemporary mental health care around ‘a fictional ideal’ must step away from debate. User groups, carers and voluntary organisations need a louder voice to develop a mental health treatment program that facilitates mental health wellness and not contribute to the demise of it.

About the Author.

Feleena Mason is a researcher at Oxford University’s Centre for Criminology. She has range of interests in criminology, penology, class and mental health. You can view her academic profile and publications here

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