Book Tickets Now • People Not Pathology: Humanising Counselling and Psychotherapy – Conference 2-3 May


Eventbrite booking here

Psychotherapy and counselling in the UK is alive and well. The demand for therapy and the supply of therapists have both been growing steadily for decades. But how well are we doing as a vocation of the heart and soul?

For the last two decades at least, the humanity of our profession has been under attack from the state, the ideologies of the market and our own professional bodies. So, for example:

‣ the dominance of the medical model of mental health, psychiatric diagnosis and treatment plans

‣ the short-term utilitarianism of “evidence-based” CBT and CBT-like state therapy – eg IAPT

‣ the emphasis on individual responsibility over social responsibility

‣ our professional bodies have become state regulators of therapy and gatekeepers of training and employability – eg SCoPEd

‣ the growing homogenisation of therapeutic practice and the human spirit

‣ Dept of Work and Pension’s use of therapy as psycho-compulsion of benefit claimants

‣ the ubiquity of unpaid work by counsellors, psychotherapists, art therapists & group therapists.

‣ the growth of an underpaid, overworked, deskilled gig economy for psy workers in the public and voluntary sector

‣ open-ended client-led relational therapy increasingly the domain of the well off.

It’s time to take a stand and start to turn the tide. How do we stand together to humanise our profession and play our part in transforming neoliberal narratives about mental health into a vision of society organised around people’s needs?

Most of us are versed in the arguments and the experience of how relational client-led and client-paced therapy has been undermined over the last couple of decades, to the detriment of clients and therapists alike.

We want this to be a conference focusing on action over analysis. What are we doing, what can we be doing to take a stand and turn the tide?

The conference will be as participatory and “bottom up” as possible, putting the emphasis on small group discussion in workshops alongside relatively brief contributions from inspirational speakers. We hope the priorities for action will emerge from the workshops on Saturday morning and will be developed as decisions for action and networking throughout the weekend.

Eventbrite booking here

Programme Outline here

Momentum “The World Transformed” Policy Lab on Capitalism and Mental Health – Saturday 21st Sept 3.00-5.30 in Brighton

 

Nicola Saunders and Paul Atkinson are organising an event at Momentum’s The World Transformed on Capitalism and Mental Health on Saturday 21st September at 3.00 – 5.30 pm in Brighton. Jacqui Dillon and Malcolm Philips are joining us to introduce the meeting.

The focus of the event is to gather together from the people at the meeting concrete proposals for radical alternative policies on mental health for the next Labour Manifesto. This will be part of Momentum’s Policy Lab programme through which an alternative manifesto will be presented by John McDonnell and others to the LP manifesto discussion.

Our aim is to quickly identify together the main policy areas and spend as much time as possible in smaller groups discussing and formulating policy proposals for each area. It really matters then that we manage to attract as wide a range of experience and opinion on transforming mental health policy.

The online Momentum flyer for the event lists five “speakers”. This is a bit misleading. In fact, Nicola will chair;  Malcolm, Jacqui and Paul will kick things off with very brief talking points around the kind of issues we face in the mental health arena; Jon Ashworth, shadow Minister for Health, will say something brief at the end of the session.

As far as possible, the meeting will belong to the people who come along. So please come if you can. Get tickets here. And please circulate the invite to anyone who might be interested.

Warm greetings from Paul and Nicola
Contact  paulwilliamatkinson@gmail.com

United against welfare cuts and welfare reform: report from the lobby of the British Psychological Society conference, 18th January 2017

The challenge to the government’s draconian welfare reforms are gathering momentum, and as part of this campaigners from across Merseyside and even as far afield as London gathered outside the annual BPS Clinical Psychology Conference at the Hilton Hotel, Liverpool on Wednesday 18th January. The British Psychological Society (BPS) is the professional body for UK psychologists and has been working with the government on aspects of its welfare reform programme.

Service users/survivors, mental health workers and clinicians from a range of groups including Psychologists Against Austerity (PAA), Mental Health Resistance Network, Disabled People Against Cuts, Social Work Action Network (SWAN) as well as trade unionists arrived bright and early at the venue to share our concerns with conference attendees. There is strong evidence of the detrimental impact of welfare reform on claimants with mental health needs so we are calling on the BPS to withdraw from all work with the Department of Work & Pensions (DWP) and join us in demanding the government end their harmful welfare reform programme.

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Campaigners from a number of groups united to send a powerful message to the BPS leadership

As a result of our lobby, delegates informed us that welfare reform had become a major discussion point for attendees inside. Then as a result of this pressure a call came through to inform us that Peter Kinderman, president of the BPS, had invited us to address the conference the following day to explain our position and present our demands.

The next morning a group of campaigners representing the breadth of our alliance –service-users/survivors, a carer, and activists from North West Psychologists Against Austerity, Mental Health Resistance Network and SWAN – spoke to 300 psychologists at the first session of the conference. The group shared a strong message about the effects of welfare reform and called on the BPS to withdraw from all collaboration with the Department of Work & Pensions. In his response BPS president Peter Kinderman accepted some of our arguments but maintained that the BPS needs to continue to work with the DWP to get its perspectives heard. We reject this argument. We believe continued BPS involvement only lends credibility to the government, and BPS withdrawal would send a strong message about clinicians’ and service users’ concerns. We will continue to call for an end to all collaboration between the BPS and DWP.

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Campaigners are invited onstage to address 300 psychologists at the BPS Conference

The DWP is an unethical body that is damaging the lives of claimants with mental health needs.

The statistics and evidence on the harmful impact of welfare reform are clear:

  • 20,000 people with mental health difficulties had their benefits sanctioned in 2015
  • Following Work Capability Reassessment, there is a greater risk of suicides, self-reported mental health problems, and antidepressant prescribing (Barr et al, 2015)
  • 2,380 people died shortly after being declared able to work between 2011 and 2014
  • Government & corporate collaborators are imposing psychological explanations for unemployment, together with mandatory activities intended to modify beliefs, attitude, disposition, or personality – this is being called psychocompulsion (Friedli & Stearn, 2015)
  • The United Nations “is deeply concerned about the various changes in the entitlements to, & cuts in, social benefits introduced by the Welfare Reform Act 2012 & the Welfare Reform & Work Act 2016”. The UN has called on the Government to: “Review the entitlement conditions & reverse the cuts in social security benefits introduced by” these Acts

However we believe that this action and the growing campaigns around the country are starting to make a difference on this issue. A number of clinical psychologists attending the conference told us that the lobby and ensuing discussions would help to strengthen their voices within the BPS to make the case against the organisation’s involvement with the DWP.

We believe that when service users/survivors, psychologists and other mental health workers come together we are stronger. We will keep building alliances to pressure the BPS to withdraw from involvement with the DWP and to bring an end to the government’s wider programme of welfare cuts, reforms and psychocompulsion. If you would like to get involved please email us on mhwelfarereform2016@gmail.com.

Mental Wealth Alliance response to the psy professional bodies’ statement on benefit sanctions and mental health 30/11/16

From:

Mental Wealth Alliance[1]

 Mental Health Resistance Network; Disabled People Against Cuts; Recovery in the Bin; Boycott Workfare; The Survivors Trust; Alliance for Counselling and Psychotherapy; College of Psychoanalysts; Psychotherapists and Counsellors for Social Responsibility; Psychologists Against Austerity; Free Psychotherapy Network; Psychotherapists and Counsellors Union; Social Work Action Network (Mental Health Charter); National Unemployed Workers Combine; Merseyside County Association of Trades Union Councils; Scottish Unemployed Workers’ Network; Critical Mental Health Nurses’ Network; National Health Action Party.

To:

British Association for Behavioural and Cognitive Psychotherapies

British Association for Counselling and Psychotherapy

British Psychoanalytic Council

British Psychological Society

United Kingdom Council for Psychotherapy

30th January 2017

MWA response to the psy professional bodies’ statement on benefit sanctions and mental health  30th November 2016

We welcome the call from the psychological therapy bodies for the government to suspend the use of sanctions by the DWP subject to the outcomes of an independent review of its welfare policies and their potential damage to the mental health of benefit claimants. Given the accumulation of evidence over many years of the material and psychological suffering inflicted on benefit claimants by workfare-based conditionality[2], it has been frankly shocking that the professional bodies directly concerned with the mental health of the nation have preferred to welcome and participate in workfare policies rather than publicly and vociferously dissociate themselves.

The timing of the statement is given to be the recent report on sanctions by the National Audit Office. Welcome as its report is, the NAO’s perspective on government policy is primarily monetary, not one of health, ethics and social justice. Its “vision is to help the nation spend wisely”.  The choice of this timing represents realpolitik on the part of the professional bodies no doubt, as perhaps is the intention of the conditional statement: “The sanctions process may be detrimental to people’s mental health and wellbeing”. But surely as psychotherapists and counsellors we can do better to represent the overwhelming evidence of personal suffering on such a scale than point to poor returns on expenditure and an ambivalent proposal that sanctions may be detrimental to people’s mental health.

Sanctions are only one dimension, albeit at the sharp end, of a welfare regime based on the political assertion that people need to be coerced off benefits and “nudged” into work. The psychological pressure of WCA and PIP assessments, job search rules, work programmes on “good employee” behaviours and the regular cuts to welfare benefits generally are part and parcel of the psycho-compulsion of the DWP benefits regime.[3]

We dispute the government’s premise that work is a therapeutic priority for people suffering from mental health difficulties. The marshalling of evidence for this modern-day workhouse mentality lacks both substance and integrity. Work has become the ideological mantra for neoliberal welfare policies.

Obviously where people want to work and where employment possibilities exist that will support and nourish people’s mental health, then encouragement, training and professional support should be available. But why is there no acknowledgement of the hundreds of thousands of claimants with mental health difficulties who cannot work, whether they want to or not?[4] Where is the evidence that people with mental health difficulties are actually benefiting from what is now two decades of workfare conditionality in the UK? Where is the evidence that in our current labour market decent jobs exist that will nourish people’s mental health? And where is the evidence that psychological therapy for benefit claimants with long-term mental health disabilities succeeds in supporting them into decent jobs they want, can survive and maintain?

When the professional bodies say, “an estimated 86-90% of people with mental health conditions that are not in employment want to work”, they are supporting the proposition that getting into work is an overwhelmingly important and efficacious goal for this group of benefit claimants. It is not clear where this figure comes from and what it means.

A similar figure is quoted by The Royal College of Psychiatrists’ report on Mental Health and Work (2013)[5], making use of a Sheffield study by J. Secker and others (2001)[6]. In fact, Secker finds that of their sample of 149 unemployed service users, when asked if they were interested in work of any kind – including voluntary and supported work –  “around half (47%) responded positively, and almost the same proportion (43%) had a tentative interest. Only 15 people (10%) had no interest in work”. At the same time, only 25% of respondents saw full-time employment as a long-term goal. 71% said that their preferred vocational assistance would be “help for mental health/keep current service”.[7]

This study does not translate into “86-90% of people with mental health conditions that are not in employment want to work”.[8] What it points to is the complex texture of attitudes, desires and fears around waged work that are the common experience of service users, alongside the harsh realities of the current labour market, the socio-economic environment generally, and the dire state of mental health services of all kinds more particularly.[9]

From our point of view, the professional bodies’ statement is a step in the right direction. It is a step that must now be followed through with active political pressure on the DWP and the Dept of Health to suspend sanctions and set up an independent review of their use, including the damage they inflict on people’s mental health.  Parliament has already called for such a review.[10]

But more than this, the remit of such a review should include all aspects of conditionality in a benefits system that deploy psycho-compulsion through mandatory rules or through the more subtle imposition of behavioural norms which aim to override the claimant’s voice.

We again suggest that the psy professional bodies would benefit by widening their own conversations to include service users and the rank and file of their membership. They would also win more credibility as organisations with ethical and social values independent of the government’s policies of dismantlement of social security and the welfare state if they were willing to make transparent their currently private conversations with DWP.


[1] Mental Wealth Alliance (MWA), formerly the Mental Wealth Foundation, is a broad, inclusive coalition of professional, grassroots, academic and survivor campaigns and movements. We bear collective witness and support collective action in response to the destructive impact of the new paradigm in health, social care, welfare and employment. We oppose the individualisation and medicalisation of the social, political and material causes of hardship and distress, which are increasing as a result of austerity cuts to services and welfare and the unjust shift of responsibility onto people on low incomes and welfare benefits. Our recent conference focused on Welfare Reforms and Mental Health, Resisting the Impact of Sanctions, Assessments and Psychological Coercion.

[2] Parliamentary committees, the national press, endless reports from charities, service user organisations, people with disabilities, claimants unions and workfare campaigners have been reporting the physical and psychological damage of ‘welfare reform’ and its tragic outcomes for a decade.

[3] On psycho-compulsion and the benefits system see Friedli and Stearn http://mh.bmj.com/content/41/1/40.full and https://vimeo.com/157125824

[4] In February 2015 over a million people claiming ESA under a MH diagnosis were in either the Support Group or WRAG. Over 70% of new applicants for ESA are found unfit for work

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/470545/3307-2015.pdf

[5] https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212266/hwwb-mental-health-and-work.pdf p.17

[6] Secker, J., Grove, B. & Seebohm, P. (2001) Challenging barriers to employment, training and education for mental health service users. The service users’ perspective. London: Institute for Applied Health & Social Policy, King’s College London.

[7] Ibid, pp. 397-399

[8] Compare a DWP survey of disabled working age benefit claimants in 2013. 56% of 1,349 respondents agreed that they wanted to work. Only 15% agreed that they were currently able to work. Only 23% agreed that having a job would be beneficial for their health. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/224543/ihr_16_v2.pdf

[9] For example, some of this complexity is flagged by Blank, Harries and Reynolds (2012) The meaning and experience of work in the context of severe and enduring mental health problems: An interpretative phenomenological analysis Work: 47 45(3)    “Stigma, the disclosure of a mental health problem and the symptoms of the mental health problem are frequently described, as well as feelings of hopelessness, seeing recovery as uncertain, and feeling a lack of encouragement from services. Difficulties in accessing occupational health services, having a disjointed work history, lack of work experience, age, lack of motivation and fears about competency, as well as the social benefits system and caring commitments, are also experienced as barriers to accessing employment for people with mental health problems.”

[10] https://www.parliament.uk/business/committees/committees-a-z/commons-select/work-and-pensions-committee/news/benefit-sanctions-report

 

Mental health activists, workfare campaigners and therapists protest against work cure therapy for benefit claimants with mental health disabilities

  It’s time for the psy professional bodies to stop colluding with the DWP 

Join the protest against the professional bodies supporting work cure therapy for benefit claimants with mental health disabilities

Tuesday 5th July at 9 am at the New Savoy Conference

Hallam Conference Centre, 44 Hallam Street, London W1W 6JJ

Central London @ Great Portland Street tube (Map here)

See the conference programme here


For a decade or more, the Government has been deploying psychotherapy to get people with mental health difficulties off benefits, back to work and mapped into the neoliberal labour market. Since 2010, austerity policies of welfare reform – punitive Work Capability Assessments, benefit cuts, workfare, sanctioning – have intensified government strategies of psycho-compulsion and work cure for welfare claimants. IAPT therapists are being co-located in Jobcentres, DWP mental health advisers and employment coaches in GP surgeriesfood banksschools and libraries.

The big five national organisations representing the professions of counselling, psychotherapy and clinical psychology* have welcomed these policies and the state funding of back-to-work therapy.

As members of the New Savoy Partnership, they have been major players in The New Savoy Conference, an annual jamboree and market stall for state therapies in the NHS. The NSC frequently stages opening addresses by DWP and Health ministers to assert the close relationship between the professional bodies, MH charities and Government mental health and work-cure policies and funding. Hundreds of mental health workers accredited by the psy professional bodies have been hired by the DWP to provide “support into work”. These are jobs that are experienced as deeply unethical by many of the professionals being steered into this kind of work.

In March this year, the Mental Wealth Foundation (see below) wrote to the five professional organisations challenging their support of the government’s use of psychological therapies to put pressure on people with mental health disabilities to get into work. You can read the exchange of letters between us and the professional bodies here.

So far, all but one of these organisations are refusing to speak to us and continue to argue that they have had private reassurances from the DWP that “work cure” therapy will not be mandatory for claimants, and will not involve setting entry into employment as a therapeutic outcome. This claim defies the reality of the DWP’s record of punitive and coercive policies of workfare, Work Capability Assessment and sanctioning and its growing determination through its Work and Health initiatives to prioritise work as the therapy of choice for long-term mental health disability.

British Association for Behavioural and Cognitive Psychotherapies; British Association for Counselling and Psychotherapy; British Psychoanalytic Council; British Psychological Society; United Kingdom Council for Psychotherapy

Come and join the protest against work cure therapy for benefit claimants with mental health disabilities. All welcome. Gather at 9am on Tuesday 5th July outside the Hallam Conference Centre, 44 Hallam Street, London W1W 6JJ. For more info contact eventsatfpn@yahoo.com


The Mental Wealth Foundation (MWF) is a broad, inclusive coalition of professional, grassroots, academic and survivor campaigns and movements. We bear collective witness and support collective action in response to the destructive impact of the new paradigm in health, social care, welfare and employment. We oppose the individualisation and medicalisation of the social, political and material causes of hardship and distress, which are increasing as a result of austerity cuts to services and welfare and the unjust shift of responsibility onto people on low incomes and welfare benefits. Our recent conference focused on Welfare Reforms and Mental Health, Resisting the Impact of Sanctions, Assessments and Psychological Coercion.

Currently, seventeen organisations are gathered under the MWF umbrella: Mental Health Resistance Network; Disabled People Against Cuts; Recovery in the Bin; Boycott Workfare; The Survivors Trust; Alliance for Counselling and Psychotherapy; College of Psychoanalysts; Psychotherapists and Counsellors for Social Responsibility; Psychologists Against Austerity; Free Psychotherapy Network; Psychotherapists and Counsellors Union; Critical Mental Health Nurses’ Network; Social Work Action Network (Mental Health Charter); National Unemployed Workers Combine; Merseyside County Association of Trades Union Councils; Scottish Unemployed Workers’ Network; National Health Action Party

Manchester Conference Saturday 21st May 2016

Mind the Gap: Free Psychotherapy in an Unjust World

Sat, May 21, 2016 at 11:00 AM

Friends Meeting House, – 6 Mount St, , Manchester M2 5NS, United Kingdom – View Map

A conference organised by the Free Psychotherapy Network

The state of our emotional and psychological lives is as fundamental as our material standard of living – our incomes, our physical health, our working conditions, our education and housing. Yet we live in a society whose dominant political and cultural messages over-emphasize money, profit, property and consumption. At the same time, the quality of our emotional lives and relationships with our families, friends, co-workers, neighbours and wider communities is undervalued.

This conference is an opportunity to explore and develop sustainable networks of psychological support which are community led. The aim is to create a collaborative space for therapists, service users, survivors, claimants’ unions and community groups to explore our experience, our needs and desires together. We have much to learn from each other!

The day will be workshop based. Workshop themes may include: sick individual or sick society?; peer led groups – what works, what doesn’t; the experience of FPN so far – free work and working free of funding and institutional restraints; minding the gap between the ‘professional’ and the ‘client’ – exploring the power relationship between therapists and clients; building the relationship between FPN and community groups; developing FPN local groups.

If you would like to suggest or run a workshop, please email: eventsatfpn@yahoo.com – add your suggestions here

The conference is free. All welcome.

If you would like help with travel costs we may be able to help, email: paulwilliamatkinson@gmail.com

 

The venue is wheelchair accessible.

Book a free place via Eventbrite here

 


Turn illness into weapon: Mental distress from a Socialist perspective Bruce Scott

This article was written as a response (partly) to an article that came to my attention that was posted on the Common Space website[1] concerning “mental health”[2].

It is laudable that the aforementioned Common Space article and many such similar articles[3] [4]show concern for the “mental health” of our citizens; it is also let us not forget, Mental Health Awareness Week[5].

However I have grave reservations on several issues with this campaign for “mental health” which are routinely overlooked.

Primarily, the discourse of “mental health” or “mental illness” is not all it is cracked up to be. In other words, the biological model of “mental health” is not watertight and it remains to be seen, and most likely will remain firmly remaining to be seen. The evidence of organic substrates attributed to the cause of “mental illness” is nowhere near to that of physical illness. In fact they are incomparable from a scientific point of view; for example see the work of Healy (2003)[6], Joanna Moncrieff (2003)[7], Boyle (2002)[8] , and Kutchins and Kirk (2003)[9].

Secondly, the neuro-cognitive imperialistic discourse of mental disorders is misleading and excludes other discourses of conceptualising mental distress. There are thousands of years of philosophy and numerous other alternative psychotherapeutic and psychoanalytic practices which deal with “mental distress” in rather different ways, which do “work”, but are hardly amenable to the “rigorous” nature of “evidence based medicine”. See the work of the philosopher Martin Heidegger [10] for example and his critique of the positivistic, biologic, and psychological approach to mental distress.

Certain discourses, for example, the Diagnostic and Statistical Manual of Mental Disorders[11] (one of the main dogmas which create the deployment of the concept of mental illness) destroy other ways of conceptualising meaning making regarding mental distress. The symbolic (language) of the DSM discourse is regarded as cast iron; words are taken as entities, these entities are taken as facts, and as a result of the proliferation of DSM diagnoses in the media, the DSM discourse becomes solidified into the symbolic/language of the public. However, such a covering-over and domination of the symbolic prevents one from contributing to the meaning-making of the world. What the systematisers cannot accept is that there may be many meanings or even that there is no final meaning; why is the realisation of a questionable or imperfect symbolic such a terror? Is it such a terror? For many it is a terror; we live in a society where risk prevention is paramount, where avenues of alternative thought and searching for alternative meaning are outlawed, and where the questioning and traversing of ideological borders (e.g., patients questioning the psychological and psychiatric masters’ ideas about the psychological and neurochemical basis of mental disorder) are forbidden and not taught in any of our state educational contexts.

Karl Marx alluded to this situation of alienation[12]. Alienation has certainly occurred in work or labour especially in the 21st century (e.g., McJobs & Zero hours contracts), but also most certainly in our productivity regarding our subjectivities; we have depression, we have OCD, we have ADHD etc. Our products or our productions of our psyches are limited within narrow confines; in other words, we produce or are coerced to produce subjectivities in relation to the dominant congnitve-neuro imperialistic discourse of “mental illness”. As Gilles Deleuze and Felix Guattari (authors of Capitalism and Schizophrenia; Anti-Oedipus[13], and, A Thousand Plateaus[14]) would argue, we have been territorialised by the machines of capitalist discourse to only produce subjectivities which place mental distress within an individual context; the individual is to “blame”, ones faulty cognitions or neurochemistry is to blame and we need experts to fix this. After all the state needs workers who blame themselves, put themselves at the mercy of the psycho-experts to rehabilitate them, but never to question the socio- economic ideology. Yes austerity causes distress, but please do not call it exacerbating existing “mental illness”. That is not the whole story, or an accurate story.

So, while I wholly understand the need and desire to campaign for those in mental distress, we have to be very careful what we demand (As a side issue though, are we all not in some form of distress, especially in Scotland due to the punitive nature of austerity politics? We do after all now have the Tories as the new bosses!). Jacques Lacan, the French psychoanalyst, who had quite a few things to say about the ravages of capitalism, warned about asking the masters (Government) for change. He said beware what you ask for, because all you will get is a new master; here is a harsh lesson for aspiring developing subjectivity and consciousness in light of the glut of campaigning for “mental health” at this poignant time.

The situation in Scotland regarding “mental health” is paradoxically not very healthy, and not likely to get healthy if we continually ask for the limited menu what is on offer.

As Siobhan Tolland (2012)[15] in the Scottish Left Review argues:
“In 2010, the Scottish Government quietly abandoned its commitment to reduce antidepressant use within Scotland. The original commitment came amidst a wave of concern and worry that ten per cent of Scots were taking antidepressants, and the SNP promised to promote alternative treatments. Recommending this abandonment, the Scottish Government Audit Committee suggested that the reduction commitment did not reflect the complexity of treatment options within Scotland. Importantly, it argued, recent research concluded most GPs were prescribing appropriately anyway. Thus concerns over the high use of antidepressants within Scotland were unfounded.”

And she continues:

“At present the mental health strategy, Towards a Mentally Flourishing Scotland is under review, but the abandonment of that commitment is a cause for concern. And abandoning it on the basis of the Aberdeen University research is extremely concerning for it accepts a very controversial view of mental illness that reduces complex emotions to a single biomedical cause. Depression, for instance, is caused by chemical or biological abnormalities of the brain, and should be treated accordingly. Accepting the study’s conclusion that GPs were prescribing appropriately then means they also accept Depression is biomedical in origin. As a consequence, it promotes antidepressant medication above, say, counselling, CBT[16] or even exercise.

The biomedical view additionally prevents any social analysis of unhappiness or desperately low mood, and medicalises these problems. It ignores the correlation between poverty, inequality and poor mental health, for instance. Research suggests that poor mental health is caused by poverty, for instance, with Bristol University suggesting that as many as 50 per cent of people in poverty have signs of depression. Reverting to a biomedical discourse of poor mental health prevents these social and economic connections from being established, citing responsibility on the individual’s biology, and not society.  And thus any sense of collective social responsibility for our health and welfare is abandoned. We don’t need to change society to make it more mentally healthy, we just need doctors and scientists manipulate the brain.”

Tolland also highlights the worrying links, associations with pharmaceuticals companies which in part ignores other discourses about mental distress:

“….by 2011 the SNP was openly promising to open NHS Research Scotland up to the pharmaceutical industry. This involved a mission to double the economic contribution of life sciences and accelerate growth with an emphasis on business and institutional collaboration. Promoting health seems pretty absent against this language of business interest. One example of such a promise was a joint partnership with companies carrying out clinical trials which involved streamlining the ‘regulatory approval processes’, meeting the open demands of the ABPI. Since Psychiatry and Neuroscience are proposed areas for NHS Research/industry development, the biomedical influence of mental health and illness seems pretty inevitable.”

But it must be reiterated even the so- called utopia of Cognitive behavioural therapy (CBT) and related technological therapies, even if they were more available, do not address the neuro-cognitive imperialism of mental distress. We are more than cognitions and more than psyches or subjectivities to be “fixed”. David Pavon-Cuellar[17] argues for this case using the work and ideas of Jacques Lacan, the founder of Lacanian psychoanalysis, to bolster his argument.

“Lacan is not a psychologist, but a psychoanalyst. He is a radical psychoanalyst who drastically rejects psychology. This rejection of psychology is constitutive of Lacanian psychoanalysis, which has been aggressively constructed against psychology, especially Ego-psychology and other psychological deviations from psy­choanalysis. For Lacan, psychoanalysis must resist psychology. Psychoanalysis must not let itself be absorbed, employed, or con­taminated by psychology. In short, psychoanalysis must avoid psychology.

The term “psychology” usually has a negative connotation in Lacanian discourse. Here, as the case may be, psychology implies misinterpretation, misrepresentation, illusion, deception, manip­ulation, trivialization, and so on. These implications synthesize elaborate Lacanian denunciations of psychology. Among these denunciations, there is one that seems to be directly connected to the position of Marx in Lacan. It is the denunciation of the complicity between psychology and capitalism. This complicity is emphasized in 1965, in the twelfth seminary, when Lacan explicitly maintains that “all modern psychology is made to explain how a human being can behave in the capitalist structure” (Lacan, 1964-1965, 09.06.65). Lacan does not simply say that psychology explains how a human being behaves in the capitalist structure. What Lacan says, is that psychology explains how a human being can behave, or how it is possible for him to behave in the capital­ist structure. At stake here is the possibility of human behaviour in the reality of the capitalist structure……Psychology produces wellbeing, comfort, adaptation. It produces adapted workers, or happy workers, that is to say, good workers. But these good workers are also real sub­jects whose interest proves to be, thanks to Marx, opposed to that which produces them as good workers in order to enable their exploitation. Thus, in the Marxian pole, the workers are essen­tially “opposed” to the pole of psychology and other “means of production” as “form of existence of capital.

Ultimately, the Lacanian opposition between Marx and psychol­ogy expresses the Marxian fundamental conflict between Work and Capital, which can also be lacanianly understood as a conflict between the truth of work and the capital of knowledge. But this conflict is not reducible to an opposition. Capital is not only op­posed to Work, but also generated by Work. The truth of work is the truth of capital. It is the truth of the capital of knowledge. Yet knowledge cannot know its truth. It cannot control or man­age it, even if it is supposed to control and manage it. Even if the truth should theoretically not resist knowledge, it intrinsically resists knowledge. So the resisting truth appears as a symptom, a hysterical symptom of the irresistible knowledge. It emerges as a real symptom of a purely symbolic system. This symptomatic emergence is just another name for the subversive revelation. Ac­tually, in a Lacanian perspective, we may say that the Marxian revelation of truth is subversive because the revealed truth is a hysterical symptom that has no place in the obsessive normality of Modern knowledge.

The revelation of truth is subversive because it is symptomatic. But there is another reason why the revelation is subversive. It is subversive because the revealed symptomatic truth of enunciation is also the unbearable truth of exploitation, alienation and prole­tarianization of a real subject completely reduced to the suffer­ing workforce that generates the enunciated symbolic value. This truth is obviously frustrating. It is also comprehensibly revolting. This is also why its revelation may be subversive. The Marxian revelation of the truth is subversive, for example, because it can­not reveal the generation of capital without revealing the revolt­ing situation of exploitation, alienation and proletarianization of those whose workforce generates capital.”

Conclusion:

We have a long way to go, for those of us, all of us, in mental distress, to subvert the master-slave dialectic of the cognitive-neuroscientific imperialistic and alienating discourse of “mental illness”. “Mental illness” is holed up in all the nooks and crannies of the establishment; universities, psychiatry, psychology, pharmaceutical companies, and also in certain psychotherapeutic fashions (e.g., Mindfulness[18]) who want a piece of capital pie. Mental distress is far more than an alert to an illness to be cured by a pharmaceutical straight jacket (i.e., drugs), or a program of thought control (i.e., cognitive behavioural therapy).

As this article is partly inspired by Jean Paul Sartre and in honour of his ideas, it is fitting to leave the last word to him. This is a quote From Sartre[19] to the Socialists Patients Collective[20], a radical Socialist anti-psychiatric movement in Germany.
“Dear Comrades,
I read your book with the greatest interest. In it I found not only the sole possible radicalization of anti-psychiatry, but a coherent practice which aims at replacing the so-called “cures” of mental illness. To put things generally, what Marx called alienation-a general fact in capitalist society – you have given the name illness. It seems to me that you are right. In 1845, Engels wrote in Situation of the Working Class: “[industrialization has created a world in which] a race can only exist once it has been dehumanized, degraded, rendered physically morbid and lowered to a bestial level both intellectually and morally”. As atomizing forces applied themselves to systematically degrading a class of men into sub-men, from the exterior as well as the interior, one can understand how the ensemble of persons of whom Engels spoke has been affected by the “illness”; it can be grasped at one and the same time as an injury that wage-earners are made to suffer, and as a revolt of life against this injury which tends to reduce them to the condition of object. Since 1845 things have changed profoundly, but alienation remains and will remain as long as there is a capitalist system; since it is, as you say, the “condition and result” of economic production.”
Illness, you say, is the only form of life possible in capitalism. The psychiatrist is at once a wage-earner and a sick person like everyone else. The ruling class has simply given him the power to “cure” or intern. Obviously, the cure cannot, in our regime, be the suppression of the illness: it is the capacity to continue producing all the while remaining ill. Thus in our society there are the sane and the cured (two categories of ill persons who are unaware of themselves, and who observe the norms of production) and, on the other hand, the identified “ill persons”– those whose disturbed revolt places them outside the conditions of production and against the wage given the psychiatrist. This policeman begins by outlawing them, in so far as he refuses them their most elementary rights. He is a natural accessory to atomizing forces: he considers individual cases in isolation, as if psychoneurotic disturbances were the characteristic detects of certain subjectivities, their particular destinies. Thus bringing together ill persons who seem to look alike as singular beings, he studies diverse behaviours-which are only effects-and the connection between them, thereby constituting nosological entities that he treats as illnesses and then submits to a classification. The ill person is thus atomized in so far as he is thrown into a particular category (schizophrenic, paranoiac, etc.), in which are found other ill persons with whom he cannot relate socially, since they are all considered as identical exemplars of the same psychoneurosis.”

Bruce Scott 

[1] Retrieved from: https://commonspace.scot/articles/1312/mental-health-treatment-three-times-more-likely-among-people-from-deprived-communities-says-new-study
[2] It will hopefully become clear that I am critical of the term “mental health” as I feel that it is conceptually, from a philosophical, medical, psychological, and Socialist perspective, inappropriate.

[3] Retrieved from: http://www.theguardian.com/society/2015/apr/17/hundreds-of-mental-health-experts-issue-rallying-call-against-austerity

[4] Retrieved from: http://www.heraldscotland.com/news/health/leading-psychologists-warn-of-dangers-of-further-austerity-policies.124990661

[5] This article was written the week commencing 11th May 2015 which was mental health awareness week.

[6] Healy, D. (2003). Lines of evidence on the risks of suicide with selective serotonin reuptake inhibitors. Psychotherapy and Psychosomatics, 72, 71-79.

[7] Moncrieff, J. (2003). A comparison of antidepressant trials using active and inert placebos.

International Journal of Medicine, 12, 117-127.

[8] Boyle, M. (2002). Schizophrenia: A scientific delusion? 2nd Edition. Oxford, Routledge.

[9] Kutchins, H., & Kirk, S.T. (2003). Making Us Crazy: DSM – The Psychiatric Bible and the Creation of Mental Disorders. The Free Press, Washington D.C.

[10] Heidegger, M. (2001). Zollikon Seminars. Protocols-conversations-letters. M. Boss (Ed.). Translated by F. Mayer & R. Askay. USA: Northwestern University Press.

[11] Diagnostic and Statistical Manual of mental Disorders: Fifth Edition (2013). American Psychiatric Association.

[12] Marx, K. (1964). Economic and Philosophic Manuscripts of 1884, pp-106-19. International Publishers Co. New York.

[13] Deleuze, G., & Guattari, F. (2004). Anti-Oedipus: Capitalism and schizophrenia. London, Continuum.

[14] Deleuze, G., & Guattari, F. (2004). A thousand plateaus: Capitalism and schizophrenia.London, Continuum.

[15] Tolland, S. (2012). Prozac Nationalism. Scottish Left Review, 70, pp-19-19.

[16] Cognitive behavioural therapy.

[17] Cuellar, D. P. (2011). Marx in Lacan: Proletarian truth in opposition to Capitalist psychology. Annual Review of Critical Psychology, 9, pp70-77.

[18] Mindfulness has become the next big thing in the cure of “mental illness”. It is however, flawed in its ideological constructs, and is consumed by the neo-liberal capitalist project for its own advantage. See: http://www.theguardian.com/healthcare-network/2015/may/14/mindfulness-mental-health-treatment-nhs

Indeed, the philosopher Friedrich Nietzsche warned of this development in western society when he declared that the West would be engulfed in a watered down Buddhism. See Nietzsche, F. (1974). The Gay Science. Translated by Walter Kaufmann. Ontario Canada, Random House.

[19] Jean Paul Sartre quote: Reproduction from The Journal of the British Society for Phenomenology, Vol. 18 No. I, January 1987, pp. 3-5-From the Book; SPK: Turn Illness into a Weapon (The Preface).

[20] From http://en.wikipedia.org/wiki/Socialist_Patients’_Collective: “The Socialist Patients’ Collective (in German: Sozialistisches Patientenkollektiv, and known as the SPK) was a patients’ collective founded in Heidelberg, Germany, in February 1970, by Wolfgang Huber. The kernel of the SPK’s ideological program is summated in the slogan, “Turn illness into a weapon”, which is representative of an ethos that is continually and actively practiced under the new title, Patients’ Front/Socialist Patients’ Collective, PF/SPK(H). The original group, SPK, declared its self-dissolution in July 1971 as a strategic withdrawal.

The SPK assumes that illness exists as an undeniable fact and believe that it is caused by the capitalist system. The SPK promotes illness as the protest against capitalism and considers illness as the foundation on which to create the human species. The SPK is opposed to doctors, considering them to be the ruling class of capitalism and responsible for poisoning the human species. The most widely recognized text of the PF/SPK(H) is the communique, SPK – Turn illness into a weapon, which has prefaces by both the founder of the SPK, Wolfgang Huber, and Jean-Paul Sartre.”

Recovery In The Bin

This User Led group is for MH survivors and supporters who are fed up with the way colonised ‘recovery’ is being used to discipline and control those who are trying to find a place in the world, to live as they wish, trying to deal with the very real mental distress they encounter on a daily basis.

Recovery In The Bin 18 Key Principles, agreed and adopted by group members on 6th February 2015.

• We oppose the ways in which the concept of ‘recovery’ has been colonised by mental health services, commissioners and policy makers.

• We believe the growing development of this form of the ‘Recovery Model’ is a symptom of neoliberalism, and capitalism is the crisis! Many of us will never be able to ‘recover’ living under these intolerable social and economic conditions, due to the effects of social and economic circumstances such as poor housing, poverty, stigma, racism, sexism, unreasonable work expectations, and countless other barriers.

• We believe “UnRecovered” is a valid and legitimate self-definition, and we emphasise its political and social contrast to “Recovered”. This doesn’t mean we want to remain ‘unwell’ or ‘ill’, but that we reject the new neoliberal intrusion on the word ‘recovery’ that has been redefined, and taken over by market forces, humiliating treatment techniques and atomising outcome measurements.

• We are critical of tools such as “Recovery Stars” as a means of measuring ‘progress’ as they represent a narrow & judgemental view of wellness and self-definition . We do not believe outcome measures are a helpful way to steer policy, techniques or services towards helping people cope with mental distress.

• We believe that mental health services are using ‘recovery’ ideology to mask greater coercion. For example, the claim that Community Treatment Orders are imposed as a “step towards recovery”.

• We demand that no one is put under unnecessary pressure or unreasonable expectations to ‘recover’ by mental health services. For example, being discharged too soon or being pushed into inappropriate employment.

• We object to therapeutic techniques like ‘mindfulness’ and “positive thinking” being used to pacify patients and stifle collective dissent.

• We propose to spread awareness of how neoliberalism and market forces shape the way mental health ‘recovery’ is planned and delivered by services, including those within the voluntary sector.
• We want a robust ‘Social Model of Madness’, from the left of politics, placing mental health within the context of the wider class struggle. We know from experience and evidence that capitalism and social inequality can be bad for your mental health!

• We demand an immediate halt to the erosion of the welfare state, an end to benefits cuts, delays and sanctions, and the abolishment of ‘Work Capability Assessments’ & ‘Workfare’, which are both unfit for purpose. As a consequence of austerity, people are killing themselves, and policy-makers must be held to account.

• We want genuine non-medicalised alternatives, like Open Dialogue and Soteria type houses to be given far greater credence, and sufficient funding, in order to be planned & delivered effectively. (No half measures, redistribution of resources from traditional MH services if necessary).

• We demand the immediate fair redistribution of the country’s wealth, and that all capital for military/nuclear purposes is redirected to progressive User-Led Community/Social Care mental health services.

• We need a broader range of Survivor narratives to be recognised, honoured, respected and promoted that include an understanding of the difficulties and struggles that people face every day when unable to‘recover’, not just ‘successful recovery’ type stories.

• We oppose how ‘Peer Support Workers’ are now expected to have acceptable ‘recovery stories’ that entail gratuitous self-exploration, and versions of ‘successful recovery’ fulfilling expectations, yet no such job requirements are expected of other workers in the mental health sector.

• We refuse to feel compelled to tell our ‘stories’, in order to be validated, whether as Peer Support Workers, Activists, Campaigners and/orAcademics. We believe being made to feel like you have to tell your ‘story’ to justify your experience is a form of disempowerment, under the guise of empowerment.

• We are opposed to “Recovery Colleges” and their establishment, as a cheap alternative to more effective services. Their course contents fall short of being ‘evidence based’, and fail to lead to academic accreditation, recognised by employers.

• We believe that there are core principles of ‘recovery’ that are worth saving, and that the colonisation of ‘recovery’ undermines those principles, which have hitherto championed autonomy and self-determination. These principles cannot be found in a one size fits all technique, or calibrated by an outcome measure. We also believe that autonomy and self-determination, as we are social beings, can only be attained through collective struggle rather than through individualistic striving and aspiration.

• We demand that an independent enquiry is commissioned into the so-called ‘Recovery Model’ and associated ideology that it stems from.

We call for our fellow mental health Survivors and allies to adopt our principles, and join us in campaigning against this new ‘recovery’ ideology by non-violent protest. We know our views about ‘recovery’ will be controversial, and used by supporters of the ideologies behind ‘recovery’ colonisation to try to divide us. However, we seek to balance the protection of existing services valued by Survivors with agitation for fundamental change.

Join us at Recovery In The Bin Facebook Group.

1

Middle Class Solutions To Working Class Problems Is Why Charities Like MIND Keep Getting It So Wrong

Originally posted by  13th February 2015

didnt-go-to-work-todayIain Duncan Smith must be pissing himself.  A report released at the end of last year by mental health charity MIND could not have gone further in endorsing the core ideas that lie behind his bungled and brutal welfare reforms.

The report is titled “We’ve Got Work To Do” and claims to demand ‘fundamental reform’ of the workplace and social security system to better support people with a mental health condition.  Sadly it is calling for nothing of the sort and is underpinned by the exact same lies and toxic assumptions that have driven both Tory and Labour welfare reforms.

Just like the DWP, MIND have adopted the flawed medical consensus that work is good for your health. The charity does acknowledge that this isn’t actually always true, but falls short of saying that work can be bad for your health, instead arguing that “inappropriate or poor quality work can have as negative an effect on people’s mental health as not being in work”.  They base this opinion on research carried out in Australia that found that “the mental health of those who were unemployed was comparable or more often superior to those in jobs of the poorest psychosocial quality.”  In other words work can be worse for your mental health than being unemployed, rather than just equally bad as MIND claim.

It is not nit-picking to point out the discrepency between what this research found and what MIND say it found because it reveals the charity’s opinions to be based on ideology, not facts.  This same factual slippage occurs elsewhere in the report when MIND begin by saying that most people with mental health conditions want to work, which later becomes everyone with a mental health condition wants to work. The truth, as revealed in the footnotes to the report, are that only around 58% of people out of work due to a mental health condition strongly agreed they wanted to return to work whilst 20% did not feel they were well enough.

These two distortions – or let’s call them lies – have allowed the despised Work Capability Assessment, benefit sanctions and workfare all to be misrepresented as ‘support’ or ‘help’.  In truth these measures destroy lives.  The medical consensus that work is good for you does often not apply to those on the lower end of the income scale who face being forced by Jobcentres into the kind of work likely to make them ill.

MIND’s Chief Executive Paul Farmer claims at the beginning of the report that there have been “improvements in how people with mental health problems are supported”, although it is unclear what they are. There then follows an emotive story about someone’s journey through the benefit system after leaving work due to depression.  This is actually where their journey would stop, because unless they could provide reems of medical evidence to the Jobcentre they would be disallowed benefits for giving up work.  That this reports begins by misrepresenting the benefit system as it currently functions just shows how removed these giant disability charities have become from the lives of those they claim to support.

Instead the ‘fundamental reform’ they call for is actually more of the same or worse – such as the dangerous idea that sensitive health information from the Work Capability Assessment should be passed over to Work Programme providers like A4e and G4S.  This is like your boss having access to your medical history and appallingly MIND seem pretty relaxed about this as well.

Much of the early part of the report is taken up by calling for improvements in the working environment for people suffering mental ill-health.  Which is fine, everyone wants that, except greedy employers who worry it might cost them money or who harbour nasty little prejudices about mental health.  According to MIND themselves this is about 40% of them.  Yet one of MIND’s recommendations is that the Maximus run ‘Fit To Work’ service – the new telephone helpline which will be used to certify time off instead of GPs – should more effectively engage with employers.  About the only decent thing about Fit To Work, which is designed to bully people back into the workplace before they are better, is that currently you have the right to keep your boss out of any discussions.

The final part of the report discusses what future welfare-to-work schemes should look like for those with a mental health condition.  The charity are calling for “new specialist scheme for people with mental health problems on
ESA”.  A scheme which should be run by those who “have expertise and experience of working with people with mental health problems”.  And here lies the real reason for this report.  It’s a fucking advert to any incoming Labour Government to give MIND a lucrative contract to run a new welfare-to-work service.

There is no longer any doubt that endless Atos assessments, workfare and benefit sanctions are creating a crisis in the lives of those with a mental health condition.  The tragic death toll rises ever higher.  Yet nowhere in this report does MIND call for these brutal policies to be scrapped.  Even if MIND were handed a contract to be nicer to people on ESA this would still leave those who have been found fit for work abandoned and dumped onto mainstream unemployment benefits alongside those whose condition is at yet undiagnosed.  On twitter yesterday MIND claimed they couldn’t call for sanctions to be scrapped for people who are unemployed because it wasn’t a key issue.  If your mental health condition isn’t bad enough to be able to claim ESA then tough shit seems to be the charity’s response if you get sanctioned.

The thing is, naked profiteering aside, MIND are not bastards.  They have dedicated front line workers who don’t get paid anywhere near enough and are sincere committed people.  Workers who would probably agree that benefit sanctions and the Work Capability Assessment should be scrapped immediately.  They see the carnage that is being caused everyday.

The problem is that reports like these are overseen and commissioned by highly paid charity executives who live lifestyles that their service users and lowest paid staff can only dream of.  These lifestyles lead them to make assumptions based on their own distorted experience of the world.  Over time they become unable to avoid inflicting solutions to the problems faced by working class people based on their own middle class values because that is all they know.  Often these solutions are utterly bizarre, like the boss of homelessness charity Thamesreach Jeremy Swain’s obsessive belief that the biggest problem facing homeless people is that beer is too cheap.  You read that right.  Too cheap.

It is near impossible for someone on a huge salary who does a job they love to understand why someone may not feel up to working at present.  That, to someone like MIND Chief Executive Paul Farmer, really does seem like madness. Likewise charity bosses have no real understanding of why it might be dangerous to allow other bosses to snoop around your health records.  Bosses think bosses are lovely people who would never abuse their powers – or at least not without a damn good reason.  And bosses know best, they tell each other that all the time.

Charity bosses in particular have their own view of themselves as benevolent experts confirmed everyday by politicians and journalists who would far rather talk to them than someone on the dole.  Their whopping salaries provide further proof of their own ability.  As do arse-licking middle managers who continually tell them how wonderful and clever they are, to their faces at least.  So Paul Farmer must be is right because he’s Paul Farmer and MIND are right because they are MIND and anyone criticising them just doesn’t understand.  Because they are not experts.

That’s how MIND alongside other disability and anti-poverty charities can so easily dismiss the demands of grassroots campaigns comprising of disabled people and benefit claimants.  Groups which are more or less united in calling for benefit sanctions and the WCA to be scrapped completely.  These people are not experts.  At worst they might even be service users.  And you don’t want them getting too uppity.  Before you know where you are you’ll have working class people running organisations together to address working class problems.  Then there’d be nothing at all for poor Paul Farmer to do.    He might even have to get a real job.

Please sign/share/tweet the petition Benefit Sanctions Must Be Stopped Without Exceptions.

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What’s wrong with psychiatry and how we might change things

British psychologist Gary Sidley and US reforming psychiatrist Peter Breggin discuss Gary’s journey of disillusionment with the NHS “mental health” establishment, and then freely indulge their thoughts and fantasies about what an ideal “mental health service” would look like. Find it here.

Gary Sidley’s new book is now available Tales from the Madhouse PCCS Books

Current psychiatric practices are based on pseudo-scientific assumptions that are barely more valid than those of witchcraft and demonic possession that dominated society’s approach to madness in bygone centuries. In Tales from the Madhouse, the evidence for psychiatry’s deficiencies are comprehensively reviewed, and disturbing anecdotes from the author’s 33 years of practice in mental health illustrate how these failings are currently playing out within psychiatric services throughout the UK and beyond.

Find his blog here.


Mental Health Charter – the Social Work Action Network

A Charter for Mental Health

Mental health services have reached a crisis point. The problems are so acute that even the government itself has been forced to acknowledge them. In response the Social Work Action Network (SWAN) has developed A Charter for Mental Health. The idea for the Charter emerged from debates at recent SWAN conferences. However it has been developed in discussion with a range of individuals and groups both within and beyond SWAN including service users and practitioners in mental health services. The Charter describes reasons for the current crisis and suggests what needs to be done to resist and build alternatives. It seeks to be a starting point for discussion and action rather than a definitive statement. SWAN invites those who support the broad perspective described here whether as an individual or on behalf of service user and community groups, campaigns, trade unions and services to endorse the Charter but also to develop further resources from it. More importantly we hope the Charter will be a useful campaigning tool for activists to help build alliances of resistance and to contribute to the development of more and better support for those with mental health needs.

1. The problems

The crisis facing service users

The support on which many service users rely is being brutally cut as a result of the government’s austerity policies. This includes closure or reductions in the availability of community services alongside increased charges, time limited support and reduced funding for user-led organisations. Meanwhile the government’s welfare ‘reform’ programme is creating poverty through draconian measures such as the Work Capability Assessment, implemented by private healthcare firm ATOS, and the Bedroom Tax. These policies are having catastrophic effects. Service users’ networks of support are being damaged, and levels of stress are escalating. The result is increased anxiety and fear and a rising incidence of suicide and self-harm.

The onslaught faced by mental health workers

Practitioners are facing ever-increasing caseloads and enormous demands to meet targets, with little organizational support to prevent isolation and burnout. These workload pressures limit the space to listen and work in person-centred ways with individuals, families and communities. Swingeing cuts to community services and in-patient facilities mean that workers are reduced to crisis intervention. This results in delays for those in need of support often with tragic consequences. It also marginalises preventative work and reduces the support available to little more than medication.

The role of the market

The introduction of payment by results is creating a ‘throughput’ approach that means short-term therapy and medical model drug interventions are prioritized over longer-term talking treatments and other forms of family and social support valued by users and carers. The growing presence of private sector providers such as Virgin Care also diverts scarce NHS resources away from frontline support and into corporate profits.

The pre-occupation with negative risk

Services are increasingly focused on risk management, monitoring of medication ‘compliance’ and controlling forms of intervention. This is particularly acute for service users from black and minority ethnic communities who have inferior access to support services and are more likely to be subject to community treatment orders or forensic interventions.

Austerity, welfare reform and inequality

While the government says mental health and wellbeing should be given the same priority as physical health care their programme is creating unprecedented levels of mental distress. Austerity and welfare reform are contributing to the rising tide of inequality, itself a cause of increasing mental health need in society. As a consequence Coalition policy is both increasing levels of mental distress and simultaneously, through cuts and the market, restricting the support available to those most in need.

2. What is to be done?

• More user-led support and social approaches

Recent years have seen growing demands by service users for greater choice and control through person-centred and user-led forms of support. This is a result of campaigning and activism. Progress on this will require a greater shift towards social approaches and the creation of enabling environments. These recognize and challenge the barriers faced by those experiencing mental distress in a number of areas such as employment, housing and education. Social approaches mean the removal of obstacles to the inclusion of family, friends and community in responses to mental distress. It means support for social participation and contributing lived experience to practitioner education programmes, along with full commitment to user-led organisations, services and forms of mutual support.

• Challenging discrimination

Challenging all forms of discrimination including sexism, racism, homophobia and ageism as well as the demonization of welfare claimants is also crucial. This includes the stigma faced by mental health service users in society. However, while work continues to make anti-oppressive approaches, social perspectives and user and carer involvement a reality, cuts to collective services and individual support jeopardise this positive change.

• Overcoming conflict and obstacles to participation

Mental health workers would like to work in more relationship-based and person-centred ways. Meanwhile service users and carers are demanding more social and community- oriented support. Herein lies the potential for shared interests. But in the mental health field these may seem difficult to achieve. Historically the medical profession wielded the power to define and treat ‘mental illness’ in biomedical ways. This led to the growth of service user movements who challenged this focus and to conflict between psychiatrists and other mental health workers who rejected medical dominance.

• Resources of hope: joint campaigns and struggles

Yet realization that cuts, privatisation and a target-driven culture in mental health services are negatively impacting on service users, carers and different groups of workers in similar ways is breaking down older divisions. This opens up the possibility of joint struggles. Recent campaigns against cuts have increasingly been built on alliances between service users, practitioners and their trade unions. Whilst such campaigns may start with a focus on opposing cuts, the struggle frequently raises questions about how services should be organised and run. The recent victory of a user-led campaign against mental health cuts in Salford that was supported by trade unionists ensured not only that the service was saved with decent staffing levels but also that it was more democratically and collaboratively run in partnership with service users.

• More and better support

We need more alliances such as this to stop cuts and privatization and ensure people are not denied access to properly resourced community and inpatient services. However it is not enough to save services as they are, we want them to be better. This means services shaped by users with democracy and participation at the centre. Interventions based on social approaches and that challenge discrimination. Support driven by social justice rather than the profit motive. Joint campaigns by service users, carers, practitioners, trade unionists and activists have the potential not only to defend but also to transform services. SWAN invites you to join us in this struggle. The following demands are a starting point for realising these goals.

3. What we demand

  • Stop the closures or reductions in community-based support and day services
  • For relationship-based mental health support: achieved through increased staffing ratios, limits on the size of caseloads, less form-filling, bureaucracy and targets and more administrative support
  • Increase the availability to service users of individual and group therapies, community and user-led support and reduce the emphasis on medication
  • No to early withdrawal of support services from users due to ‘throughput’ care pathway models linked to payment by results
  • Ensure services are staffed with properly trained practitioners and peer-support workers employed on permanent not temporary contracts
  • Guarantee service user involvement in the training and continuing professional development of all mental health workers
  • Develop services in line with the principles of social approaches – remove obstacles to family and community involvement; facilitate safe spaces for service users to regain confidence and skills as a basis for moving into the mainstream; support users’ social participation though volunteering and civic involvement
  • Extend the availability of person-centred support to service users, no cuts to individual budgets and no increased charges for community services
  • Repeal the bedroom tax and stop the evictions
  • An end to welfare cuts and ’reform’; withdraw the Work Capability Assessment
  • Remove multinational corporations such as ATOS from the welfare sector
  • No to privatization and outsourcing of NHS, community and welfare services – for public services not private profit
  • Stop the cuts of inpatient services; improve inpatient provision through a better environment, improve staff ratios; guarantee of a local placement for anyone admitted to hospital
  • More funding for the development of alternatives to inpatient services such as user- led crisis houses
  • An end to the use of community treatment orders (CTOs)
  • An end to institutionalized discrimination in mental health services: reducing disproportionate rates of admission and compulsory detention of people from black and minority ethnic (BME) communities; increase access to culturally appropriate services; improve gender sensitivity of services and safety of women on acute inpatient wards For more information and to endorse the Charter contact:
@SWANsocialwork (#MHCharter);
mentalhealthcharter@gmail.com
SWAN: tiny.cc/gwhcdx; W: socialworkfuture.org