As a psychologist I see the effects of neoliberal values on mental health
7 November 2017
A cup of tea won't solve this one - Tories are determined to focus on more mild mental health problems Getty
As a psychologist I see the fantasy of neoliberal values having a devastating effect on mental health treatment
The Tories may believe in the ‘dignity’ of work, but not everyone can function as expected. People with serious needs are being punished as a result
The worse your mental health problems are, the more likely you are to get help. Right?
Not necessarily in today’s mental health services.
Laura is 46. She has a diagnosis of paranoid schizophrenia. “My day centre closed last year”, she said. “We protested and lobbied the locality, and they knew it was keeping people like me alive, but now there is nothing.” Laura has been sectioned three times since the day centre was closed, due to the absence of day-to-day care and contact with peers that was so vital for her.
Laura’s situation is far from unique. Mental health professionals, service users, family and friends are becoming increasingly desperate as the infrastructure that supported those with long-term needs is decimated by an increasing focus on those with mild mental health problems. Community mental health teams, short-staffed and short-changed, are under huge pressure to discharge people to GPs. Day centres and so-called therapeutic communities for those with the most entrenched problems are all but gone. Psychotherapy for those with moderate to serious difficulties is almost impossible to access. Assertive outreach and rehabilitation teams, developed to engage and intensively support those with the most complex needs, have had their funding cut. Treatment packages are sheared to their bare bones.
This cutback in funding and access, it is important to point out, is happening despite robust evidence that these type of treatments not only work but are also cost-effective.
“We are treating more people at the mild end of the illness spectrum where demand for care has increased massively,” said Lenny Cornwall, consultant psychiatrist and chair of the Faculty for General Adult Psychiatry, “but the most severely ill are left worse off.”
Why has this happened?
People with complex needs are the casualties of a raft of reforms that privilege neoliberalist values. Neoliberalism is an ideology that has been espoused by all the political parties who have held power since Thatcher. In this ideology, state provision is situated as something that fosters a state of dependency. Dependency is seen as an impairment to individual growth, and a drain on society. People who question these values are positioned as functioning under an illusion that the state has infinite resources, and denying individuals their right to an upward journey.
Resources go to initiatives that sustain the neoliberal fantasy that individuals have equal opportunity, which they can fulfil with the briefest of state intervention. If one fails to perform commitment to these ideals, resources are taken away. For example, people who do not show they are trying to return to work during every waking minute are sanctioned by the benefits system. And mental health funding is skewed to initiatives that use brief cognitive-behavioural interventions to return the masses to productivity as quickly as possible.
Those who are not willing or able to pursue the fantasy that everything is possible for anyone are tucked out of sight, as if they were an embarrassment somehow, or left to fend for themselves. Those with the most complex problems often end up for years on end in private mental health hospitals, abandoned and overmedicated to silence their howls of despair. In the NHS, people with even the most complex needs are told they can recover.
The recovery movement was intended to give people hope they can lead fulfilling lives. But it has been co-opted by the neoliberal agenda to support certain practices that foreclose the reality of long-term impairment and structural disadvantage. For example, community mental health teams are under huge pressure to discharge people to recovery colleges, and then their GPs, with a graduation certificate to sustain society’s fantasy that they have been provided with the means to survive.
At the same time, alternatives to state provision are under threat. Many of the most innovative forms of support have been developed by people with complex mental health problems in the community. With infrastructure like community halls and grants decimated by austerity cuts, there is often now nowhere left to go. Further, many people on benefits are too scared to engage in the voluntary work that sustained these initiatives, for fear of having their benefits cut. For people on disability benefits are constantly scrutinised by Department for Work and Pensions assessors looking for reasons to stop people’s benefits, a common form of which is misreading a capacity to function sometimes with the capacity to function all the time.
People with complex needs often identify with neoliberal propaganda telling them that they are responsible for their condition, that they are “trying to get away with it”, that they should be able to recover and work.
These ideas speak to and reinforce internal persecutors that tell those struggling they are worthless and should be ashamed. Imposition of these narratives – which goes against robust evidence linking mental health problems with early trauma, adversity and structural disadvantage, things we all have responsibility for – is a form of violence. Thus, policy turns are making those with long-term needs feel worse whilst at the same time denying them the means to get better.
This has created a perverse situation where the public are told mental health care has never been so good when the reality, at least for people with complex mental health difficulties, is anything but.
“I don’t know how much longer I can go on,” Laura said. “There is no help available. I am desperate.”
Dr Jay Watts is a consultant clinical psychologist and psychotherapist, and honorary senior research fellow at Queen Mary, University of London