From shame to blame: institutionalising oppression through the moralisation of mental distress in austerity England

Abstract

This paper interrogates qualitative data regarding the changing experiences of mental health service and welfare state interventions for those who self-identify as experiencing long-term mental distress. We focus on austerity-related reforms in the English welfare and mental health policy architecture to explore the socio-cultural and material bases of benefit claims-making in relation to long-term illness and incapacity. Recent neoliberal social policy reforms contest the ontological status of mental distress, in effect recasting distress as a ‘moral’ status. This tendency is reinforced via three primary dynamics in contemporary mental health and welfare policy: the delegitimisation of sick role status in relation to mental distress; the foregrounding of individual responsibility and concomitant re-orientation of services towards self-help; and an increasing punitive conditionality. These intersecting processes represent an institutionalisation of ‘blame’ in various policy contexts (Scambler in Sociol Health Illn 31(3): 441–455, 2009; Sociol Rev Monogr 66(4):766–782, 2018), the moral stigmatisation of mental distress and escalating experiences of oppression for mental health service users and welfare recipients. Shifting conceptions of distress are thereby entwined with transformations in social policy regimes and political economies. Presenting distress as a personal failure legitimates austerity-related restrictions on benefit and service entitlements as part of a wider project of neoliberal welfare state transformation.