Understanding Mental Distress

Abstract

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