Using Fraser’s model of ‘progressive neoliberalism’ to analyse deinstitutionalisation and community care

Abstract

This article will argue that Nancy Fraser’s (2017, 2019) notion of ‘progressive neoliberalism’ provides a conceptual lens that can be effective in the development of a critical analysis of mental health policy in England and Wales during the period of deinstitutionalisation and community care. Mental health policies that came steeped in an originally progressive discourse of choice, empowerment and wider service user rights were introduced by governments largely committed to the free market. In the UK and US, this produced a contradictory position where moves towards a community-oriented vision of mental health service provision were overseen by administrations that were committed to a small state and fiscal conservatism. There were similar developments in other areas. Fraser (2017, 2019) terms this mixture of socially progressive rhetoric and market economics ‘progressive neoliberalism’. Fraser’s model of progressive neoliberalism argues that neoliberalism has colonised progressive discourses. The article outlines this theoretical model and then applies it to the development of community care. It argues that policy responses to the perceived failings of community care focused on increased powers of surveillance, including the introduction of legislation that allows for compulsory treatment in the community. This focus on legislation was at the expense of social investment. The article concludes that the introduction of austerity in the UK has strengthened these trends. For example, The Coalition government (2010–15) introduced new mental health policies such as ‘No decision about me without me’, which emphasised inclusive approaches to service organisation and delivery. At the same time, it followed social and economic policies that increased inequality, reduced welfare payments and entitlements, and cut services. These are all factors that contribute to higher levels of mental distress across society.