Reimaging professionalism while thinking about a new politics of mental health

Mick McKeown writes on the politics of mental health.

I have thoroughly enjoyed participating in the two seminars to date, dealing in turn with democratisation and values based practice as cornerstones of a reimagined mental health professionalism in a context of thinking about co-production. In my view, mental health professionalism certainly needs re-thinking and reorganising and the prospect of addressing the pivotal issue of power in the social relations of care appears to be central to any critical consideration of coproduction. Big questions arise in contemplation of the very idea of professional identity, and these go to the heart of considerations regarding how the psychiatric system is organised as a whole and the nature of relationships between staff and patients at the level of individual encounters. So, let’s make hay with all manner of co-conceiving, co-creating and co-constructing – of ideals, practices and politics!

If our task is to bring about an imagined, democratised and value based professionalism then arguably the means by which we arrive at this desirable end must themselves be democratic and live up to relevant espoused values. In this regard the seminar series has made an excellent start. The university spaces within which an ESRC sponsored seminar series is enacted, along with limitations on numbers of participants, can arguably affect the quality of democracy we are able to achieve in our deliberations. On the one hand, university spaces protect free speech and association, and allies can meet in reasonably convivial surroundings with an expectation of fairly polite, civil and respectful dialogue inclusive of difference. Alternately, if these debates are to have wider appeal and impact, reaching broader constituencies (crucially grass-roots staff who would have to adopt any new professional mantle and the diversity of service users engaged in contemporary mental health care – both, perhaps, alienated in different ways), then more turbulent encounters might occur. Anticipation that this may be a possibility must not impede motivations to deepen and broaden the reach of our discussions – and blogging is certainly one way to start.

These endeavours also take place in perhaps unpropitious times for forging the necessary alliances between staff and patient interests to take forward novel and progressive developments. Mental health services are beset with the negative impact of austerity policies. Similarly, the wider welfare state that provides valued support to many service users faces huge threats to its continued existence. Neoliberalism remains the orthodoxy, despite quite obvious material and ideological challenges to its credibility. The result, as remarked by Bauman, is a state of liquid uncertainty that is the enemy of consistent and compassionate care relations. Hence, services appear to be entrenching coercive and singularly bio-medical models of provision; constituted as much about control as care. In parallel, practitioner trade unions are engaged in a battle for survival and arguably adopt defensive, conservative or avoidant positions on change. Nevertheless, both new and old ideas circulate offering possibilities for more radical objectives, even if their realisation may be unsettling along the way. My professional discipline, has a new-found outlet for serious debate in the Critical Mental Health Nurses Network (https://criticalmhnursing.org/about-us/) and this is mirrored in other fora such as: The Social Work Action Network (http://www.socialworkfuture.org/), Psychologists Against Austerity (https://psychagainstausterity.wordpress.com/) and Critical Psychiatry Network (http://www.criticalpsychiatry.co.uk/). All of these seek alliances with each other and radical service users/survivors. It may even be the case that the current ascendancy of neoliberalism is the spur to change rather than an omnipotent and insurmountable barrier.

Peter Sedgwick’s classic book, Psychopolitics, first appeared in 1982, another period of austerity and the beginning of neoliberalism, and has been reissued this year, published by Unkant. Sedgwick was a Marxist activist who bemoaned the lack of sophisticated interest in mental health on the part of the British left and urged cross-sectional, democratic alliances to forge a new politics of mental health. Of necessity this must include ally-ship between labour movement groups, bringing in staff interest, and service user/survivor groups. Sedgwick neatly weaves a commitment to dialectical materialism with anarchist informed ideas for prefigurative alternative forms of care that should be uniquely democratic and responsive to mental distress. He rejected narrow bio-medicine but held on to the value of an ‘illness’ concept as a means for ensuring state level support for adequate service responses. As such, Sedgwick was highly critical of the protagonists of anti-psychiatry because their critique could be co-opted by unscrupulous politicians concerned primarily with retraction of state welfare provision.

Latterly, the emergence of campaigning groups such as ‘Recovery in the Bin’ and critical thinking initiatives such as Mad Studies and have opened up new vistas of criticism and contention. Mad Studies is informed more by identity politics than class oppression and materialism, but seeks inter-sectional solutions and, perhaps contra to Sedgwick, often takes an abolitionist stance to services as we know them. Thus, Mad Studies is the unruly, recalcitrant child of neoliberal times. Sedgwick’s politics pre-dated neoliberalism’s rise to power but rather presciently predicted what was to come for mental health services. If we are to thoroughly grasp the challenges of reimaging professionalism we cannot abstract this from such political concerns and undoubted tensions between staff and service user interests. That said, these are exciting times and more democratised and value laden approaches are open to us. These should not escape thorough contemplation and wholesale adoption for want of trying.

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