Cummins - Mental Health Services and Community Care: A Critical History

MENTAL HEALTH SERVICES AND COMMUNITY CARE

A Critical History

Ian Cummins

Policy Press 2020

Into the nothingness of scorn and noise,

Into the living sea of waking dreams,

Where there is neither sense of life or joys,

But the vast shipwreck of my lifes esteems;

Even the dearest that I loved the best

Are strangenay, rather, stranger than the rest.

John Clare, I Am

My late mother worked incredibly hard to enable me to continue my education and take advantage of the opportunities that it offered. She passed on her love of books to me. I hope that she would have enjoyed this one. I owe a huge debt to my brother and my sisters for their love and support.

I would like to thank Isobel Bainton, Shannon Kneis and all the staff at Policy Press who have been unfailing supportive of this and other projects that I have undertaken. I am very grateful to the anonymous reviewers of the initial proposal and drafts of the book for their time and constructive suggestions. I am, of course, responsible for any failings, admissions or errors in the final version.

I regard myself as extremely lucky to have had the wonderful support and encouragement of colleagues and friends: Janet Chapman, Elizabeth Collier, David Edmondson, Akwugo Emejulu, Paul Michael Garrett, Maria Grant, Marian Foley, Jameel Hadi, Stephen Jones, Emma Kelly, Gavin Kendall, Martin King, Karen Kinghorn, Jane Lucas, David McKendrick, Bernard Melling, Lisa Morriss, Muzammil Quraishi, Kate Parkinson, Donna Peach, David Platten, Nick Platten, Sarah Pollock, Barry Schilling, Jonathan Simon, Imogen Tyler, Joanne Warner, Stephen Webb, Joanne Westwood, Toni Woods.

I am extremely grateful to Gavin Davidson, Hester Parr and Cheryl McGeachan all of whom took the time to read a draft of the book.

I completed this project during a period of study leave. I am grateful for the School of Health and Society at Salford for facilitating this. I would particularly like to thank Professor Joanne Westwood, who was very supportive of my initial application.

I have also enjoyed virtual support from @asifamhp, @SchrebersSister and @Mental_Elf

Most importantly of all, I would not have been able to complete this work without my wife, Marilyn, my sons, Elliot and Nelson, and his partner, Eilidh.

When Theresa May became Prime Minister in July 2016, she made a speech on the steps of Downing Street in which she outlined a series of burning injustices her administration would seek to tackle. Many were struck by the irony of this commitment to tackling inequality and disadvantages coming, as it did, from a senior member of the coalition and Conservative governments that since 2010 had introduced a series of policies which had targeted those living in poverty and the most vulnerable. The scandals of the revelation of the real impact of the hostile environment created by Mays Home Office and the appalling treatment of the Windrush generation lay ahead. In May 2017, May announced that a review would be undertaken of the flawed Mental Health Act (MHA). In making the announcement she stated:

On my first day in Downing Street last July, I described shortfalls in mental health services as one of the burning injustices in our country. It is abundantly clear to me that the discriminatory use of a law passed more than three decades ago is a key part of the reason for this. So today I am pledging to rip up the 1983 Act and introduce in its place a new law which finally confronts the discrimination and unnecessary detention that takes place too often. (Savage, )

It was later announced that the MHA review would be chaired by an eminent psychiatrist, Sir Simon Wessely. The review was completed in December 2018 (Department of Health and Social Care, the current mental health legislation in England and Wales did not comply with international standards on human rights.

The issues that the Wessely review was asked to consider are not new. They have appeared at various points, perhaps in slightly different configurations over the past 50 to 60 years. This is the period of deinstitutionalisation the closure programme of long stay mental hospitals that was announced in Enoch Powells Water Tower speech in 1961. Despite their closure, these Gothic decaying institutions have cast a long shadow over mental health services. This volume examines the policy of community care that followed deinstitutionalisation. Community care is used as a shorthand for a range of community based mental health and other welfare services that support those experiencing mental distress. I should note here that terminology in the field of mental health is a problematic area. I use a range of terms in this volume: mad, the mentally ill, service user, people with mental health problems. This is not laziness or sloppiness on my part. The terms have all been and continue to be used in popular and academic discourse. I am not aware that there is a term that is widely accepted or not seen as problematic in some way. The terms reflect underlying values. I accept that some of these terms might be offensive. I apologise in advance for any offence caused to readers. This was not my intention.