Work and the Mental Health Crisis in Britain


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Introduction

As Amber Rudd has confirmed, the government are considering hiring additional Department for Work and Pensions staff and providing a hardship fund if economic downturn hits after Brexit. An EU withdrawal will almost uncertainly continue to add oil to this fire. That this is happening against a backdrop of buckling mental health budgets is a lesson in how economic and social disadvantage works: while austerity measures and uncertain conditions push more people into mental health crisis, disappearing community mental health teams, staff shortages and growing waiting lists mean there are fewer and fewer places they can turn to for help.

While increased funding to cash-starved mental health services should be a priority, it will amount to little more than a particularly expensive sticking plaster unless ministers address their role in the conditions driving up the need: be it a pernicious benefit system, hostile immigrations rules, or insecure housing conditions. If not, the result will be a populace whose levels of anxiety, depression and worry will only continue to grow — which right now is the one constant in these unstable political times.

You can contact the mental health charity Mind by calling or visiting mind. In Australia, the crisis support service Lifeline is on 13 11 Hotlines in other countries can be found here. Topics Mental health Hardworking Britain.

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Prior to the economic crisis, Greece had one of the lowest suicide rates in the EU. Antonakakis et al. Fiscal austerity has had an impact on the suicide rate in these countries. The authors concluded that these policies of retrenchment have short-, medium- and long-term impacts on the suicide rates of males. There is a danger that, even though attitudes have shifted to incorporate wider perspectives on the social factors that cause mental distress, the responses or solutions are viewed in terms of very traditional service models.

This is one of the criticisms of radical groups such as Recovery in the Bin [ 39 ]. This perspective is an overtly political one linking mental health issues to neoliberal political ideas in a very explicit way. It is not simply that austerity has led to cuts in services, it is argued that the neoliberal economy generates a range of mental health problems.

This is a modern recasting of the arguments of the anti-psychiatry movement Cummins [ 40 ]. Thinkers such Laing and Foucault used their criticisms of psychiatry as a base, from which, to mount a broader act on capitalism. There are a number of examples of community and other groups that tackle the impact of mental health problems. It is in these dynamic community based, service user led models that the progressive values that led to deinstitutionalisation still flourish. Service user and campaigning groups have had a significant impact on mental health services.

However, there is a concern that this can lead to tokenistic responses from service providers and mental health professionals. Recovery in the bin name sums this up. In effect, it has become a management buzz word or phrase drained of its radical and critical perspectives. It is not specifically concerned with mental health services but there are wider lessons to be drawn. I would argue that some of these, about the need to develop approaches that foster the genuine involvement of patients in decisions about their care, are particularly relevant to mental health services.

In addition, policy makers seek to ensure that patients are more heavily involved in decisions about their treatment. The positives of this approach are that patients will increase their knowledge and therefore be in a position to make more informed choices. The impact of welfare reforms has seen professional groups allying with service users to highlights the impact and injustice of these measures. For example, Psychologists Against Austerity is a group that campaigns against welfare reform:.

Social work as a profession and discipline, alongside the others in mental health services should have social inclusion and social justice at its core. Asset based approaches : These approaches focused on developing the capacities of individuals and communities. This group included, for example, art therapy or similar activities. The importance of such activities lies not just in the activity itself but the mutual support and safety that a group can provide. These approaches help to improve self-esteem and confidence. Social Skills development : Three of the group interventions focused on social skills development.

The most commonly taught skills included social problem solving, life skills, listening and communication and activity planning. They have to be viewed in the broadest social and cultural terms. Goal setting: This approach was often based on a case management model. The relationship between the participants and workers was identified as the main driver in the improvement in social networks.

Peer support : The broader advantages of peer support are well documented. The small nature of the sample makes it difficult to reach any firm conclusions. Such approaches are based in fundamental values of mutuality and respect but also require mental health professionals to shifting their thinking and approach. In addition, there are several examples of agencies that one might not expect respond to mental health issues. Network Rail, the organisation that has overall responsibility for managing the railway system, is a signatory of the Mental Health Crisis Care Concordat [ 45 ].

The Concordat was signed by 22 national bodies. It acknowledged that there was a need for a new approach from services in their response to those in acute mental distress. Network Rail has a pivotal role working with other organisations such as the British Transport Police and Samaritans to reduce the number of suicides on the railway. Samaritans organise to visit after an incident to offer support to staff and passengers. It has been involved in training over 11, rail staff on how to identify, approach and support a potentially suicidal person.


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  • Network Rail in partnership with the British Transport Police and Samaritans have identified priority locations. A range of responses are being developed. These include physical changes, such as more fencing, barriers at the end of platforms and alterations to the design of stations. Beresford [ 46 ] produced a devastating critique of the position of mental health services within the UK.

    He noted that there was a seemingly ever widening gap between a series of Government mental health policy documents, which consistently promised the completion of a mental health service revolution and the reality of service provision. For all the talk of a complete shift in focus in the structure and values in services, a series of issues remain to be addressed.

    These include the use of compulsory powers under the Mental Health Act MHA , access to services for those in crisis, the involvement of the police and other criminal justice agencies in mental health and the ongoing need for the meaningful involvement of service users in the development and delivery of mental health services. A report from London School of Economics LSE [ 47 ] concluded that, within the UK, mental illness now constitutes nearly half of all ill health suffered by people under 65—yet only a quarter of those involved are in any form of treatment. The LSE report highlighted the following:.

    Pressures on services made them increasingly difficult to access. People in mental health crisis face real barriers to access appropriate support. BAME service users were more likely to be subject to the MHA and at the same time were less likely to have access to talking therapies or other alternatives to medication. People with learning difficulties and older people continue to be poorly served by both mental health and physical care services.

    The damaging impact of welfare and benefit reforms had a direct impact on the mental health of individuals. The well documented rise in the number of detentions under the MHA in England and Wales can be seen as one indicator or symptom of a more fundamental issue—the lack of community based services that can provide appropriate support to those in crisis.

    The damage that nearly a decade of austerity has done to mental health services is apparent in a number of areas including—the pressure on inpatient beds, out of area placement, the response to individuals in crisis, the increased use of the MHA, the position of the CJS as a default provider of mental health care and the personal toll that policies such as the WCA have inflicted. Services faced increased pressures to do more with less. Any visitor to a major city in England must be immediately shocked by the increasing numbers of homeless people living on the streets.

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    The poverty aware paradigm starts from the proposition that poverty is a fundamental violation of individual human rights. It can also be viewed as the denial of human rights to groups of citizens. Bourdieu [ 50 ] argued that language is not only a means of communication but is also a medium of power.

    This is, of course, a reflection of what they see as the power dynamics of these relationships. In health generally, there has been a shift towards a more consumerist approach. This is partly a reflection of wider cultural trends.

    Austerity created this mental-health crisis. Brexit has sent it into overdrive

    However, as Karban [ 17 ] noted, this also has the potential to create a narrative of individual responsibility that hides the structural causes of health inequalities. The consumer movement in health helped to create a space for the survivor in mental health. Crossley , p. The devalued status of the patient is reversed within the movement context. There are new areas or approaches such as Trauma Informed Approaches Sweeney et al. Such approaches focus on the lived experiences of those who use mental health services.

    These perspectives recognise that institutionalised responses have the potential to inflict more harm. In addition, they acknowledge that even now the response to mental distress remains heavily focused on medical interventions. This paradigm shift can only be successful in the context of the development of a broader range of policies that are committed to reducing social inequality and tackling social injustice.

    This is the core of social work values and practice. The optimism of the initial period of deinstitutionalisation was replaced, during the s and s, by wider societal concerns that focused on risk.

    Helplines and crisis contacts | Centre for Mental Health

    There is an alternative which is to see the current position as an opportunity or an opening to create a new debate about the causes of and societal responses to mental distress. Within these debates, a consideration of the structure and role of mental health services should be a key element.

    Breaking Point: The Crisis in Britain’s Hospitals – BBC Newsnight

    This would involve a shift in focus so that mental health and broader welfare services address structural issues rather than focusing on individualised models of mental distress. National Center for Biotechnology Information , U. Published online Jun 1. Ian Cummins. Author information Article notes Copyright and License information Disclaimer. Received Apr 7; Accepted May This article has been cited by other articles in PMC.

    Abstract This is a discussion paper which examines the impact of austerity policies on the provision of mental health services in the United Kingdom. Keywords: austerity, mental health services, welfare reform. Austerity In , the banking crisis led to the Labour Government of the UK, with Gordon Brown as Prime Minister, spending huge sums of money to bail out financial institutions. The Impact of Welfare Reforms One of the key ideas in the neoliberal attack on the welfare state is that it creates dependency.

    In the assessment process, there are three possible outcomes: fit for work unfit for work but fit for pre-employment training fit for neither work nor training One of the most significant criticisms of the WCA is that the assessment is a functional one. The authors concluded that, across England, the WCA process was linked to: suicides , additional cases of self-reported mental health problems , additional prescriptions for anti-depressants Those in the lowest socio-economic groups are more likely to be in receipt of these benefits.

    Austerity and Mental Health Services in the UK Beresford [ 46 ] produced a devastating critique of the position of mental health services within the UK. The LSE report highlighted the following: Pressures on services made them increasingly difficult to access. Conclusions The damage that nearly a decade of austerity has done to mental health services is apparent in a number of areas including—the pressure on inpatient beds, out of area placement, the response to individuals in crisis, the increased use of the MHA, the position of the CJS as a default provider of mental health care and the personal toll that policies such as the WCA have inflicted.

    Conflicts of Interest The author declares no conflict of interest. References 1. Scull A. Madness in Civilization. Thames and Hudson; London, UK: Foot J. Verso Books; London, UK: Macintyre A. What has economics got to do with it? The impact of socioeconomic factors on mental health and the case for collective action.

    Palgrave Commun. Shim R. The social determinants of mental health: An overview and call to action. Murray R. Mistakes I have made in my research career. Wilkinson R. Penguin; London, UK: Marmot M. Department of Health; London, UK: Available online: www.


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    The enemy between us: The psychological and social costs of inequality. Hatzenbuehler M. Stigma as a fundamental cause of population health inequalities. Public Health. World Health Organization; Geneva, Switzerland: Silva M. Social determinants of mental health: A review of the evidence. Platt S. Samaritans; London, UK: Rafferty J. In: Compton M. The Social Determinants of Mental Health.

    Elliott I. Topor A. Money, social relationships and the sense of self: The consequences of an improved financial situation for persons suffering from serious mental illness. Community Ment.

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    Health J. Eaton W. A formal theory of selection for schizophrenia. Karban K. Developing a health inequalities approach for mental health social work. United Nations; Geneva, Switzerland: Brown W. Undoing the Demos. Krugman P. The Case for Cuts Was a Lie.

    Hills J. Policy Press; Bristol, UK: Cummins I. Blyth M. Austerity: History of a Dangerous Idea. Taylor-Gooby P. Overview: Resisting welfare state restructuring in the UK. Poverty Soc. Cameron D. My Vision for a Smarter State. Tinson A. Monitoring Poverty and Social Exclusion Crossley S. The Troubled Families Programme: In, for and against the state? Policy Rev. Debate Soc. Beatty C. Innes D. Delivering fiscal squeeze by cutting local government spending. Fiscal Stud. Tudor Hart J. The inverse care law. Bourdieu P. Polity Press; Cambridge, UK: Centre for Welfare Reform.

    Work and the Mental Health Crisis in Britain Work and the Mental Health Crisis in Britain
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