Mental Health Services and Community Care. Cummins, Ian

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Mental Health Services and Community Care - Cummins, Ian

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of economic liberalism and social conservativism that Thatcher represented was a new and influential political force. The essay was published in January 1979 before Thatcher’s election victory in May of that year. The post war social democratic settlement was unravelling at that point – most clearly in the winter of discontent (Lopez, 2014). Thatcherism was able to pose as representative of the interests ‘ordinary’ British citizen against the vested interests of the social democratic welfare state – radical trade unions, teachers and social workers, and so on.

      These processes also entail the Othering of groups such as BAME communities, the poor, welfare claimants and offenders. Hall was right in his view that Thatcherism marked a break from the post war consensus. Thatcher developed a political image that was the antithesis of consensus, attacking what she saw as the nation’s enemies within and without. Thatcher’s uses of the symbols of Nation and Empire are excellent examples of Anderson’s (2006) ‘imagined community’ as well as the fact these communities are inevitably exclusionary.

      In the city: geographies of exclusion

      Members of the Chicago school were the first to develop a spatial theorisation of the city (Soja,1996). Spatial factors play a key role in the creation and maintenance of social and community relationships (Simmel, 2004). The city represents modernity, progress (Park, 1967) and creativity but also a sense of dislocation and danger. At the same time establishes social order (Tonnies, 1955). Any analysis of the deregulated, gentrified city created by modern forms of capitalism has to consider Davis’ (1998) City of Quartz. Davis’ (1998) study of Los Angeles (LA) focuses on the way that urban spaces are sorted and segregated. Urban spaces are the key battle ground where capital establishes and maintains its dominance. Public space is essentially privatised. The poor are excluded so that the middle classes and elites can take advantage of the new leisure culture of city centres. Davis (1998: 224) argues ‘Police battle the criminalised poor for valorized spaces’. Value comes from the fact that these are spaces dedicated to consumption and recreation. They therefore need to be protected. The subtitle of City of Quartz is ‘excavating the future’. The LA model of development and regeneration is one that has been followed across late capitalist societies.

      Neoliberal forms of governance saw huge changes to the management of urban environments. This shift was based on a whole series of financial policies, such as free trade zones, deregulation and changes to planning law, that has been characterised as a process of ‘creative destruction’ (Brenner and Theodore, 2002). Alongside these financial policies a set of social policies including zero tolerance initiatives, clampdowns on anti-social behaviour and increased use of CCTV have attempted to manage the city centres and make them attractive to capital and consumers (Harvey, 1990). In these new urban environments, public space is more limited and other environments, for example shopping malls, are subject to greater forms of surveillance or private policing. These environments are replicated across cities so that they become predictable and somewhat sanitised (Sibley, 1995). Sibley (1995) argues that an integral part of these new developments is ‘boundary erection’. These boundaries are physical but also economic and psychological. They are based on conceptions of abjection and hostility. The new boundaries of the modern urban environment are increasingly moral ones (Sibley, 1995: 39–43) The exclusions are based on factors that include class, race and disability. The ultimate division is, perhaps, between consumers and the ultimate deviant in neoliberalism – the non-consumer. In these processes, the value of property is seen as higher than the value of people (Sibley, 1995). If asylums can be viewed as rural, then community care is a policy most closely associated with urban environments. Wacquant (2008) sees the city as a location or means of sorting populations into desirable/undesirable. This is done on the basis of class and race. However, mental health status also became a factor in these processes (Moon, 2000; Cummins, 2010a).

      The period of community care coincided with the initial stages of what came to be termed neoliberalism. These policies led to increased inequality, which has produced social and economic segregation (Savage, 2015). These developments have social, psychological and economic impacts (Wilkinson and Pickett, 2010). There are huge differences between the physical and mental health of the richest and poorest in society. The early development of these increasing divisions can be traced back to the 1980s. These differences are starkest in the most unequal societies. More equal societies with progressive welfare and health systems mitigate these potentially adverse outcomes (Marmot, 2015). There was a brief period under the first New Labour government where increased investment in social welfare halted some of these developments. However, they have been intensified during the austerity since 2010 (Cummins, 2018). In many ways, the progressive arguments for community care in the mental health sector assumed continued broader investment in social welfare provisions. There was an implicit view that a shift from spending money on institutionalised psychiatry to community mental health services would not only take place but also lead to better outcomes for service users.

      From the late 1990s onwards, in the UK and across Europe, there has been an ongoing moral panic (Cohen, 2011) about the ‘ghettoisation’ of socially deprived urban areas. The term ghetto – in modern usage – suggests an area of poor housing, poverty, substance misuse problems, high crime and gang violence. It also has racist overtones.

      More recently in the UK, governments of all political persuasions have been concerned with the issue of ‘sink’ estates. Slater (2018) demonstrates that the term ‘sink estate’, which is often presented as an academic or sociological term, was invented by journalists. Its use was then extended by free market think tanks before becoming a form of policy doxa. It was used as a shorthand for areas that allegedly create a range of social problems such as poverty, worklessness and welfare dependency. Slater (2009) argues that the ghetto is a social and psychological space with its boundaries created by ethnicity. Although these spaces were originally the result of discrimination, they also generate forms of community organisation.

      Wacquant (2008a, 2008b, 2009a, 2009b) suggests that modern, urban, spatially concentrated forms of poverty have made it more difficult to sustain social and community institutions. Fordism had been associated with a range of previously strong civic institutions, ranging from political to social and from trade unions to sports and youth clubs. Changing patterns of employment and the increase in precarity have been a key factor here. It is very important to note that Wacquant is not suggesting that such social systems do not exist. For example, his Body and Soul (2000) examines the experience of young black men who use a gym in Chicago and considers the function of these informal structures in some detail. In a similar vein, McKenzie’s (

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