a rather hidden world of B&Bs and often poor supported housing projects or homelessness. These moves were at odds with a narrative of independence and civic rights that was to be found in policy documents. Moon (2000: 241) argues that the ‘concealed others’ of the asylum regime were replaced with the ‘visible others’ of the new system. The asylum was a site of social hygiene. Community care became associated with the ‘street’ as a public space of potential danger. These concerns were increased by the series of homicides that are examined in Chapter 3. It led to calls for more the provision of more secure psychiatric beds.
Young (1999) discussed what he termed the ‘narrative of modernity’. He saw the Fordist regime of production as leading to a stable pattern of employment supported by a universalist welfare regime. These systems helped to generate a series of social and community bounds. The moves from asylum to community should be viewed as part of wider shifts in society. The asylum came to be seen as an abusive system that denied citizens with mental health problems fundamental rights. The inclusive nature of the Fordist regime was illusory – inclusion for some means exclusion and marginalisation for others (Foucault, 2003). The excluded groups such as women, the poor, people from minority communities and the mentally ill were seen as ‘other’ – not full citizens in both the legal and moral sense (Nye 2003; Yar and Penna, 2004) The historical narrative of modernity includes an emphasis on the development of individualism and the progressive implementation of Enlightenment ideals. This view was challenged from the 1960s by a number of social movements which included mental health service user groups. Wider democratic developments obscured the treatment and continued exclusion from civil society of marginalised groups (O’Brien and Penna, 1998).
The policy of community care became a domestic policy crisis for the beleaguered Major government (Cummins, 2010a). One of the key ways in which the modern state claims legitimacy is by ensuring public and individual safety. Thus governments must respond to a series of threats such as a possible terrorist attack. These threats are increasingly internal or domestic ones. The ‘madman’ of tabloid legend became one of these perceived threats to the legitimacy of the ‘personal security state’. The option of building new asylums was never seriously considered. This would have required a huge fiscal commitment from the state. A new much looser network of private mental health care provision developed. This was largely hidden from the wider society. Local people might be aware of a small supported housing project but these were usually terraced houses rather than purpose built accommodation. It is a sad reality that the abuse, neglect and marginalisation that took place under the old regime did not end when the asylum gates were closed.
Introduction
This chapter will explore a number of mental health inquiries that took place in the early and mid-1990s. It will argue that the media reporting – particularly that in tabloid newspapers – had a key role in undermining support for the progressive elements of community care. This is not to diminish the nature of some of the cases that led to the inquiries. It is, rather, to consider the way that this media reporting helped to construct a discourse around risk and mental health. This reporting played on a series of long standing, often racialised tropes about the nature of mental illness. One of the most important of these was the notion that there is a clear, identifiable and causal link between mental illness and violence. These are complex issues. However, complexity was drowned out by the dominant narrative that the community faced new dangers in the form of ‘psychokillers’. Alongside this, a theme in the reporting of such cases was that liberal mental health professionals were refusing to use their powers to intervene.
Before exploring the role of mental health inquiries in the late 1980s and 1990s, it is important to place inquiries in the broader policy and organisational context of New Public Management (NPM). NPM seeks to bring the so-called disciplines of the market to the public sector. According to Pollitt and Bouckaert (2004), NPM was an attempt to introduce some elements of the market, such as competition, to public services. This is part of a shift that saw the marketisation of the state (Hutton, 1996). Health and welfare services have seen huge changes in the funding and delivery of services since the early 1980s. These have included not only the sale of state assets but also the contracting out of services – for example catering, cleaning and other support services – to private companies. Skelcher (2000) outlined three modern models of the state: the overloaded state of the 1960s/1970s; the hollowed-out state of the 1980s/early 1990s; and the congested state of the late 1990s. There is something of a contradiction here as neoliberalism seeks to limit the role of the state to a ‘night watchman role’ but the role of the state has expanded. This is the case in the area of penal policy (Cummins, 2018) but also in other areas. The demands of late modern capitalism meant that a role was required for the state. For example, all advanced economies require an increasingly well-educated workforce. These demands will not be met by private institutions.
The inquiries that are the focus of this chapter took place in the period that Skelcher (2000) argued saw the ‘hollowing out’ of the state. This term covers the process where new arrangements for the audit and governance of public services were established. These new regimes included the creation of new regulatory bodies and inspection regimes for public bodies. For example, OFSTED became responsible for the inspection of schools, and subsequently children and families social work services. NPM requires what is termed a purchaser/provider split. In health and social care, this split was legally introduced by the NHS and Community Care Act (NHS and CC Act; House of Commons, 1990). The purchaser/provider split breaks up a monopoly of service provision. Social workers became care managers. The care manager role is a significantly different from the tradition social work role. A pure model of care management sees the care manager acting in a brokering role between service users and service providers. This was always an uneasy fit and the model did not transfer easily into the area of mental health social work. The NHS and CC Act (1990) and related policies were written in the language of consumer choice. One of the outcomes of NPM was the development of an audit culture. This involved the creation of bureaucracies to manage the data required to demonstrate how an organisation was performing against a series of Key Performance Indicators (KPIs). These changes have had a profound impact on the nature of the public sector. The inquiries that are discussed in this chapter have to be placed in the broader context of this development of a new form of organisational governmentality.
High profile cases such as the murder of Jonathan Zito by Christopher Clunis were reported in such as a way that they became to be seen as representative of the whole policy (Cummins, 2010b). The inquiry culture was part of the developing and ultimate dominant risk paradigm. The response to the failings of community care was a series of policies that were based on the auditing of professionals – marginalising relational approaches to work in mental health services. The media reporting of these inquiries had a particularly powerful impact in constructing a narrative that ‘community care has failed’. This phrase was used by the then Secretary of State for Health, Frank Dobson, when he introduced New Labour’s Modernising Mental Health Services: Safe, Sound and Supportive (Department of Health, 1999) – note the use of language here: supportive mental health services coming after safety.
Inquiry
