Enablement & exploitation : the contradictory potential of community care policy for mental health services user/survivor-led groups
This thesis examines ways in which social policy supported by successive Conservative and Labour Governments has affected the British User/Survivor Movement (BUSM) since the introduction of the 1990 NHS and Community Care Act. It focuses on the formalising effects of community care policy, and the discursive resistance tactics of user/survivor activists in opposition to formalisation of their movement. The aims of the thesis are: firstly, exploration of the contradictory potential of community care policy where there is a formal relationship between local and/or health authorities with mental health services user/survivor-led groups; secondly, tracking New Labour’s policy agenda and the responses of user/survivors; finally, an attempt to develop a user/survivor theoretical standpoint towards community care policy. To achieve these aims the following were undertaken: a literature review which informed the development of a theoretical standpoint; interviews with user/survivor pioneers of the movement; and interviews with discussion groups of user/survivors who were active at local, regional, and/or national level. Analysis of respondents’ statements was completed using a theoretical standpoint based on Feminist/Foucauldian methodology. The chosen methodology resulted in an amended theoretical standpoint to take account of the use of reason by user/survivors and the creation of taxonomies which describe ways in which user/survivors discursively resist formalisation. These results formed the basis for the main conclusions which are as follows: first, user/survivors who engage in ‘consumerist’/empowerment activities, such as advocacy or involvement, can rightly claim to be challenging existing power relations; second, user/survivors entering into formal relationships with health/social services authorities do not necessarily reproduce discriminatory forms of care; third, although the culture of the BUSM has changed since the late 1980s, user/survivor activists are still trying to keep informal/empathic values alive; fourth, a danger exists that user/survivors will be pushed out of providing services and relegated to being the objects of consultation; and finally, there is a need to challenge the reason/unreason dichotomy enabling New Labour to characterise user/survivors as ‘dangerous’. The distinctive focus of this thesis on theoretical standpoint and discursive knowledge provides the basis for its contribution to theoretical and social policy debates in the field of mental health.