‘The business end’: Neoliberal policy reforms and biomedical residualism in frontline community mental health practice in England

Moth, Rich (2018) ‘The business end’: Neoliberal policy reforms and biomedical residualism in frontline community mental health practice in England. Competition and Change. ISSN 1024-5294 (Accepted for Publication)

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Abstract

Mental health policy initiatives in England over the last three decades have led to significant restructuring of statutory service provision. One feature of this has been the reconfiguration of NHS mental health services to align with the requirements of internal and external markets. Based on findings from twelve months’ ethnographic fieldwork within one mainstay of NHS statutory services, the community mental health team (CMHT), this paper examines the effects of such neoliberal policy and service reforms on professional practice and conceptualisations of mental distress. The paper begins with an account of the restructuring of the labour process in mental health services. This utilises the notion of ‘strenuous welfarism’ (Mooney and Law, 2007) to describe an organisational context characterised by escalating performance management, deskilling of professional practice and the intensification of mental health work. Increasingly prominent aspects of managerialism and marketization disrupted attempts by mental health practitioners to sustain supportive and mutual structures with colleagues and engage with service users in therapeutic and relationship-based forms of practice. Moreover organisational processes increasingly recast service users as individual consumers ‘responsibilised’ to manage their own risk, or subject to increasingly coercive measures when perceived to have failed to do so. Consequently biomedical orientations were remobilised in practice in spite of a rhetorical shift in policy discourse towards socially inclusive approaches. The term ‘biomedical residualism’ is coined to describe this phenomenon. However instances of ethical professionalism that reflected resistance to these residualised modes of practice were also visible.

Item Type: Article
Additional Information and Comments: This is the author's post peer review version of an article, the final version of which is published in the Sage Publications journal Competition and Change
Keywords: Labour process, mental health, mental health services, neoliberalism, New Public Management, professions
Faculty / Department: Faculty of Arts & Humanities > School of Social Science
Depositing User: Rich Moth
Date Deposited: 14 Dec 2018 14:28
Last Modified: 14 Dec 2018 14:28
URI: http://hira.hope.ac.uk/id/eprint/2738

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