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Mental health social work is at an impasse. On the one hand, the emphasis in recent policy documents on the social roots of much mental distress ,and in the recovery approaches popular with service users seems to indicate an important role for a holistic social work practice. On the other hand, social workers have often been excluded from these initiatives and the dominant approach within mental health continues to be a medical one, albeit supplemented by short-term psychological interventions. In this short form book, part of the Critical and Radical Debates in Social Work series, Jeremy Weinstein draws on case studies and his own experience as a mental health social worker, to develop a model of practice that draws on notions of alienation, anti-discriminatory practice and the need for both workers and service users to find ‘room to breathe’ in an environment shaped by managerialism and marketisation.

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Let us start with the context. An estimated one in four of us will suffer from a mental health problem at some point in our lives. Of the 2.6 million people claiming long-term disability benefits in 2012, 43% had a mental or behavioural disorder. This huge level of suffering comes at a cost: emotional, social and also financial (in 2012, £105 billion per year, a figure expected to double in the next 20 years).

These statistics come from the Coalition government’s 2011 strategy paper No health without mental health(HM Government, 2011; hereafter, NHWMH). The paper focuses on England but recognises that the issues that it addresses resonate across the UK. It lists as ‘vulnerable groups’: children (with one in 10 between the ages of 5 and 16 having a mental health problem that may persist into adult life); women with postnatal depression (experienced by one in 10 mothers); and prisoners, 90% of whom have a diagnosable mental health problem. NHWMH also acknowledges the risk factors for ‘many people from black and minority ethnic [BME] communities’ (HM Government, 2011, p 8). It uses the language of ‘social justice’ and ‘challenging stigma’ and (perhaps reflecting the influence of Wilkinson and Pickett’s [2010] seminal text The spirit level) acknowledges that ‘Social inequality of all kinds contributes to mental ill health’ (HM Government, 2011, p 2).

NHWMH, then, links ‘mental health objectives’ to action points, whether ‘under way’, ‘new’ or ‘ongoing’, and the named government department responsible for seeing the objective through to completion.

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Radical social work was published in 1975, while Case Con, ‘the revolutionary magazine for social workers’, first appeared in 1970. Both the book and the magazine shared a social and historical moment and were engaged in the same struggles, but they stepped onto the stage at slightly different times and played somewhat different roles. This chapter explores the experience of Case Con, both as a quarterly magazine and as an aspiring organisation of radical social workers, and how it complemented and/or competed with Radical social work in the development of radical social work in Britain in the 1970s. The magazine reflected a potent mixture of theory and activism. A fairly continuous theme was homelessness, with squatters supported when they resisted the bailiffs, and on occasions, families were sheltered in social-work offices to prevent their children being received into care.

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It has been interesting and exhilarating to read the responses to my initial essay. And also saddening when we hear the gallows humour of the mental health social workers cited by Rich Moth and Andy Brammer, and Colette Bremang’s confusion when, as a newly qualified social worker, she is left unprepared and unsupported in the face of mothers struggling with mental health problems. And there is ‘the despair, helplessness, hopelessness’ of the service user, as expressed by June Sadd, survivor activist and social work educator. All the more important, then, that this concluding section should both serve as a summary of the debate so far and attempt to move us on: after all, as Marx put it, the point is ‘not to interpret the world but to change it’. In the responses, we see some important developments of the original arguments. Helen Spandler explores the deeper perspective that comes from listening to those ‘experts by experience’ and the importance, before rushing in with risk assessments and quick-fix treatments, of ‘letting madness breathe’. Rich Moth and Andy Brammer detail the corrosive impact of markets, targets and medicalisation; and Jerry Tew provides a wider policy analysis. June Sadd explores how racism impacts at both individual and institutional levels and likens this to a colonialism that traps both service user and worker.

What stays with me is the need to watch the jargon. There are the obvious danger phrases such as ‘“reorganisation”, “reconfiguration” or “re-engineering”’ (Andy Brammer). Others are more seductive: ‘clustering’ presented as improving the assessment and therefore the treatment of people’s needs but actually reinforcing the ‘commodification’ of welfare.

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Let us start with the context. An estimated one in four of us will suffer from a mental health problem at some point in our lives. Of the 2.6 million people claiming long-term disability benefits in 2012, 43% had a mental or behavioural disorder. This huge level of suffering comes at a cost: emotional, social and also financial (in 2012, £105 billion per year, a figure expected to double in the next 20 years).

These statistics come from the Coalition Government’s 2011 strategy paper No health without mental health (HM Government, 2011; hereafter, NHWMH). The paper focuses on England but recognises that the issues that it addresses resonate across the UK. It lists as ‘vulnerable groups’: children (with one in 10 between the ages of 5 and 16 having a mental health problem that may persist into adult life); women with post-natal depression (experienced by one in 10 mothers); and prisoners, 90% of whom have a diagnosable mental health problem. NHWMH also acknowledges the risk factors for ‘many people from black and minority ethnic [BME] communities’ (HM Government, 2011, p 8). It uses the language of ‘social justice’ and ‘challenging stigma’ and (perhaps reflecting the influence of Wilkinson and Pickett’s [2010] seminal text The spirit level) acknowledges that ‘Social inequality of all kinds contributes to mental ill health’ (HM Government, 2011, p 2).

NHWMH, then, links ‘mental health objectives’ to action points, whether ‘under way’, ‘new’ or ‘ongoing’, and the named government department responsible for seeing the objective through to completion. One of the major strands in this strategy is Improving Access to Psychological Therapies (IAPT), with a further investment of £400 million for the New Labour government initiative that purports to offer a choice of psychological therapies for free within the NHS, although NICE, the body authorised to approve ‘evidence-based’ practice across the health field, currently limits this to Cognitive Behavioural Therapy (CBT).

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