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Thomas Szasz, ‘Care’ in the Community, and Lansley’s NHS ‘Reform’

April 9, 2011

Thomas Szasz, a self-described ‘libertarian psychiatrist’, has written extensively about the ‘myth’ of mental illness. He holds that the idea of ‘mental illness’ is as much a category error as a ‘married bachelor’, and has written passionately against what he sees as the coercive tendency in mental health care.

The points he makes about coercion and the potential for abuse within the mental health system are, I believe, salient and important. Debates over the potential for pathologisation of difference and instances of ‘symptom creep’ have hit the headlines again this week with report of increasing numbers of antidepressant prescriptions, and there is always a balance to be maintained between genuine care for and treatment of those suffering from mental distress, and the use of extrajudicial power to curtail the rights of the individual.

However, his ideas also resonate in a worrying fashion with both the infamous ‘Care in the Community’ policy of Thatcher’s government, and the current Tory administration’s approach to disability, welfare and the NHS. Szasz’s critique of the psychiatry as an institution is founded in a free-market fundamentalism which views state-provided healthcare as coercive since it obscures the financial relationships which underpin the therapeutic relationship between doctor and patient.  In his re-framing of the concept of mental illness, he casts those traditionally considered mentally ill as either victims deprived of liberty, or as merely using the label as an excuse for not taking responsibility for their own actions, and for restricting the liberty of others.

In this context, Care in the Community can be seen as a deliberate attempt to reduce the extent to which people who refuse to take responsibility can impact on others. This is not to argue that the policy was necessarily influenced directly by Szasz’s views (although this is not unlikely), but that the logic is the same – focus the argument on the problematic tension between liberty and clinical intervention, and use this as a way to withdraw care and place blame on the service user.

The worrying thing about this is the similarities between the model suggested for ‘Care in the Community’ in the 1988 Griffiths Report and Lansley’s NHS reform proposals. The Griffiths Report is summarised as follows by Vicki Coppock and John Hopton:

Local authority service departments:
– Should be given the lead role in the provision of community care;
– Should receive cash limited funds;
– should undertake ‘needs-led’ assessments and design individual ‘packages of care’;
– should become ‘enabling agencies’, purchasing and overseeing care, NOT directly providing it. (2000: 42)

This ‘market led’ approach to ‘Care in the Community’ was a demonstrable failure, and its basis can be placed within the development of an explicitly market-libertarian ideology diametrically opposed to NHS-style state healthcare.

It is unsurprising, therefore, that Lansley’s policies should follow a similar pattern (and be expressed in similar language), but also deeply worrying. This is not a path anyone who suffers from mental distress (or indeed anyone who might get ill, ever) wants to take, and one which should be opposed as strongly as possible.

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One Comment leave one →
  1. January 22, 2012 10:05 am

    have just been disabled at guardian,is it because i dj for the fbi.i really do at the moment.
    thought you should know this is a case for mulder and scully.

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