The Ambivalence Gap
Three of the most intractable problems in the field of mental health services are stigma; isolation and disempowerment.
Stigma can be partly be combated through educating the public and through marketing campaigns. But there is very little that is better at dispelling stereotypes than direct contact.
Isolation and loneliness can be addressed through neighbourhood activities and institutions that bring people together.
As we recently argued, disempowerment can partly be understood as having a lack of resources in your social network. If you do not know people who can help you to get things done then you are much more likely to feel like you cannot control the forces that act on you. Part of empowering people, therefore, is sustaining and developing their social networks, for example introducing them to people who might be useful to them in the future.
In short, part of the solution to all three of these problems must involve talking about people’s relationships. This can be a tricky subject for mental health professionals and for service users.
I recently chaired a panel discussion around this topic at the One In Four conference.
There was no shortage of at the conference. People were discussing how personal budgets, micro enterprises, co-production and network weaving could all be ways of supporting and developing people’s social networks.
It struck me that this would require a quite different role for the state. Rather than delivering solutions to service users the state would be supporting and sustaining an environment in which people are able to develop their own social networks. If you want a practical example of what this would look like you might have a look at the Southwark Circle project that Participle started.
One of the many reasons why I do not think we are going to see this type of culture change within mental health services is our own ambivalence towards the state. One the one hand there is huge mistrust of the state; we are sceptical on the efficiency of the government (“waste”) and often on the motives of government (e.g. “stealth taxes” or “big brother”). On the other hand there is a strong belief that the government is largely responsible (see this report especially from page 12 onwards) for bringing communities together. This “ambivalence gap” leads to a type of risk adverse paternalism from public services.
Worryingly this means that changing the way public services are delivered means changing ourselves.