Using Simon's Governing through crime to explore the development of mental health policy in England and Wales since 1983

Abstract

The reform of the Mental Health Act in 2007 saw the introduction of Supervised Community Treatment Orders (CTOs) in England and Wales. It is argued that this marks a fundamental shift in the rights of those subject to mental health legislation. This paper will explore the developments in mental health policy in the 1980s and 1990s that form the backdrop to the introduction of CTOs. It uses Simon's Governing through crime (2007) as a basis to explore the developments in mental health policy that resulted in the final introduction of CTOs. The paper explores the paradox at the heart of mental health policy. This paradox being that while the protections and the rights of the mentally ill have increased in a formal legal sense, this has not resulted in the achievement of full citizenship that the idealism of the original proponent of the closure of the asylums envisaged.

The policy of deinstitutionalisation was based on a series of progressive notions and explicit rights based approach to the treatment of citizens with mental health problems. However, the implication of this policy has not resulted in the end of stigma, marginalisation and discrimination. Many commentators would suggest that the asylums have now come to the community rather than the reverse. The mental health policy response to the failings of community care was one characterised by an increased managerialist culture with a focus on audit and risk. These events are discussed in terms of Cohen's (1972) notion of a ‘moral panic’. In addition, they are analysed as part of Hall and others' view of the crisis of legitimacy faced by Welfare States from the early 1970s onwards. The eventual result was the introduction of CTOs. This marks a fundamental shift in the balance between individuals with mental health problems and the therapeutic state. It is argued that the fact that such a significant change has been introduced in the face of opposition from virtually all the key stakeholders in the area indicates that the ‘mentally ill’ and the ‘mad’ continue to be a marginalised.

Keywords:

• community treatment orders
• deinstitutionalisation, governing through crime