Introduction

This chapter provides an overview of some of the key political processes shaping mental health policy and their implications for social work practice in this setting. It begins with a historical outline of policy responses to mental distress from the era of the asylum, through the 20th-century development of, first, hospital and then community care, and into the present period characterised by increasingly market-oriented and residualised service provision and individual responsibility placed on service users. In spite of these challenges from above, there remain a number of resources of hope for mental health social work. These emerge from person-centred initiatives and collective struggles ‘from below’ by social workers and service users to develop and extend support rooted in the values of social justice. The chapter gives examples of these and concludes with a case study to illustrate implications for practice.

Historical context of service provision

Mental health social work practice is significantly influenced by the policy context in which it takes place. Mental health policy in the UK is continually evolving, and shaped by a range of legal, professional and organisational strands (Glasby and Tew, 2015) within a wider context of neoliberal ideology (see Chapter 4). In order to understand social work in mental health in the present, it is necessary to reflect on the historical processes and institutions that have shaped it. There have been four key stages in the history of mental health service provision in the UK which, we argue, continue to exert an influence on contemporary policy and practice: the custodial asylum, the biomedical hospital system, community care and the current neoliberal period. In this section we outline the first three of these historical stages of mental health policy and practice. In the following section we then describe the main contours and dynamics of the contemporary neoliberal era and its implications for mental health social work.

Custodialism and the asylum

The primary response to mental distress in Britain during the Victorian era and before would have been either the removal of the person to a small-scale private ‘madhouse’ or segregation into one of the large-scale public asylums that had emerged by the early 19th century (Porter, 1987).