Part I offered an outline of the emergence of systems of mental health provision in England from the Victorian asylum to the neoliberal present in order to place prominent models for understanding and responding to mental distress in historical context. Part II presents an account of the fieldwork over six chapters. I begin in this chapter with an introduction to ‘Southville’ Community Mental Health Team (CMHT), a fictional name to protect anonymity. This includes an overview of the CMHT model, its structure and processes, and the range of mental health professions working within it. My main argument is that neoliberalism, market-based delivery and performance mechanisms have reshaped the labour process and forms of professional practice. Mental health work that was predominantly based on relationships has shifted to target-oriented, bureaucratic and informational forms of practice. This has generated tensions and stress for practitioners and service users alike.

Community Mental Health Teams: an overview

CMHTs were an important element of the closure of large psychiatric institutions and the transition towards ‘care in the community’. Early forms of the CMHT involved both health and social services, although, at first, provision was uneven and fragmented (Langan, 1990; Onyett, 2003). However, the 1990s was a period of consolidation for the generic integrated, multidisciplinary CMHT model. By this point, it constituted the mainstay of community mental health provision for people of working age who met its criteria. CMHT provision tended to orient to those with so-called ‘severe’ – that is, longer-term and complex – levels of mental health need. But the ‘balanced caseload’ model meant that CMHTs also provided more short-term support to some people with moderate levels of distress. The case management model was the Care Programme Approach (CPA), which offered a form of individualised support known as ‘care coordination’ (Glasby and Tew, 2015). This model was contemporaneous and integrated with the market-oriented care management model.

From 1999 onwards, a range of more ‘functionalised’ community teams, including ‘crisis resolution and home treatment’, ‘assertive outreach’ and ‘early intervention’ services, were established to operate alongside CMHTs (Burns, 2004). But the generic CMHT retained a central coordinating role. In this period, an array of key performance indicators (KPIs) and metrics linked to internal and external markets began to reshape organisational structures and professional practice.