Introduction

I am delighted to be able to respond to the issues Jeremy Weinstein highlights in his article. His detailed account evidently results from a wealth of experience in the field of mental health social work. He offers an important contribution to the Social Work Action Network (SWAN) imperative to ‘bridge public issues and private pain’ (Jones et al, 2007), and mental health is an excellent example of the need for this ‘bridging’. Yet, this imperative raises some pressing challenges for mental health social work today.

While I have no fundamental disagreements with his article, I would like to use this opportunity to emphasise further some of the insights from radical mental health practitioners, psychiatric users/survivors and broader movements for social change. With these insights in mind, I have tried to distill the complex issues Weinstein covers into five key challenges facing mental health social work today.

New understandings of madness and distress

The first challenge for mental health social work today relates to its role in challenging the prevailing dominance of bio-psychiatric understandings of ‘mental illness’. Arguably, developing psychosocial understandings of, and approaches to, madness and distress should go further than tackling stigma, discrimination, oppression and social exclusion (seen as resulting from a pre-existing ‘mental illness’). While these concerns are vitally important, the challenge is about developing a ‘wider’ and ‘deeper’ politics of mental health. This means not just seeing mental illness as being merely ‘triggered by’ social factors, or exacerbated by social pressures ‘on top of ‘ a mental illness. It means understanding how madness, distress or mental illness can be experienced by the person as thoroughly meaningful and can potentially be intelligible within a person's social context (Tew, 2011). It also means understanding and challenging the way that mental health and mental illness is socially constructed, framed and understood in our society.

The challenges made by service users, psychiatric survivors and ‘mad activists’ are complex and offer mental health social workers no easy answers. However, it is vital that we take these forms of ‘experiential knowledge’ seriously and engage with them meaningfully. Meaningful engagement with so-called ‘experts by experience’ is profoundly challenging for mental health workers because it often questions our own ‘common-sense’ understandings, or professional judgements, and this may be experienced as difficult and deeply ‘unsettling’ (Church, 1995).