The issues of care and justice in mental health

Many chapters of this book have attended to the potential renewal offered by the ethics of care in various realms of everyday life. Here I use the ethics of care to address care in mental health services by drawing on data from a small qualitative research project. Justice and care are intertwined in the ethics of care, where achieving social justice requires relational care (Barnes and Brannelly, 2008). Two key aspects of the ethics of care make the analysis of justice and care possible. First, justice requires that practices are seen so that they may be judged (Tronto, 2013). As practices associated with detention and compulsion are ‘hidden’, in that they are largely unknown to people not connected to them, to be able to judge them requires that these practices are surfaced. Second, Tronto's (1993 and 2013) phases of care provide an analytical tool for the analysis of research data, and also, importantly, a position from which to renew care. First it is necessary to take a brief overview of the territory in which care is attempted in the context of mental health. My focus here is on policy and practice in the UK and New Zealand, which have similar mental health policy, legislation and services.

Every society has responses to care for people in need. But in the case of people with mental health problems particular responses are invoked that differentiate them as a group from others considered ‘needy’. Deeply entrenched normative values operate to marginalise people who experience long-term mental illness. Societies that value productive, consuming citizens often reinforce the ‘otherness’ associated with mental illness. People with mental illness are marginalised and excluded on many levels. Acknowledging inequality for a particular group of people surfaces issues related to it, stated by Tronto (2013, p 91 quoting from Hirschmann, 2002, p 231):