Moving beyond neoliberal rationalities of risk in mental health policy and practice

In this chapter we, the editors, explain why it is important and what it means to adopt a critically reflective approach to the mentality of risk (Culpitt, 1999; Rose, 1996) that informs current neoliberal welfare approaches to the organization, management and resourcing of services that respond to mental health problems. In keeping with a key theme of this book, we position mental illness as a human rights and social justice issue. That is, we locate the lived experience of mental illness, and its asso­ciated risks, as structured. In this way we connect the subjective experi­ence of mental health problems with social inequality, which requires critical reflection of the 'social misery' (Frost & Haggett, 2008, p. 438) that both gives rise to and that arises from living with mental illness. As Harrison and Melville (2010) note, globalization and neoliberal economic policies have introduced a new range of risk inequalities that impact peo­ple's mental health worldwide. Our beginning point in the chapter is to explicate how neoliberal risk rationalities reinforce prevailing inequali­ties that are associated with mental ill health, limiting and in some cases precluding social justice. Next, we clarify the mutability of rationalities of risk, even though they are institutionalized in law, policy and practice. By understanding that risk forms a part of the rhetorical apparatus that supports the politic of neoliberalism, we are challenged to envisage how we might 'speak back' to its logic at macro (structural), meso (policy and organizational) and micro (interpersonal) levels. We therefore present our model for critically reflecting on neoliberal rationalities of risk and how they operate in men­tal health settings, and we consider the implications such critical analysis has for moving beyond the risk paradigm in mental health policy and practice