'The Business End': Perspectives on mental distress in the context of neoliberal restructuring of community mental health services

Contemporary neoliberal reconfigurations of statutory mental health services involve significant organisational changes. Based on findings from twelve months fieldwork within a community mental health team, the thesis examines the effects of this new service landscape on the way conceptualisations of mental distress are utilised and articulated. The thesis combines critical realist epistemology and reflexive ethnographic method to produce a contextually situated understanding of the field capturing the dynamic relationships between concepts, agents and the context of action. This draws on and extends Rhodes’ ‘pentimento’ (1993) as a conceptual framework for understanding mental health practice. It argues the mental health team is a ‘differentially sedimented structural institution’ in which practitioners and service users navigate a field of contradictions defined by four strata: the custodial system of the asylum; the biomedical treatment system of the hospital; community care within the Keynesian welfare state; and neoliberal welfare reconfigurations. These are conceptualised as ideological positions that coexist within practitioners as alternative modes of thinking and operate in a relationship of mutual tension. Practice should be understood as a process shaped by mechanisms at different levels of scale from micro to macro, and involving movement between these overlapping and co-existing strata of historically sedimented meaning