Using Simon's Governing through crime to explore the development of mental health policy in England and Wales\ud since 1983

摘要

The reform of the Mental Health Act in 2007 saw the introduction of SupervisedCommunity Treatment Orders (CTOs) in England and Wales. It is argued that this marks a fundamental shift in the rights of those subject to mental health legislation.This paper will explore the developments in mental health policy in the 1980s and1990s that form the backdrop to the introduction of CTOs. It uses Simon’s Governingthrough crime (2007) as a basis to explore the developments in mental health policy that resulted in the final introduction of CTOs. The paper explores the paradox at theheart of mental health policy. This paradox being that while the protections and the rights of the mentally ill have increased in a formal legal sense, this has not resulted inthe achievement of full citizenship that the idealism of the original proponent of the\udclosure of the asylums envisaged.The policy of deinstitutionalisation was based on a series of progressive notionsand explicit rights based approach to the treatment of citizens with mental healthproblems. However, the implication of this policy has not resulted in the end of stigma,marginalisation and discrimination. Many commentators would suggest that the asylums have now come to the community rather than the reverse. The mental health\udpolicy response to the failings of community care was one characterised by an increasedmanagerialist culture with a focus on audit and risk. These events are discussed in terms\udof Cohen’s (1972) notion of a ‘moral panic’. In addition, they are analysed as part ofHall and others’ view of the crisis of legitimacy faced by Welfare States from the early1970s onwards. The eventual result was the introduction of CTOs. This marks afundamental shift in the balance between individuals with mental health problems andthe therapeutic state. It is argued that the fact that such a significant change has beenintroduced in the face of opposition from virtually all the key stakeholders in the areaindicates that the ‘mentally ill’ and the ‘mad’ continue to be a marginalised.