By Mark Brown
If personalised and ongoing care makes so much sense for chronic conditions, what’s the problem with mental health being seen the same way? Why are those asking for it seen as being at odds with what’s considered ‘best’ for them? What makes it so hard to accept that severe mental ill-health or distress can be an ongoing experience that requires ongoing care and support?
When people think about long-term care and support for the kinds of mental health difficulties that don't go away, they are mainly thinking about the kind of support that might fall under social care. This is less about treatment and more about ongoing support: both to address ongoing needs that don't go away, and to find ways to work around them or through them. This is mainly informed, whether people realise it or not, by thinking similar to the social model of disability.
The social model of disability rests in part on a Marxist analysis of capitalist society, which holds that because disabled people have been seen as contributing no labour, they are seen as a surplus of needs to be managed, and not as contributors. Society being arranged around money and labour, disabled people have been excluded: from the means of making money and through the structuring of society around the needs of those contributing, but also from the means to find ways of supporting themselves. The social model of disability rests on the idea that societies have a duty to all of their citizens, not just those who are economically active.
The social model of disability grew from a desire to escape from institutionalisation and limited opportunities. Without personalised support, care and adjustment backed up by law and taxation, the logic of ‘care’ for Disabled people was one of maintenance and cost minimisation.
To be Disabled, politically, is to be excluded from the rights and entitlements others take for granted because you are different from others. The answer is that society has a duty to remove as many of the barriers to Disabled people as possible so that they can take up all of the social goods and civic responsibilities that others would expect. In practice this means the provision of care, adjustment and support that, as much as possible, level the playing field. In this understanding, care and support are provided not as a benevolent act of charity but as a fundamental recognition of rights. It’s hard to extricate the idea of the rights of Disabled people from the notion of a State being able to provide or to intervene in the ways that social and economic processes happen, especially where the idea of adaptation and adjustment of existing circumstances is required. Someone must pay somewhere for the support, care and adjustment that disabled people require to benefit from the opportunities and rights others take for granted.
The wider world of mental health has not always been on great terms with the social model of Disability, leading to conflict around whether long-term mental health difficulty is truly comparable to physical or intellectual disability. The Equalities Act 2010
When we tell a community that ‘it’s not what’s wrong; it’s what’s strong’ without acknowledging inequality it can feel like what is being said is ‘what are you going to do to sort your own problems out?’