Why we need to hear maverick voices more in mental health nursing
In the 2019 Skellern Lecture, Mick McKeown argues for better services and a better world
Mick McKeown uses the 2019 Skellern Lecture to argue why nurses need to harness their ability to think critically
I am pleased to have been chosen to give this year’s Skellern Lecture, which annually celebrates advances in the field of mental health and mental health nursing. Eileen Skellern was a pioneering figure in mental health nursing, and her interest in democratic care has inspired some of the main themes in my talk.
We have lived through the most extreme period of economic depression since the 1920s (International Labour Organisation and International Monetary Fund 2010, Varoufakis et al 2012). Driven by neoliberal ideology, western governments have attempted to solve this crisis of capitalism with austerity measures, piling adversity onto the poorest and consolidating the wealth of a powerful few, while failing miserably to rescue the economy.
‘The system lumbers on, in a zombie-like stagger towards the next crisis’
The prevailing economic system, favouring privatisation and diminishing government intervention, should have had its shortcomings fatally exposed by the banking crisis and subsequent failings of austerity policies. Yet, the system lumbers on in a zombie-like stagger towards the next crisis (Quiggin 2012). This peculiar resilience of a failed system can be explained only by the abject alliance that props it up: between government, big business and the mass media, where government is arguably the weaker partner (Crouch 2011).
Uncertainty and poor morale
Over the years since a fully formed neoliberalism appeared in the late 1970s, there has been a transformation of the UK economy, with a dismantling of manufacturing and creeping privatisation of public utilities and parts of the NHS. Workers pay has been driven down, job security has been diluted with a casualisation of work and a proliferation of low-grade jobs and zero-hour contracts, correctly referred to as ‘McDonaldization’ (Ritzer 1993).
The experience of work has become characterised by uncertainty and poor morale. In the NHS, for example, too few nurses and overuse of agency staff gives a temporary feel to the workforce, so that staff and service users can go from one day to the next unsure of who will be providing care, which affects care quality and alienates staff and service users.
Available forms of defence, such as trade unions, have beaten a substantial retreat in the same period, with total trade union membership figures at an all-time low in recent years, but picking up slightly this year (Roper 2019). For people out of work, including those who have disabilities or long-term illnesses and who most need health services, the picture is even worse. Hostile welfare benefits systems, work capability tests, prejudice and stigma add to their misery.
‘The failings of our social and political institutions and systems have resulted in huge levels of dissatisfaction’
Within such an economic system, citizens are understandably aggrieved. The failings of our social and political institutions and systems have resulted in huge levels of dissatisfaction, and ultimately a crisis of confidence in democracy itself. The not-unrelated crises in healthcare, for example at Mid Staffordshire (Francis 2013), Winterbourne View (Department of Health 2012) and Whorlton Hall (Triggle 2019), have resulted in a corollary loss of faith in services and practitioners, with nurses in particular accused of lack of compassion (Stenhouse et al 2016).
In the field of mental health, this is compounded by long-standing service user and survivor grievances regarding compulsion, coercion and a predominant biomedical model favouring medication over relational responses to distress (Crossley 2006, Read et al 2009, Russo and Sweeney 2016).
Practitioners with radical, maverick voices offer alternatives to the current state of affairs and misguided, insular populism. They reclaim notions of militancy as utopian, creative and democratic impulses towards better services and, ultimately, a better world.
As nurses, we need to harness our ability to think critically to escape the current traps of oppression and disadvantage in which we find ourselves.
Find out more
- Crossley N (2006) Contesting Psychiatry: Social Movements in Mental Health. Routledge, London
- Crouch C (2011) The Strange Non-Death of Neoliberalism. Polity, Cambridge
- Department of Health (2012) Transforming Care: A National Response to Winterbourne View Hospital. Department of Health Review: Final Review Report
- Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry
- International Labour Organisation, International Monetary Fund (2010) The Challenges of Growth, Employment and Social Cohesion
- Quiggin J (2012) Zombie Economics: How Dead Ideas Still Walk Among Us. Princeton University Press, Princeton NJ
- Read J, Bentall RP, Fosse R (2009) Time to abandon the bio-bio-bio model of psychosis: exploring the epigenetic and psychological mechanisms by which adverse life events lead to psychotic symptoms. Epidemiology and Psychiatric Sciences. 18, 4, 299-310
- Ritzer G (1993) The McDonaldization of Society. Pine Forge Press, Thousand Oaks CA
- Roper C (2019) Trade union membership rises by 100,000 in a single year – but challenges remain
- Russo J, Sweeney A (Eds) (2016) Searching for a Rose Garden: Challenging Psychiatry, Fostering Mad Studies. PCCS Books, Wyastone Leys
- Stenhouse R, Ion R, Roxburgh M et al (2016) Exploring the compassion deficit debate. Nurse Education Today. 39, 12-15
- Triggle N (2019) Whorlton Hall: Hospital 'Abused' Vulnerable Adults
- Varoufakis Y, Halevi J, Theocarakis NJ (2012) Modern Political Economics: Making Sense of the Post-2008 World. Routledge, London
About the author
Mick McKeown is professor of democratic mental health at the University of Central Lancashire