Mental Health Services and Community Care. Cummins, Ian
Keywords for Today. Community is one of their keywords. Williams had suggested that community is a word that is never used in a negative fashion. They do not consider its use in the phrase community care, which clearly developed negative connotations, in a very relatively short period in the late 1980s and early 1990s. Community is long established in the English language. It originally meant the common people as opposed to those of rank, the people of a local area or the quality of holding something in common (MacCabe and Yanacek, 2018). The authors note that, as society became more complex, community was the word used for alternative approaches to group living, for example, a religious community. This use made its way into the history of mental health – for example Laing’s establishment of therapeutic communities (Cummins, 2017a). These communities were self-contained and in a sense self-governing. They were attempts to live an alternative, healthier life. The use of community has spread. It is used in a broader political sense – for example the emergence of the term gay community in the 1980s – to represent a grouping of individuals with a shared social identity or shared political and cultural interests. It should be noted that this use of the term is fraught with difficulties. It assumes that there is a commonality of interests which might not necessarily be the case. The notion of community politics is used to denote a more informal, localised approach to campaigning. This is presented as a purer form of political activity. Here community stands in opposition or contrast to the tainted world of machine politics. In one of those ironies of usage, in recent times, there has been the emergence of ‘gated communities’ – as previously noted, a number on the site of former asylums. The use of community plays to notion of inclusion and a nostalgic vision of what life used to be while they are gated to ensure that unwanted elements are kept out.
Community, then, is a term that carries within it elements of nostalgia but also positive notions of making better social connections between individuals and groups. There remains a sense of flexibility in the use of the term community. It can be used as a cipher for a range of values. In the political and policy sphere, it is used as a marker to claim that there is something of an ethical core to proposals. For Bauman (2001) community acts as a counter to a more individualised present or Rose’s (1996) ‘death of the social’. Thus, community is presented as the solution to a whole range of social and other problems. However, we cannot find the mechanisms that will help to recreate it (Bauman, 2001). These trends seem to have become more entrenched since the development of social media. Social media creates communities of a different sort to the organic forms that are the basis of these debates.
Arendt (1959) argues that some form of commonality is central to our physical survival. Individualism and autonomy are core values of our increasingly dislocated community. However, there are contradictions here as we cannot survive without care from others – as infants but also at other times in our lives (Fineman, 2004). The notion of community is a powerful one. In his analysis of nationalism, Anderson (2006) argued that a nation is ‘an imagined political community’ – this is true of all nations. Politicians and elites can make calls based on the idea that though citizens will never meet most of the members of the imagined community, they share interests or an identity. There are periods where this is most keenly felt, for example, major events such as the Olympic Games. This notion of an imagined community can also be applied at a more regional or micro level. Community is an elusive ideal – it is constructed from memory. An idea that is projected into both the past – as it never existed in the way that it is remembered – and the future where it can never exist in the way that it is imagined.
The multiplicity of meanings attached to community allow it to be used with little analytical work (Crow and Allan, 1995). In the late 1970s and early 1980s, as policies of deindustrialisation began to take effect, there was an increasing interest in the notion of community. Community was seen as providing a bulwark against the impact of New Right economic and social policies. Even though many on the Left were attracted to these notions, the use of the term across the political spectrum meant that it was problematic. In particular, the term seems to imply some sense of greater localised, democratic involvement in decision making, but this was often not the case. Policies were often constructed and shaped by the needs of the wider state. The result was that the responsibility for hugely significant social problems was localised limiting the role of state actors and policies in their creation. Brown (2015) notes the way that neoliberal politics pushes the nexus of social problems and their solutions further and further away from the site of their creation. Calls to communities are part of this process. Issues such as class and inequality become marginalised. The language of community is a potentially powerful depoliticising force.
The main expansion of the policy of community care was, somewhat ironically, undertaken by a government whose leader, Thatcher, famously declared that there was no such thing as society. Hall (1979) was one of the first to identify the implications of the shifting political and economic trends of the 1970s. In his seminal essay ‘The Great Moving Right Show’, Hall (1979) saw that the mixture of economic liberalism and social conservativism that Thatcher represented was a new and influential political force. The essay was published in January 1979 before Thatcher’s election victory in May of that year. The post war social democratic settlement was unravelling at that point – most clearly in the winter of discontent (Lopez, 2014). Thatcherism was able to pose as representative of the interests ‘ordinary’ British citizen against the vested interests of the social democratic welfare state – radical trade unions, teachers and social workers, and so on.
These processes also entail the Othering of groups such as BAME communities, the poor, welfare claimants and offenders. Hall was right in his view that Thatcherism marked a break from the post war consensus. Thatcher developed a political image that was the antithesis of consensus, attacking what she saw as the nation’s enemies within and without. Thatcher’s uses of the symbols of Nation and Empire are excellent examples of Anderson’s (2006) ‘imagined community’ as well as the fact these communities are inevitably exclusionary.
In the city: geographies of exclusion
Members of the Chicago school were the first to develop a spatial theorisation of the city (Soja,1996). Spatial factors play a key role in the creation and maintenance of social and community relationships (Simmel, 2004). The city represents modernity, progress (Park, 1967) and creativity but also a sense of dislocation and danger. At the same time establishes social order (Tonnies, 1955). Any analysis of the deregulated, gentrified city created by modern forms of capitalism has to consider Davis’ (1998) City of Quartz. Davis’ (1998) study of Los Angeles (LA) focuses on the way that urban spaces are sorted and segregated. Urban spaces are the key battle ground where capital establishes and maintains its dominance. Public space is essentially privatised. The poor are excluded so that the middle classes and elites can take advantage of the new leisure culture of city centres. Davis (1998: 224) argues ‘Police battle the criminalised poor for valorized spaces’. Value comes from the fact that these are spaces dedicated to consumption and recreation. They therefore need to be protected. The subtitle of City of Quartz is ‘excavating the future’. The LA model of development and regeneration is one that has been followed across late capitalist societies.
Neoliberal forms of governance saw huge