The last two years have seen a small but significant increase in the level of resistance by service users and practitioners to the coalition government’s policy of austerity and neoliberal restructuring of mental health services in England. This article provides an overview and analysis of these developments by examining four recent campaigns that feature alliances between service users, workers, trade unionists and anti-cuts activists. It considers both challenges faced and successes achieved by campaigners

Mental health policy initiatives in England over the last three decades have led to significant restructuring of statutory service provision. One feature of this has been the reconfiguration of NHS mental health services to align with the requirements of internal and external markets. Based on findings from 12 months’ ethnographic fieldwork within one mainstay of NHS statutory provision, the community mental health team, this paper examines the effects of these neoliberal policy and service reforms on professional practice and conceptualizations of mental distress. The paper begins with an account of the restructuring of the labour process in community mental health services. This utilizes the notion of ‘strenuous welfarism’ to describe an organizational context characterized by escalating performance management, deskilling of professional practice and the intensification of mental health work. Increasingly prominent aspects of managerialism and marketization disrupted attempts by mental health practitioners to sustain supportive and mutual structures with colleagues and engage service users in therapeutic and relationship-based forms of practice. Moreover, organizational processes increasingly recast service users as individual consumers ‘responsibilized’ to manage their own risk or subject to increasingly coercive measures when perceived to have failed to do so. Consequently, biomedical orientations were remobilized in practice in spite of a purported shift in policy discourse towards more socially inclusive approaches. The term ‘biomedical residualism’ is coined to describe this phenomenon. However, instances of ethical professionalism that reflected resistance to these residualized modes of practice were also visible.

There has recently been a re-emergence of interest in non-reductive historical materialist modes for analysing social movements. A precursor of this is found in the work of mental health activist and Marxist theorist Peter Sedgwick. We contend that Sedgwick's work retains utility for theorising radical mental health movements in the twenty-first century, though we argue his framework needs extension in light of intervening debates regarding the interaction of material (distributive) and post-material (recognition) concerns. Having established this we will turn to an overview of recent neoliberal work, welfare and mental health policy reforms as a basis for consideration of strategic implications and challenges for resistance and coalition building amongst survivor and worker activists. We will propose a contemporary Sedgwickian strategy that identifies transitional organizing goals combining concrete material demands with imaginative, prefigurative means oriented towards ruptural change. In conclusion we argue that tools for promoting this strategy such as the Social Work Action Network's (SWAN) Mental Health Charter may assist in binding together diverse constituencies to strengthen alliances of resistance and deepen a politics of solidarity.

This opening chapter provides historical and policy context for the fieldwork chapters that follow in the book. It begins by arguing that models of mental distress cannot be understood in isolation from the activities and action environments of which they form a part. Therefore, to develop a more contextually situated account of these forms of knowledge, the chapter proposes a socio-historical framework for understanding key phases in the development of policies and systems of mental health provision. These four ‘conjunctural settlements’ begin with the nineteenth century asylum, followed by the biomedical hospital system and community care in the twentieth century then contemporary neoliberal provision. Prominent ways of understanding and responding to mental distress associated with each settlement are introduced.

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