“Mad, Bad and Dangerous to Know”: The pervasive socio-medical and spatial coding of mental health day centres

Abstract

This paper explores the experiences of long-term, mental health service users in community day centres. Academic literature often focuses on macro-level analysis of the social, political and geographical position with society of those with mental health distress. In doing so service users can be positioned as a largely homogenous group who often reside at the boundaries of society due to the negative social representations of mental distress. Community spaces, such as day centres, can be presented as 'therapeutic spaces', in which service users engage in consensual and non-judgemental behaviour. Such accounts suggest a high level of mutual camaraderie exists within day centres.However, this approach can negate the realities encountered by service users on a daily basis, where perceived associations with medical ascriptions such as 'depression' and 'schizophrenia' can influence service users' identity and behaviour, and acceptance by other members. In this paper we develop a relational understanding of the production of day centre space, constituted through discursive and materially-embodied forces. We argue that Spinoza's writings on affect are a particularly useful way to analyse the ways that service user experience is produced through practices that incorporate social and individual discursive activity, which comes to be indelibly linked to bodies' "capacities to act". In doing so we hope to emphasise how important embodied relational dynamics are to the production and experience of day centres, and the potential value of a Spinozist account of affect to do so. Consequently the paper works up an argument that key spaces in community mental health be explored in terms of the way spaces are produced through "Mad, Bad and Dangerous to Know": The pervasive socio-medical and spatial coding of mental health day centre spaces 2 affective practices that are inter-personal, rather than shaping service users as a homogenous group. Key to this process, as we will see, is the role of perceived diagnostic identity, derived from embodied activity, as an organising affective force.

Unpacking ‘the City’: An experience-based approach to the role of urban living in psychosis

“…It focuses on issues of identity, exclusion and social norms (e.g. Butler and Bowlby, 1997;Butler and Parr, 1999;Chouinard et al, 2010;Giggs, 1988;Hansen and Philo, 2007;Knowles, 2000;Parr, 1997Parr, , 2000, senses of home and belonging (Fields, 2011;Tucker and Smith, 2014); or relations to community health centres (Smith and Tucker, 2015;Stroud et al, 2015) is based on different qualitative methods -semi-structured or biographic interviews, observation, focus groups, go-alongs, videosgiving in-depth access to patients' everyday experience. In this literature, there is a recent interest in narrative, autobiographical and phenomenological approaches to this experience (Atkinson, 2009;Chouinard, 2012;Davidson and Smith, 2009).…”

Digital community assets: Investigating the impact of online engagement with arts and peer support groups on mental health during COVID‐19

“…Location has always been an important factor in relation to the shape of mental health support from institution‐based care that dominated until the second half of the 20 th century through to community‐based services in the present day (McGrath & Reavey, 2015; Parr, 2008; Smith & Tucker, 2015). Digital community assets introduce additional layers to consider regarding location, as they can typically be used in multiple settings, disconnecting or weakening the link between location and formal support practices.…”

“…art therapy, community assets, COVID-19, digital health, online mental health, peer support of 'platform-as-agent' captures the agential role that platforms as mediators play in life (Eli et al, 2018), which the media theorist, Grant Bollmer, captures in stating: This means that our bodies, and the relations we have with others, are fundamentally informed by the technologies we use, and technologies do not so much "mediate" as they provide the grounds for any experience of our own selves and relations with others. Bollmer (2018, p. 146) Location has always been an important factor in relation to the shape of mental health support from institution-based care that dominated until the second half of the 20 th century through to community-based services in the present day (McGrath & Reavey, 2015;Parr, 2008;Smith & Tucker, 2015). Digital community assets introduce additional layers to consider regarding location, as they can typically be used in multiple settings, disconnecting or weakening the link between location and formal support practices.…”

Living ‘in between’ outside and inside: The forensic psychiatric unit as an impermanent assemblage

“…Existing research investigating the role of space and place in mental health has predominantly focused on community settings, often in terms of recovery, such as Duff's (2011) 'enabling places', Pinfold's (2000) 'landscapes of care', and Gesler's (1992) 'therapeutic landscape' (Wood et al, 2015, Lengen, 2015, Piat et al, 2017, Gastaldo et al, 2004. Studies have also highlighted the importance of belonging (Parr, 2008), social inclusion (Andresen et al, 2011) and the impacts on service user experiences of places such as community day centres (McGrath & Reavey, 2016;Smith & Tucker, 2015) and home environments (Tucker, 2012;Tucker, 2013). The present paper extends research through a focus on forensic spaces, one of the few remaining institutional spaces of mental health care.…”