Building capacity of local governments, service users and carers to scale up provision for community mental health services in Africa: a case study of Kenya and Uganda

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.

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Experiences of mental health service users on their empowerment and social integration in the community

The European Journal of Counselling Psychology ◽

10.5964/ejcop.v7i1.147 ◽

2018 ◽

Vol 7 (1) ◽

pp. 165-180 ◽

Cited By ~ 1

Author(s):

Vasiliki Yotsidi ◽

Kalliope Kounenou

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Mental Health Services ◽

Community Mental Health ◽

Mental Disorders ◽

Health Service ◽

Health Services ◽

Service Providers ◽

Community Mental Health Services ◽

Service Users

The transition from institutionalized towards community mental health services demands the evolution from social exclusion to integration practices. Empowerment of people with mental disorders, through their involvement in planning and service provision, prevails as a cutting-edge in such practices. Along these lines, this study adopted a structured bottom-up research methodology to explore the experiences of people with severe mental disorders on nine areas of their community participation. Three focus groups of 18 persons with psychotic disorders who were treated on an out-patient community mental health centre were set up. Qualitative data analysis showed that the areas of treatment, housing, education, and entertainment have turned to be more accessible for mental health service users than those of employment, active citizenship, social relations, social networks and activities in the community. The latter were revealed to still be obstructed by specific personal and social variables, which should be taken into account for community-based treatment to become more responsive and tailor-made. Results are discussed in relation to the role of counselling psychology in improving community mental health services and ensuring that service providers empathize with and respond to individuals' understanding of their condition and what contributes to their care and well-being.

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