The times they are a-changing

Will inclusion and citizenship triumph over compulsion? asks Rachel Perkins

Openmind 131, January/February 2005

The social and political climate now facing those of us with mental health problems seems to me to reflect the traditional battles between good and evil that are the stuff of legend.

Nowhere are the forces of evil more clearly represented than in the seemingly inexorable process of changing the mental health legislation. Just about everyone in the mental health arena has already described the damaging impact that the current draft Mental Health Bill will have on the lives of people with mental health problems, so I will not reiterate them here. Suffice to say that what has probably been the most united action ever seen in the mental health arena - action that has brought together professional, campaigning and user/survivor organisations under a single banner of opposition to the draft Bill - has failed to stem the extension of compulsion.The draft Bill reflects the climate of prejudice, ignorance and fear that we have for so long faced.

Call me an unreconstructed optimist if you will, but there would seem to be a fair few forces of good around as well. Paradoxically, we are witnessing unprecedented attention to the need to reduce exclusion faced by people with mental health problems, both within and outside the mental health arena.

At 'NHS Live' earlier this year, the Mental Health 'Tsar' chaired a masterclass on challenging discrimination. Around the world, national and local anti-stigma and anti-discrimination campaigns abound, and at the first World Psychiatric Association Conference on Stigma and Discrimination in 2001, the President of the Association, Professor Norman Sartorius, declared that: 'There is no greater problem in the field of mental health internationally than stigma.'

For the first time, we have a Prime Minister who has talked about the 'huge impact on the individuals concerned and on our wider society' of the exclusion of people with mental health problems 'from many aspects of life the rest of us take for granted - from jobs, family support, proper health care and community life', and also of the need for all government departments to work together to eliminate such exclusion. And there is a plan, in the form of the 2004 Social Exclusion Unit Report on 'Mental Health and Social Exclusion'.

And then there is the new Disability Bill. Intensive lobbying has ensured changes in the Bill that should make it work better for people with mental health problems. If this government bill is passed, no longer will mental health service users and survivors have to prove they have a 'clinically well-recognised' condition any more than people with diabetes or a fractured spine have to do so. What is more, it was these changes relating to mental health (rather than those relating to the broader disability arena) that took pride of place in the statements of both the Secretary of State, Andrew Smith, and the Chair of the Disability Rights Commission, Bert Massie, about the Bill. Have we ever before seen mental health issues feature so prominently outside the narrow mental health arena?

Will the forces of inclusion and citizenship triumph over the forces of compulsion and control that serve to reinforce prejudice and fear? Who knows ... but perhaps we have something to learn from previous liberation struggles.

When African National Congress activists were imprisoned in the dark ages of South African apartheid, many began to campaign against the fact that the conditions facing black prisoners were significantly worse than those for white prisoners. However, Nelson Mandela wisely cautioned 'prison conditions will not change until the country changes'.1 The position of black people in prison reflected their position in a wider society, and until this was changed discriminatory prison regimes would continue.

Perhaps it is also true that mental health legislation is simply a reflection of the position of people with mental health problems in society, and hat such restrictive and discriminatory legislation will not change until society changes. And perhaps we should take advantage of the window of opportunity that now exists: the rising recognition of the importance of ensuring that people with mental health problems really do have access to the opportunities that all citizens take for granted.

It may be that it is only when people with mental health problems are able to participate as full and equal citizens - seen for the contribution that we make to our communities rather than the 'burden' and 'danger' that pervade popular images - that mental health legislation can be effectively challenged.

1. Nelson Mandela (1995) Long Walk to Freedom, Abacus.