Skip to main content
main-content
Top

About this book

This book proposes theoretical models and practical strategies for tackling the widespread social exclusion faced by people diagnosed mentally ill. Based primarily on research in the US and UK but with reference to other international examples, it analyses evidence of discrimination and the effectiveness of different remedies: disability discrimination law, work to re-frame media and cultural images, grassroots inclusion programmes, challenges to the 'nimby' factor. It places the growing user/survivor and disability movements as central to achieving any radical change.

Table of Contents

Introduction

Abstract
I don’t want half a life. I want a life (Lionel Aldridge, ex-Green Bay Packers player and mental health user/survivor, 1995).
Liz Sayce

Chapter 1. A Dream of Inclusion

Abstract
I want to be able to talk to someone in a pub and say ‘I have been mentally ill’ and for them to say ‘that’s interesting, what did you experience?’ (user/survivor, UK, 1997).
Liz Sayce

Chapter 2. Future Dreams, Future Nightmares

Abstract
It’s like being hidden. It’s as if you have been put in a garage where, if they don’t have room for something but aren’t sure if they should throw it out, they put it there, where they don’t need to think of it again... If people in New York woke up one day and learned that we were gone, that we had simply died or left for somewhere else, how would they feel? I think they’d be relieved... People in Manhattan could go on and lead their lives and not feel worried about being robbed and not feel guilty and not need to pay for welfare babies... I think they look on us as obstacles to moving forward (15-year-old girl living on the New York streets, quoted in Kozol 1995).
Liz Sayce

Chapter 3. The Illusion of Citizenship

Abstract
The fact that people with mental health problems may not be full citizens — sharing rights, responsibilities and complete membership of a society with everyone else — is evident in some countries at the point of entry.
Liz Sayce

Chapter 4. Models of Anti-discrimination Work: The Brain Disease Model

Abstract
If deinstitutionalisation has not fundamentally changed the values underpinning segregation, do we have a model now that is sufficiently robust not to lead to future disillusionment? This chapter explores the contradictory aims of different ‘anti-stigma’ approaches and looks in detail at one of those most in favour, the brain disease model.
Liz Sayce

Chapter 5. The Individual Growth Model

Abstract
This model tears down distinct disease categories, or at least minimises their importance, in favour of a single line, stretching from ‘emotional well-being’ at one end — including the capacity to learn, achieve autonomy, be self-aware, enjoy relationships and meet challenges — to ill-health at the other. We are all somewhere on this line. We move up and down it. This ‘continuum’ notion has underpinned much mental health promotion work. It is influential in the traditions of counselling and psychotherapy (Pilgrim and Rogers 1993) and New Age spirituality (Coward 1989) as well as in users’ critiques of the damage inflicted by psychiatric labels (see, for example, Wallcraft 1996, Foner 1997).
Liz Sayce

Chapter 6. The Libertarian Model

Abstract
The libertarian model is perhaps best summed up by a button (a ‘badge’ in UK terms) on sale at the 1995 conference of the National Association of Rights Protection and Advocacy (NARPA), which read ‘Equal civil rights and equal criminal responsibility for mental patients’. It was next to buttons reading ‘You bet I’m non-compliant and inappropriate’ and ‘Go manage your own case and get off mine’.
Liz Sayce

Chapter 7. The Disability Inclusion Model: No to Shame

Abstract
The disability inclusion model aims to dismantle the discrimination faced by people because they have a diagnosis or record of mental illness, and to open up new opportunities. It does not matter where the discrimination occurs: in the legal system, the hospital ward, the boss’s office or the TV studio. The constructions of user/survivors as morally tainted, dangerous, to be feared and segregated, have to be replaced and the discriminatory behaviour of employers, judges and ‘nimby’ campaigners curbed. The aim is citizenship inclusion, on a fair basis with all other citizens — and fairness for would-be citizens, who should not be barred from immigration on the grounds of mental disorder. This would change user/survivors’ lived experience — people’s income, opportunities and legal rights — rather than only, as in the ‘brain disease’ and ‘individual growth’ models, making it easier for people to seek help. The paternalistic notion that all disabled people need is ‘services’ to ‘help’ them has to be replaced by a broader view of people’s aspirations and potential.
Liz Sayce

Chapter 8. The Potential of Anti-discrimination Law

Abstract
Once we have established a clear aim of working for social inclusion and developed banner headlines like ‘No to shame’, ‘Full participation’, even ‘Mad and proud’ — to replace hate, to head off pity — we are still left with the crunch question of how best to achieve change.
Liz Sayce

Chapter 9. The Limits of the Law

Abstract
For all the impressive ADA implementation activity (see Ch. 8), there are certain types of discrimination, identified in Chapter 3, that were not even touched by the ADA in its first years.
Liz Sayce

Chapter 10. Public Debate, Political Action

Abstract
If law alone will not usher in social inclusion, we need to understand the context in which law is framed, passed and interpreted, in order to identify methods of intervening in these social and cultural arenas.
Liz Sayce

Chapter 11. Influencing Public Opinion

Abstract
An almost automatic response from users and service providers to evidence of discrimination on mental health grounds is to call for education, in schools or through the media (Rose 1996). For example:
Liz Sayce

Chapter 12. Making Inclusion Happen at the Grassroots

Abstract
Discrimination is overcome at the grassroots, not by writing policies in Washington (co-ordinator, user-run drop-in centre, 1995).
Liz Sayce

Conclusion

Abstract
As the growing power of the user/survivor movement collides with pressures for increased social exclusion, we need robust, tested conceptual models to take the mental health world into a new phase of development. Otherwise, as cyclical analysts warn us (see Ch. 4), our latest idea will be just another in a long line of approaches — building asylums, closing them down again in favour of community care — that do not quite live up to their promise, if they take hold at all.
Liz Sayce
Additional information