Introduction

This chapter begins with a brief analysis of the ‘changing work paradigm’ in globalised economies and the evidence for the impact of this on mental health outcomes, particularly in terms of those who are or may become ‘precariously distressed’ (Rogers and Pilgrim, 2003). This is followed by an account of structural stigma within mainstream mental health policies and the way in which they continue to reflect a risk agenda. The chapter then identifies the relationship between networks of risk in mental health and the networks of trust that have been negotiated between major constituencies, particularly between the state and relatives of victims of so-called ‘community care homicides’. The fourth and final section analyses in more depth the power of the lobby that broadly represents the latter group through the “organising power of grief “ (Peay, 1996, p 23, after Rock in the same volume). The chapter concludes by explicating the circular and paradoxical nature of current policies. It is argued that they are liable to fail, not only those citizens who require mainstream mental health services, but also the much larger number of people who, regardless of the reality of the risks, consider their lives and livelihoods as precarious and insecure.

During any single year, more than one in four adults in the European Union (EU) will experience some form of mental ill health, the most common forms being anxiety disorders and depression (European Commission, 2005). Suicide accounts for more deaths per annum in the EU than deaths from either homicide, HIV/AIDS or road traffic accidents (European Commission, 2005) and, while suicide statistics are notoriously problematic, the greater likelihood is that this is an under-rather than an over-estimate. In the UK in 2004, 5,906 people aged 15 years or older committed suicide (ONS, 2006). The economic and social costs associated with poor mental health are substantial and are rising throughout Europe, due largely to escalating levels of absenteeism from work (Mental Health Europe, 2002-04). While the severity of more common forms of mental distress such as depression and anxiety is sometimes minimised in comparison with psychotic illnesses such as schizophrenia, there is clear evidence that their impact on social functioning can be major and the economic costs substantial as a result (Glozier, 2002; Layard, 2006).