This chapter begins by exploring discontent with currently dominant situational logics and associated directional tendencies, before identifying countervailing logics, tendencies and forms of resistance. It then goes on to consider how the latter might inform the development of alternative ‘thick’ social-relational approaches within mental health services, and the collective agents and particular forms of agency through which these might be realised.

Discontent with biomedical residualism (and custodial paternalism)

The previous chapter provided a detailed account of the dominant logics, and strategic directional tendencies of biomedical residualism and custodial paternalism generated by them, that have emerged in the context of neoliberalising mental health services. While there were a range of responses to these developments, the fieldwork chapters illustrated that critical perspectives were widespread among practitioners and service users. A common theme animating this ‘discontent’ was that valued opportunities for social and relational forms of support were increasingly limited within this setting. Instead, biomedical and residualised forms of practice were predominant. However, as Chapter 1 noted, there has been a nominal shift in mental health policy from a predominantly biomedical orientation towards a more recovery-focused social inclusion agenda in recent years. Thus, at the ideational level these policy positions might appear to suggest a more favourable terrain for social and relational perspectives for understanding and responding to mental distress. This first section of the chapter will build on the analysis developed across the previous chapters to demonstrate how emergent structural conditions during the neoliberal era have constituted a barrier to such developments.

Situational logics and disciplining mechanisms

In the previous chapter I focused primarily on the ‘top-down’ situational logics and the directional tendencies associated with processes of neoliberalisation. These powerful logics and tendencies shaped practitioner activities in ways that reproduced residualised and biomedically oriented forms of intervention. Sometimes this was because logics generated ‘strategic directional guidance’ that influenced practitioners’ rationalisations or situational interpretations in ways that encouraged alignments with these tendencies. More frequently, however, when reflecting on these dynamics, practitioners stressed a lack of identification with these modes of practice. Rather, in many instances, the logic operated through the imposition of opportunity costs on practitioners who defied dominant logics by not acting in accordance with them.