Introduction

This chapter examines broader notions of citizenship, placing the impact of discrimination against people with mental health problems within this context. It argues that the discrimination that people with mental health problems face amounts to an ongoing denial of the full rights that citizenship should bestow. It then goes on to examine the impact of neoliberal social policy and austerity. These policies in the UK have increased inequality and poverty, which have broader impacts on mental health. In addition, the reforms of the welfare system have targeted people with mental health problems who are in receipt of benefits.

Two important recent works – Scull's (2015) Madness in civilisation: A cultural history of insanity and Foot's (2015) The man who closed the asylums – highlight the barriers that had to be overcome in the struggle to humanise mental health provision. Scull (2015) shows the way that all cultures, in myriad ways, engage with the experiences of what we can loosely term mental distress. His work also illustrates that societal responses have often involved processes of exclusion, seclusion and abuse. Foot's (2015) study of Franco Basaglia makes very clear the essential political nature of the structure and delivery of mental health care. There is an implicit danger that, in examining the current crisis in community mental health services, the failures and abuses of the past are assigned to history. The assumption being that such progress has been made that these issues are now resolved. The impacts of major mental illness are clearly social as they affect people's opportunities to work, relationships with loved ones and other areas of life. There is a loop here as this social marginalisation, by its nature, has potentially damaging impacts on an individual's mental health and sense of wellbeing.

Mental health is a political as well as personal issue as it intersects a number of areas – social, cultural and economic. In addition, one needs to examine a range of other issues including the power of psychiatry and other mental health professionals. A mental health diagnosis can have ramifications in a number of areas – one's own personal sense of identity but also in areas such as employment and the legal system.