Introduction

This chapter will discuss the broader impact of neoliberal social and welfare policy. In particular, it explores the impacts of increased inequality and the spatial concentration of poverty. These processes are referred to as ‘advanced marginality’. This concept captures the ways in which areas of poverty are surrounded by areas of affluence. In addition, advanced marginality symbolises the processes whereby groups and individuals are effectively excluded in a literal and metaphorical sense from major areas of modern society. This section is influenced by the work of Loic Wacquant (2008a, 2008b, 2009a, 2009b) and his notion of territorial stigmatisation. This is the modern context of community care. It then goes on to examine the impact of austerity policies that have been followed since 2010 on both mental health service users and wider mental health provision. The links between poverty and poor mental health are examined in this section. Increases in inequality have broader impacts in this area. Wilkinson and Pickett (2010, 2018) argue that mental health can be used as one of the measures of inequality. In addition, they argue that polarised societies produce a range of social harms that have negative impacts on individuals and communities. The fundamental argument that I put forward here is that austerity has impacts on individuals’ mental health while increasing pressures on statutory and voluntary services. One impact of these processes has been an increase in the use of the MHA, including compulsory admissions to hospital and police involvement in responding to mental health crises. These were among the factors that led to the Wessely Review of the MHA, which was completed in 2018 (Department of Health and Social Care, 2018). There is concern that the wide crisis in mental health services has led to calls for a return to the notion of asylum.

Advanced marginality

Davis (1998) outlined a series of trends in the development of the modern urban environment that served to exclude but also manage poverty and the urban poor. Los Angeles is portrayed by Davis as something of a laboratory for social and economic policies such as the management of public space. His classic work has a prophetic quality. The trends that he identified have intensified and become more widespread over the past 25 years.