The Organising Challenge Ahead
This blog is the second part of a larger article published in Soundings Futures about the mental health crisis and developing a political response to it. To read the full article click here.
Our survey www.thefutureoftherapy.org raises a number of questions about how we might influence the way mental health services are delivered in the future. How do mental health workers get to the point of organised industrial activity – a point from where they can make demands about wages and working conditions across the mental health sector? How do we open up a debate within the sector about the political project ahead for defending quality mental health services, and how can we start to organise around this agenda?
Firstly, on a policy level, mental health services deserve a public inquiry into the current regime of performance management and the IAPT model – to be run by a group of people who are not financially invested in the outcome. There is an emerging leadership in the campaign against the IAPT model and the co-option of therapies to deliver welfare cuts – which, unsurprisingly, is led by disability and mental health service user networks. The most radical challenge to the current mental health system has not come from workers or their collective institutions, but rather from disability and mental health networks such as DPAC, NSUN, Recovery in the Bin, Mental Health Resistance Network and the Mental Wealth Alliance. These networks are uniquely placed to provide data and information about what is happening to service users, particularly those on benefits, as well as a critical perspective on the IAPT model. From the perspective of the mental health workforce critical and outspoken networks exist and will continue to emerge as the crisis deepens.
Secondly, there is a need for the development of a new network of interested parties (including trade unions, service user groups, alternative networks and those professional bodies that have an interest in political action) that can start to research and debate the workforce crisis in mental health services, and work towards creating a platform for negotiation on wages and working conditions in the sector. Many organisations and activists are involved in this data collection, and in raising concerns within the sector. If pooled this work could be developed to help create a platform for national engagement on the key workforce issues.
Although many mental health workers are members of trade unions – principally Unison, Unite and the RCN, with the addition of a new small union, the Psychotherapy and Counselling Union – there is no clear platform for debating workforce issues within these structures, and none have put forward a response to the expansion of IAPT services, not least because many members are employed by them. However, within all of these structures a critical perspective on IAPT exists and, combined with the new networks that are emerging, there is potential for establishing an initial working group to drive the work of the kind of strategic organising and negotiating network we have been describing.
There is an important and growing constituency of self-organised groups of professionals that are emerging and offer a workplace perspective and front-line memberships that are crucial to any serious strategic response. These currently include Counsellors Together UK, Alliance for Counselling and Psychotherapy, Psychotherapists and Counsellors for Social Responsibility, Free Psychotherapy Network, Critical Mental Health Nurses Network, Social Work Action Network. There are also some campaigning networks such as Health Campaigns Together that offers an umbrella for current NHS campaigns and Action for Care-worker Wellbeing that campaigns on workforce issues in health and social care. All of these networks offer important perspectives and support to frontline workers. All have highly experienced and well networked activists within their ranks that could form a key constituency within any negotiating platform.
Whatever constellation of organisations and networks emerges, or puts itself forward to join this platform, there will also be a need to supplement its work with expertise from employment relations and academic fields. As the recent fallout from the poorly negotiated nurses’ pay deal shows, any credible platform has to have the expertise to develop a negotiating strategy that can improve rather than compound existing workforce issues. Combined with the professional and trade union bodies, and capitalising on the Labour Party’s recent rethinking of a national mental health policy, a genuine attempt to organise a platform could be set in place.
As experienced campaigners know, the process of creating an inclusive body is a hard one and must be driven by the explicit objective to create inclusivity rather than suppress it. Splitting and territorialism run right through the histories of political and workplace activism and has potential for undermining even the most determined efforts to organise in the sector. As a result the primary principle of any platform must be inclusivity and an openness to new networks and organisations as they inevitably come into existence during the crisis. Without that premise then the debates about mental health will continue to focus on defending an ever decreasing professional circle rather than addressing the strategic downgrading that is actually taking place.
This issue of inclusivity relates to the third and potentially most important line of action which is to find ways of organising at the level of the workplace in order to make sure that services and jobs are protected.
Something that stood out in our survey responses was the low number of people who took their workplace problems to a trade union, or to colleagues. Of therapists working outside of the NHS, only 4 per cent had spoken to a colleague about problems at work. The most consistent question I have been asked by mental health workers throughout this research process is whether I know of a group in their local area that they could join to get support. This is in spite of the existence of a range of large trade unions in the sector. Considering that this is a group of people trained to increase relationality, there is a real question about why we seem unable to do this with the people we work with.
Although the purpose of this article is not to outline methods of solidarity and organising, the way we organise as a sector needs to be addressed in tandem with our development of national policy responses. To do any of this ordinary organising work requires us to challenge the performance management systems within which we work, and, maybe more importantly, to support each other in doing that. This rests entirely on our capacities to build relationships with the people with whom we actually work.
The dual meaning of free association is important here, offering us a way to utilise both our experiences of freedom of association – to collectivise at work – and our abilities in developing deep relationality with the people around us. A relational model of organising is needed, which enables workers to create spaces in which they can seek an understanding of the societal and industrial changes that are taking place, and to build dialogue and strong solidaristic relationships in situations of industrial conflict – relationships that are able to mobilise members in a context of diminishing resources.
In the current mental health context, this organising work is not principally an ideological project but rather a developmental one. We need to devote resources and time to organising groups of mental health workers across professional silos and employers, in a process that enables the emergence of spaces for dialogue between diverse interests and provides safe environments out of which new political and psychological ideas can grow.
In the context of downgraded mental health services, the fact that mental health workers are unorganised and silenced is a matter for both professional and personal ethical concern. Sometimes working in healthcare forces you to walk a very thin line between the personal and the political, and this means there is a need for both a defence of ethical and clinical principles, and for negotiating the conditions under which those principles can survive.
Workplace organising would also benefit from drawing on the emancipatory educational methods of Paulo Freire, which were taken up by some of the workers’ education traditions in Western Europe. These methods are based on a framework made up of essentially three connected stages of learning: problem identification; getting information (in particular identifying what resources are available); and planning concrete next steps. Emancipatory education is underpinned by a number of principles, including confidentiality and solidarity, and its activities aim to provide a safe space for expressing and processing diverse and often difficult workplace experiences. Because these methods open up debate, if used well they can support the inherently political processes of consciousness raising and collective planning, which serve to identify and mobilise collective interests – the basis of putting solidarity into action.
This approach offers us a methodology that has important parallels with the psychoanalytic project, as well as the capacity to build relationality at work. It can be understood as psychosocial – looking at both internal and external realities, and requiring the raising of consciousness, collectivisation and praxis (i.e. understanding reality and taking action to transform it). Its methods aim to promote a dialogue between participants – looking at their experiences of the real world, reflecting on them and making material changes, particularly in relation to wages and working conditions.
In order for this model to work it has to transform ‘individual dissatisfaction into collective grievance’;whatever organisations or networks or groups we are part of, they have to create a collective sense of injustice, including a sense of who is responsible for the situation, and sufficient organisation to shape collective demands and action. In the current mental health context, the political work of any collective project has to be built not as an ideological project but rather as a developmental one. The primary value of organising collective structures is that they are able to create spaces for dialogue between diverse interests and provide a safe environment out of which new political ideas can grow. It is on this basis that the existing networks and organisations for mental health workers will ultimately be judged.
Next week Survival Surgeries and the methods of solidarity.
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