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Challenging ideas in mental health
Challenging ideas in mental health

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3 The business of madness

This is a photograph of a pile of money.
Figure 8 Profitable mental health services, the way of the future?

In this section you’ll consider mental health as a business. This is not the way mental health services are usually regarded, as it is more common, at least in the UK, to regard them as public services. However, ideas about being more business-like in health and social care have gained prominence in recent years. What does being a business, or more business-like, mean? For one thing, it implies a profit motive: goods or services delivered to make money for private companies and their shareholders. This is quite controversial when applied to mental health services. There is a tension between mental health services as a business – a growth industry – and as a regulated public service. Caught between the two are the service users/survivors and their families. How are their needs met by the competing forces in the mental health marketplace?

Being a business also suggests the importance of delivering what customers want so that the provider stays in business and flourishes. Further, it means being efficient, systematic and practical. That, at least on the face of it, looks like a very positive attribute for mental health services.

This section takes these three issues – the profit motive, delivering what the customer wants, and efficient, systematic and practical services – as its organising framework. In Section 3.1 you begin to consider the concept of mental health as a business, and in Section 3.2 you focus on the profit motive and the controversial role of pharmaceutical companies. Section 3.3 considers ‘what the customer wants’, and Section 3.4 tackles the question of pharmaceuticals for mental health, and some specific historical examples – the National Institute for Health and Care Excellence (NICE) guidelines and the National Service Framework for Mental Health.