3.2 Mental health as business: introducing the debate
Is mental health a business? There are a number of signs that it could be, and Activity 8 presents a discussion between two people with strong views on mental health services and how they should be delivered. Dr Harvey Gordon is a forensic psychiatrist who has been a long-term consultant at Broadmoor High Security Hospital, and also a consultant at the Maudesley Hospital in London. Jim Read has worked for many years in organisations and networks of mental health service users/survivors as a consultant, trainer and writer.
Activity 8: Mental health as business
Listen to the two sequences of audio below. You might find it helpful to listen right through both, with the questions in front of you, and then make detailed notes after a second hearing.
What does ‘business’ mean to Jim and Harvey?
What are their main points of difference?
Are there any areas where they agree?
Click play to listen to audio clip 1 (10 minutes).
Transcript: Audio clip 1
Click play to listen to audio clip 2 (10 minutes).
Transcript: Audio clip 2
What does ‘business’ mean? Course testers noted the following:
‘affected by financial factors’; ‘budget constraints’ (HG)
contrasted with a public service (HG)
constant reorganisation in the NHS (to make it more businesslike?) (JR)
choice for service users (both)
the use of direct payments to put the user in charge (JR)
pharmaceutical companies are motivated by financial gain, but they need to produce something that doctors will prescribe and people will benefit from (HG)
new markets for drugs are created by identifying new conditions needing treatment (HG)
standardising services is difficult because of geographical constraints on where people can get treatment (HG) and because the quality of services depends on the people delivering them (JR)
community-based services, which may well be less expensive, produce better outcomes than services which rely heavily on drugs (JR).
Points of difference: the major area is over the use of drugs. Jim is basically against the use of drugs to treat mental distress, while Harvey offers a spirited defence of them, for the benefit not only of service users/survivors but also of their families.
Points of agreement: both speakers agree that it is not easy to offer choice in this context. And neither of them wholeheartedly embraces the idea of mental health services run on business principles.
In the next section you focus on one strand of this debate, touched on by Jim and Harvey – the role of drug companies, and the lure of the profit motive.