Our contemporary chronic crisis in mental healthcare is generally attributed to a simple failure to fund services to the degree required (“the whinge”). In this presentation, jointly developed with a fellow forensic psychiatrist Dr Calum Smith, I argue that underfunding is only a part of the problem. I will outline how the failure to develop adequate, effective community-based services following deinstitutionalisation has arisen within a matrix of inter-related sociocultural shifts, which have combined to both facilitate and obfuscate the impacts of chronic underfunding.
The endpoint of this is process is starkly demonstrated in our recognition and treatment of schizophrenia. I outline how six mutually interacting shifts in society have influenced how we approach the challenge of schizophrenia and argue that these have given rise to a new and fundamentally changed episteme: a radical re-framing of what we ‘know’ about its presentation, its progress, its associated risks, and its treatment.
I argue that the outcome of this epistemic shift is what we see today: systemic neglect of the needs of people suffering with schizophrenia. This neglect not only results in preventable suffering and criminalisation of those with severe mental illness, but has significant implications for community safety.
I will conclude by offering some tentative ideas for a way out of this dangerous situation.