ABSTRACT
This chapter sets out to convey the main forces that push practice from behind and describe the ways in which distal forces and political policies have a direct bearing on how practice is measured and assessed and services are reshaped. It summarizes the constraints on expression that can permeate daily practice in many settings, as well as threaten to dehumanise practice. The systemic nature of cuts and constraints directly affects the functioning of practitioners and the clients who use the services. The case of the adulterated letter reveals how power over the practitioner is experienced as oppressive; a deliberate attempt to alter the meaning and purpose of an important therapeutic letter from a father to his son. The chapter addresses the historical–political precedents to the current state of affairs in mental health provision and their impact on the culture within the National Health Service (NHS) and mental health services.
