ABSTRACT
Medicalisation has shaped the structure and functions of mental health services, leading to a neglect of the social causes of woes and non-medical approaches. However, the relationship between expert knowledge and grass-roots opinion (and perception of need) is a complex one. Furthermore, the traditional nature of the professions has changed, and present mental health services are led by managers whose priorities are at variance with the aims and values of a personal helping relationship. It is argued that a managed technical approach to ‘mental health’ conflicts with and fails to appreciate that woes often need to be understood as idiosyncratic and contextually determined. Some examples of innovative alternatives to current practice are outlined. These have generally involved professionals working in partnership with woeful individuals or grass-roots organisations. A review of several recent UK mental health policy documents concludes that the assumptions upon which they are based cannot serve as the foundation of an approach that is likely to prove effective or sustainable.
