Exploitation of people with mental health problems: a critical discourse analysis of the role of mental health service policy in Scotland

Abstract

This thesis engages with the phenomenon of abuse and exploitation of people with a diagnosis or experience of mental health problems. The thesis focuses especially on exploitation that does not meet legal thresholds of criminality. In this thesis, this type of exploitation is called “noncriminal exploitation”. The research project was designed to answer the research questions: RQ1) How does the relationship between society and people with mental health problems affect or allow noncriminal exploitation of people with mental health problems? RQ2) How are mental health service providers represented in this relationship? RQ3) What are the obligations – moral or otherwise - of mental health service providers in addressing noncriminal exploitation of people with mental health problems? RQ4) Are existing policies and procedures effective in protecting the rights of people with mental health problems from exploitation?

To answer these questions, Foucauldian influenced critical discourse analysis is applied as a theoretical orientation and methodological framework to examine the policies that shape mental health services and practice in Scotland; and the potential effects of these texts on the lives of people who use those services, especially as it relates to exploitation of people who have mental health problems. The actual and potential roles of mental health services in preventing and addressing exploitation are examined.

An archive of policy and related documents relevant to mental health services in Scotland was selected; 10 representative documents from this archive were analysed for discursive themes, especially related to exploitation. A focused analysis of the current Mental Health Strategy of Scotland was conducted, to examine it both for internal discursive themes and for the presence of broader themes which emerged from the archive.

Competing discursive narratives embedded within the archive were discovered: Discourses that can be described as emancipatory and empowering of people with mental health problems (Rights-Autonomy discourses) are countered by discourses that embody paternalistic attitudes, medicalization, and stigma (Harms-Paternalist discourses). This thesis critically examines sample texts for the presence and effects of these discourses; traces the discourses throughout the Scottish Mental Health Strategy and discusses potential effects of these discourses.

When assessed by the stated goals of the Strategy and related policies, these discourses impede progress towards development of services that are person-centred and rights-based. This reinforces the marginalization of people with mental health problems and can impede progress towards the explicitly stated goals of the Strategy.

The thesis discusses the impact of these discursive realities on the issue of non-criminal exploitation. Roles and obligations of mental health workers encountering exploitation are explored. Policy solutions, as well as actions aimed at mitigating Harms-Paternalist Discourses, are proposed.