Mental health, social science and the capabilities approach

by Richard Brunner

In the late 1990s, I did the hardest job I hope I will ever do: advocating for the rights of patients in a psychiatric hospital in one of London’s most disadvantaged boroughs.

What made it so tough? Whilst patients were usually pleased to have someone on their side, the hierarchies of clinical power made it hard for patients to get what they wanted. These were usually modest requests – perhaps escorted time outside the hospital grounds or changes to medication. But what made it even more challenging was what happened once people were discharged from hospital. They would generally return to the same difficult circumstances that had led to their admission in the first place; care plans and advocacy made little difference. And so I would see the same people admitted over and over again. Without knowing it, I was learning about the social and environmental determinants of health. Continue reading