Between coercion, conditionality and abandonment: A descriptive analysis of English mental health spending and provision under austerity

Abstract

While critical scholarship has demonstrated the harmful effects of austerity on public mental health, relatively little attention has been paid to austerity’s impacts on health services themselves. In response, this paper develops a descriptive analysis of mental health spending and provision in England during the austerity period, from 2009–10 to 2019–20. It examines spending patterns at the national and local level, highlighting a major growth in funding that has been overlooked by prior studies. Then it interrogates national trends in mental health provisioning, utilisation and treatment. The paper argues that austerity has divergent impacts on localities which are best understood as multiple localised austerities. Meanwhile, the overall mental health service landscape under austerity is characterised by three trends, all of which have the potential to harm public health. Inpatient services are utilising more coercion; community services are increasingly conditionalised; and a significant population – too ill for work but judged too healthy for treatment – has been abandoned by services. For critical scholars and practitioners of public health, these findings highlight the complexity of the political, economic and institutional dynamics which distribute spending cuts and therefore mediate austerity’s effects on health.