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OF mental health care and mentally ill

Who is psychiatry’s client?

One of the ambiguities surrounding psychiatric work is whether or not the identified patient is the actual client of the service. Clearly, some party other than the patient is being served under those sections of the Mental Health Act which empower professionals to remove a person’s liberty and/or impose treatment interventions against the patient’s will. Coulter’s work on decision making about madness in the lay area traces such a process.

Professionals are summoned in order to resolve a distressing drama to those around the patient. Similarly, when members of the public contact the police about a person acting bizarrely in the street it is clear that the client of the police-psychiatrist ‘disposal’ is not the patient, although quite who psychiatry is serving in this instance is ambiguous. Is it the distressed and perplexed member of public making the first police contact, is it the police themselves, or is it both? Clearly, if a person is detained without trial, and they are interfered with without consent, then it is difficult to conceptualize them as ‘customers’ or ‘clients’ of psychiatry. Instead, the terminology favoured by the psychiatric service users’ movement would seem to be more appropriate, of ‘recipients’ or ‘survivors’. On the other hand, if a person chooses freely to make contact with a mental health worker, to seek help with a personal diff iculty, in this instance they would seem to have a genuine ‘client’ status.

However, even with this voluntary contact there is still a sense in which the client does not enjoy the same rights and privileges as other types of customers accessing a service industry.

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