Journal Of‘Conzmunity & Applied Social Psychology, Vol. 2, 104 (1992)

Postscript

After the General Election: Prospects for Primary Prevention I am writing this brief response to the commentaries of Hawks (1992), Newton (1992) and Rappaport (1992) in the immediate wake of the British General Election, which has returned the Conservative Party to power for a fourth successive time.

Such an event, I suggest, is likely to have a significant impact on the future prospects of primary prevention initiatives in the mental health services. Clearly, the organisation of and funding levels for the national health service was one of the main battlegrounds over which the major political parties chose to fight the election. Such a battleground was chosen, I believe, in part, because it provided an opportunity to sharply contrast ideological differences between the parties. That the Conservative Party emerged victorious appears, from my contacts with com- munity mental health service workers, to have resulted in considerable frustration and despon- dency among this group. It is, perhaps, worth considering why this has been a consequence.

Clearly, the considerable change which has already been initiated in the organisation of health services will continue. Increasingly, the ideology of the market place is being promoted. Hence, for example, the development of ‘trusts’ and of ‘fundholding’ practices. It is not my purpose to explicitly argue the rights or wrongs of such an ideology. Rather, it is to indicate that such an ideology may have significant consequences for primary prevention initiatives.

One danger inherent in this ideology is that such market forces are likely to engender a relatively narrow and short-term focus with regard to the planning and delivery of health care. As I have indicated (Blair, 1992), primary prevention initiatives tend to demand policy at a national or, a t least, a community based level, policies which may take several years to fully implement and evaluate. Instead, however, the need for quick results to justify local investment decisions may serve to work against such initiatives.

Another danger with this ideology is an increasing focus upon the ‘treatment’ package, the ‘patient’s charter’ and so on; in other words with a concern for remedying illness as opposed to promoting health. The ‘purchasers’ are oriented towards buying services for their ‘clients’ (the unwell). The ‘providers’ are oriented towards supplying such services. There is little demand for purchasing ‘continued health’ or ‘support through periods of risk’.

Ultimately, perhaps a fear among mental health service workers is that, rather than the ‘marginalisation’ of primary prevention initiatives (Blair, 1992), we shall in future come to experience the complete absence of such initiatives. Against such a backdrop, there is a para- mount need for a strong and clearly directed case to be made in favour of primary prevention. Thus, I welcome David Hawks’ (1992) encouragement of quality research and Jennifer New- ton’s (1992) advocacy of prioritisation and the provision of appropriate examples of good practice. However, to echo the perspectives of Julian Rappaport (1992) and Janet Bostock ( I 991), perhaps such a case needs to locate itself within and ally itselfwith radical and dissenting positions, such as that of feminism, positions that actively challenge the ideologies which dominate the organisation and provision of physical and mental health care.

ALAN BLAIR

REFERENCES Blair, A.J. (1992). ’The role of primary prevention in community mental health services: a review and

Bostock, J. (1991). ‘Developing a radical approach: the contributions and dangers of community psy-

Hawks, D. (1992). ‘Commentary,’ Journal of Community and Applied Social Psychology, 2, 102- 103. Newton, J . (1992). ‘Commentary,’ Journal of Community and AppliedSocial Psychology. 2, 100-101. Rappaport, J. (1992). ‘The dilemma of primary prevention in mental health services: rationalize the

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0 1992 by John Wiley & Sons, Ltd.