Social justice is pivotal to mental health care

Abstract

In this structured debate we will discuss the possibility and value of using the concept of social justice for psychiatry. Jan Verhaegh, Reinhold Hasel: Some participants in the debate on social justice argue strongly in favour of using the concept of social justice in mental health care. The WHO Commission on Social Determinants of Health has published a report entitled ‘Closing the gap in one generation, concluding that „social injustice kills people on a large scale.“ Some agree with this statement and argue that in psychiatry social justice is very important. Some say that „without social justice there is no mental health.“ Research by Richard Wilkinson has shown that the more equality and social justice exist in society, the higher is the level of mental health. In rich countries with high levels of inequality, there can be low levels of mental health, whereas in poor countries with high levels of equality, mental health levels may be high. Those favouring the concept of social justice argue that „inequality is a kind of social cancer.“ The concept of human rights, in psychiatry, is very important at the micro level of understanding patients and the practice of psychiatry. There is an acceptance of social factors contributing to the onset, treatment and recovery of schizophrenia. As van Os and colleagues have written in a recent issue of Nature, the ethical quality of social relations is very important. Is social justice (or the quality of social relations) as important as the concept of neurotransmitter disorders? When brains have plasticity, can brains be seen apart from social relations and social justice? Also, there is a clear international case for social justice as a key concept. Social justice has a juridical basis in UN declarations on human rights. The UN convention on human rights of disabled people is very important in this perspective. Thomas Becker: This talk will outline contrasting positions on the issue of social justice. Some participants in the debate oppose the ‘social justice’ position arguing for a maximum of freedom and free market economy. Provided everyone in society is „egoistic“ and free to be so, the argument goes, this situation will lead to a flourishing free market economy and that in turn will lead to the best outcome for all. Experience in communist countries, the argument goes, has shown that concepts such as social justice do not work and lead to forms of ‘dictatorship’ and bureaucracy. The welfare state leads to a danger of citizens being lazy and their depending on government support. In „Punishing the Poor“, Loic Wacquant describes neo-liberal politics based on this model. The model says that by abolishing the welfare state, social pensions for disabled people and the poor, by diminishing the level of public (mental) health care (or restricting it to people who can pay), government does the best it can do. Thus, people unable to work might finally find themselves in prison. The book argues that in this model psychiatry might be replaced by prison. This talk will discuss such positions with the aim of clarifying some aspects of the social justice concept. It will also address the issue of whether it is possible to find a balance between ‘autonomy’ and ‘public assistance/welfare’. We (users, survivors, managers, scientists, psychiatrists, social workers) invite you to come to this debate to discuss the above questions.