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James Norris’ paper invites us to consider not only the structural disintegration of NHS mental health services, but also the psychic fragmentation this engenders in those who work within them. In drawing on psychoanalytic frameworks, Norris illuminates the attacks on thinking that emerge when organisations become saturated with anxiety, loss and unprocessed grievances. I want to respond to this by building on his reflections in exploring how unconscious processes might manifest in Child and Adolescent Mental Health Services (CAMHS), where the weight of these dynamics are acutely felt.
Norris’ paper is well written and well researched. The focus initially is on the negative impact of recent changes in the long history of the undermining and fragmentation of the NHS. He mentions two major policy shifts resulting in IAPT (Improving Access to Psychological Therapies) and the Health and Social Care Act, their negative impact on services and the blocks to treatment they have created.
The NHS has long functioned not just as a healthcare provider but symbolising care, dependability and the containing function of the benign state. Its creation was fraught with conflict: political, economic and ideological. The early resistance from the British Medical Association and the Conservative Party reflects a deeper ambivalence about dependency, socialism and the loss of power.
Letwin and Redwood’s (1988) blueprint for privatisation can be read as a defence against vulnerability – an attempt to replace a containing structure with the promise of market profitability. As privatisation advances in stealth, the NHS shifts from being a predictable, unified, ubiquitous service to a network of fragmented services often in competition with each other. This has a profound effect on those working within the organisation and leads to mistrust, anxiety and splitting.
The private sector, particularly the health insurance companies from the US who have more or less saturated their own country now see