Introduction

Despair, helplessness, hopelessness; my experience for 30 years and I go back there occasionally. Mostly, I stay away, avoiding invitations to return. What has this to do with the lead essay? These same overwhelming feelings pervade the social work profession, particularly in mental health. Social work needs alliances with activists in the user movement. My perspectives as a survivor activist and social work educator influence my response to the author. (Note: I include mental health service users in the description ‘disabled people’ as it is used in its political context and I recognise that not all mental health service users accept this description.)

I agree with the author's critical analysis of the medical model's dominance in diagnoses and interventions. I agree with his exhortation to value-driven, relationship-based social work based on the social model. I agree that social work, particularly in mental health, needs to integrate the political and professional, valuing Marxist theory. Otherwise, it will fail when faced with the opportunistic alliance of state, corporations and financial institutions. In individual practice through supposed partnership-working with other disciplines, social work has tried to educate colleagues. There is recognition of the approach and values that social work brings to mental health teams but its influence is limited as the system and its structures remain healthdominated. Continue talking, but also act in the ways recommended by the author.

There is so much of value in the article, and in my response, I would like to go deeper on one particular aspect, the author's thoughts on ‘connecting psychological stress and colonialism’, drawing on my own identity and narrative. There are deep-rooted similarities between colonialism and the psychiatric system. Both blighted my life for many years and would continue to do so if I had not become aware of the connections – the former caused mental illness and the latter prolonged it. There is much research into the effect of colonialist attitudes on causation, diagnosis and treatment of mental illness, both historically and currently. It is morally wrong that the psychiatric system can perpetuate the experience of oppression for minority communities, immigrants and those born here alike. Over many years, research has evidenced racist practice in the psychiatric system at the individual and institutional levels.