In my dream job, I have the task of imagining how the Power Threat Meaning Framework can be brought alive in a new grassroots-led health service. The opportunity is momentous, but the health service is just one part. Without a change in our economic system, we are limited in what we can do. Something like introducing a Universal Basic Income could really be a platform to create a society that works for everyone. I imagine the bosses and shareholders of Capita looking on in horror as their gold mine is shut down and their demands for compensation fall on deaf ears.
I bring my attention back to the here and now. My husband isn’t happy that we are downsizing our house. Although he sympathises with the cause to a great extent, the step back from prioritising personal economic gain is a difficult one. This is an opportunity to put humanity and the good of the majority back where market forces had been placed on a pedestal. I know I need to hold onto a faith that a focus on meaning and agency can create a thriving equitable society, even though meanings vary across groups within our communities. It will not be plain sailing, but things worth doing never are.
The Health Minister has been replaced by a Citizens Assembly organised by PPR’s Right to Work Activists. Health Board staff have been invited to stay on in post, with a flat salary for everyone and a recruitment drive for experts in lived experience of social inequalities. This has transformed our conception of what type of expertise matters at the top of the health service, and now it is time to focus on the coal face of health care. GP partnerships are to become State employees and dragged into the 21st century with a quota of half of the Practice Partners having lived experience of social inequalities. This is a transitional stage, with a longer-term plan of having wellbeing centers as the crux of healthcare, with experts in human rights and the social model of disability being the highest status leaders. All of the wellness hubs will have an array of roles that are unfamiliar to many, such as Income Maximisation Workers. Psychiatry and Psychology professions will be downsized, with those remaining trained in Open Dialogue and Social Prescribing.
The most fulfilling part of my first week in post is seeing the work put together to ban the use of the terms ‘mental illness’, ’ mental health’ and ‘psychological disorder’ in scientific and governmental contexts
Then onto the generation of knowledge to support our new flourishing society. Top of the agenda is a high-level committee with two core aims. The first is an inquiry into the ‘distortion for-profit’ that pharmaceutical companies introduce into the evidence base for wellbeing. Legal powers will be put in place to ensure that a focus on the social determinants of health and the use of qualitative research will no longer be side-lined within research and innovation. The committee will also be tasked with addressing the overuse of psychiatric medication to treat the impact of social issues on individuals and communities, recognising the harms of prescribed medication as a major public health concern. The most fulfilling part of my first week in post is seeing the work put together to ban the use of the terms ‘mental illness’, ’ mental health’ and ‘psychological disorder’ in scientific and governmental contexts, acknowledging these terms as discriminatory and harmful concepts that place social ills within the individuals most badly affected by structural inequalities.
In quiet moments of leisure, I day dream about a public denouncement of the Sewell report on racial disparity and an apology for its harmful assertions. Followed with a report on the true harms of empire, with an action plan for an ethical recovery plan including reparations. Reparations can never go far enough, but no one can move forward until this demonstration of humility, recognition and substantial material amends are made. I dream too of extending judicial reviews, creating community based judicial committees. These committees will retain some existing judges and at least half of the new judicial system will be permanent, salaried members with lived experience of imprisonment. Another quarter will be made up of citizens who were deemed ‘immigrants’ under the old political system. Then we can sit back and see what they create.