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Mental health coverage for forced migrants: Managing failure as everyday governance in the public and NGO sectors in England

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  • Mladovsky, Philipa

Abstract

High-income countries (HICs) which are said to have “reached” universal health coverage (UHC) typically still have coverage gaps, due to both formal policies and informal barriers which result in “hypothetical access”. In England, a user fee exemption has in principle made access to treatment for post-traumatic stress disorder (PTSD) and other mental health conditions thought to be caused by certain forms of violence universal, regardless of immigration status. This study explores the everyday governance of this mental health coverage for forced migrants in the English National Health Service (NHS) and NGO sector. Fieldwork was conducted in two waves, in 2015–2016 and 2019–2021, including six months of participant observation in an NGO and 21 semi-structured interviews with psy professionals across 16 NHS and NGO service providers. Further interviews were conducted with mental health commissioners and policymakers, as well as analysis of grey literature. Despite being formally covered for certain types of mental health care, in practice asylum seekers and undocumented migrants were often excluded by NHS providers. Undocumented migrants were also often excluded by NGO providers. Several rationalities linked discursive fields to practices developed by psy professionals and other street-level bureaucrats to govern coverage, in a process of “managing failure”. These rationalities are presented under three paired themes which draw attention to tensions and resistance in the governance of coverage: medicalisation and biolegitimacy; austerity and ethico-politics; and differential racialisation and decolonisation. Rationalities were associated with strategies and tactics such as social triage, clinical advocacy, obfuscation, evidence-based advocacy and silencing critique. The concept of “health coverage assemblage” is introduced to explain the complex, unstable, contingent and fragmented nature of UHC policies and programmes. Misrecognition and underestimation of the everyday work of health professionals in promoting, resisting and reproducing diverse rationalities within the assemblage may lead to missed opportunities for reform.

Suggested Citation

  • Mladovsky, Philipa, 2023. "Mental health coverage for forced migrants: Managing failure as everyday governance in the public and NGO sectors in England," Social Science & Medicine, Elsevier, vol. 319(C).
    • Handle: RePEc:eee:socmed:v:319:y:2023:i:c:s0277953622006918
    DOI: 10.1016/j.socscimed.2022.115385
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    References listed on IDEAS

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    1. Viruell-Fuentes, Edna A. & Miranda, Patricia Y. & Abdulrahim, Sawsan, 2012. "More than culture: Structural racism, intersectionality theory, and immigrant health," Social Science & Medicine, Elsevier, vol. 75(12), pages 2099-2106.
    2. Horton, Sarah, 2006. "The double burden on safety net providers: Placing health disparities in the context of the privatization of health care in the US," Social Science & Medicine, Elsevier, vol. 63(10), pages 2702-2714, November.
    3. Thilo Wiertz, 2021. "Biopolitics of migration: An assemblage approach," Environment and Planning C, , vol. 39(7), pages 1375-1388, November.
    4. Ian Cummins, 2018. "The Impact of Austerity on Mental Health Service Provision: A UK Perspective," IJERPH, MDPI, vol. 15(6), pages 1-11, June.
    5. Ken McPhail & Robert Ochoki Nyamori & Savitri Taylor, 2016. "Escaping accountability: a case of Australia’s asylum seeker policy," Accounting, Auditing & Accountability Journal, Emerald Group Publishing Limited, vol. 29(6), pages 947-984, August.
    6. Chiapello, Eve, 2017. "Critical accounting research and neoliberalism," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 43(C), pages 47-64.
    7. Sparke, Matthew, 2017. "Austerity and the embodiment of neoliberalism as ill-health: Towards a theory of biological sub-citizenship," Social Science & Medicine, Elsevier, vol. 187(C), pages 287-295.
    8. Mladovsky, Philipa, 2020. "Fragmentation by design: Universal health coverage policies as governmentality in Senegal," Social Science & Medicine, Elsevier, vol. 260(C).
    9. Ken McPhail & Robert Ochoki Nyamori & Savitri Taylor, 2016. "Escaping accountability: a case of Australia’s asylum seeker policy," Accounting, Auditing & Accountability Journal, Emerald Group Publishing Limited, vol. 29(6), pages 947-984, August.
    10. repec:eme:aaaj00:aaaj-03-2014-1639 is not listed on IDEAS
    11. Mladovsky, Philipa, 2020. "Fragmentation by design: universal health coverage policies as governmentality in Senegal," LSE Research Online Documents on Economics 105156, London School of Economics and Political Science, LSE Library.
    12. Cylus, Jonathan & Papanicolas, Irene, 2015. "An analysis of perceived access to health care in Europe: How universal is universal coverage?," Health Policy, Elsevier, vol. 119(9), pages 1133-1144.
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