IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v319y2023ics0277953622006918.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953622006918
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2022.115385?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    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. Mladovsky, Philipa, 2020. "Fragmentation by design: Universal health coverage policies as governmentality in Senegal," Social Science & Medicine, Elsevier, vol. 260(C).
    5. Ian Cummins, 2018. "The Impact of Austerity on Mental Health Service Provision: A UK Perspective," IJERPH, MDPI, vol. 15(6), pages 1-11, June.
    6. 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.
    7. 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.
    8. Chiapello, Eve, 2017. "Critical accounting research and neoliberalism," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 43(C), pages 47-64.
    9. repec:eme:aaaj00:aaaj-03-2014-1639 is not listed on IDEAS
    10. 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.
    11. 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.
    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.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Walaa Wahid ElKelish*, 2023. "Accounting for Corporate Human Rights: Literature Review and Future Insights," Australian Accounting Review, CPA Australia, vol. 33(2), pages 203-226, June.
    2. Valéry Ridde & Ibrahima Gaye & Bruno Ventelou & Elisabeth Paul & Adama Faye, 2023. "Mandatory membership of community-based mutual health insurance in Senegal: A national survey," ULB Institutional Repository 2013/363350, ULB -- Universite Libre de Bruxelles.
    3. Valéry Ridde & Ibrahima Gaye & Bruno Ventelou & Elisabeth Paul & Adama Faye, 2023. "Mandatory membership of community-based mutual health insurance in Senegal: A national survey," Post-Print hal-04222420, HAL.
    4. Probst, Ursula, 2023. "Health insurance for the good European citizen? Migrant sex workers’ quests for health insurance and the moral economy of health care," Social Science & Medicine, Elsevier, vol. 319(C).
    5. Wood, Anna, 2023. "Patronage, partnership, voluntarism: Community-based health insurance and the improvisation of universal health coverage in Senegal," Social Science & Medicine, Elsevier, vol. 319(C).
    6. Bannister, David, 2023. "Whose public, whose goods? Generations of patients and visions of fairness in Ghanaian health," Social Science & Medicine, Elsevier, vol. 319(C).
    7. Daniel Demant & Oscar Oviedo-Trespalacios & Julie-Anne Carroll & Jason A. Ferris & Larissa Maier & Monica J. Barratt & Adam R. Winstock, 2018. "Do people with intersecting identities report more high-risk alcohol use and lifetime substance use?," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 63(5), pages 621-630, June.
    8. Islam, Muhammad Azizul & Deegan, Craig & Haque, Shamima, 2021. "Corporate human rights performance and moral power: A study of retail MNCs’ supply chains in Bangladesh," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 74(C).
    9. Antonio Abatemarco & Massimo Aria & Sergio Beraldo & Michela Collaro, 2023. "Measuring Access and Inequality of Access to Health Care: a Policy-Oriented Decomposition," CSEF Working Papers 666, Centre for Studies in Economics and Finance (CSEF), University of Naples, Italy.
    10. Silvia Loi & Peng Li & Mikko Myrskylä, 2022. "At the intersection of adverse life course pathways: the effects on health by nativity," MPIDR Working Papers WP-2022-018, Max Planck Institute for Demographic Research, Rostock, Germany.
    11. Cuenca Botey, Luis Emilio & Célérier, Laure, 2023. "On the relentless labour of deconstructing domination logics: The case of decolonial critical accounting research in South America," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 93(C).
    12. Bijou, Christina & Colen, Cynthia G, 2022. "Shades of health: Skin color, ethnicity, and mental health among Black Americans," Social Science & Medicine, Elsevier, vol. 313(C).
    13. Marrow, Helen B., 2012. "Deserving to a point: Unauthorized immigrants in San Francisco’s universal access healthcare model," Social Science & Medicine, Elsevier, vol. 74(6), pages 846-854.
    14. Tomasz Rokicki & Aleksandra Perkowska & Marcin Ratajczak, 2020. "Differentiation in Healthcare Financing in EU Countries," Sustainability, MDPI, vol. 13(1), pages 1-17, December.
    15. Chapman, Mimi V. & Hall, William J. & Lee, Kent & Colby, Robert & Coyne-Beasley, Tamera & Day, Steve & Eng, Eugenia & Lightfoot, Alexandra F. & Merino, Yesenia & Simán, Florence M. & Thomas, Tainayah , 2018. "Making a difference in medical trainees' attitudes toward Latino patients: A pilot study of an intervention to modify implicit and explicit attitudes," Social Science & Medicine, Elsevier, vol. 199(C), pages 202-208.
    16. Kools, Lieke & Knoef, Marike, 2019. "Health and consumption preferences; estimating the health state dependence of utility using equivalence scales," European Economic Review, Elsevier, vol. 113(C), pages 46-62.
    17. Sangaramoorthy, Thurka & Benton, Adia, 2022. "Intersectionality and syndemics: A commentary," Social Science & Medicine, Elsevier, vol. 295(C).
    18. Laura Levaggi & Rosella Levaggi, 2017. "Rationing in health care provision: a welfare approach," International Journal of Health Economics and Management, Springer, vol. 17(2), pages 235-249, June.
    19. Jonathan Zufferey, 2016. "Investigating the migrant mortality advantage at the intersections of social stratification in Switzerland," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 34(32), pages 899-926.
    20. Evans, Clare R. & Erickson, Natasha, 2019. "Intersectionality and depression in adolescence and early adulthood: A MAIHDA analysis of the national longitudinal study of adolescent to adult health, 1995–2008," Social Science & Medicine, Elsevier, vol. 220(C), pages 1-11.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:319:y:2023:i:c:s0277953622006918. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.