Stephen Tilley

Recovery in mental health policy: good strategy or bad rhetoric?

This article explores current positions on ‘recovery’ in Scottish mental health policy and the practical limitations of these positions from a rhetorical perspective. It is not our intention to conduct a formal policy analysis but rather to open up an argumentative space for thinking critically about recovery. In adopting a rhetorical perspective, we are concerned not with the quality of evidence in support of recovery per se, but with the quality of the arguments and the manner in which these have been produced, reproduced and promulgated to support recovery in terms of its adoption in policy and practice within the Scottish context. We sketch the background to the ‘case for’ recovery in Scotland by drawing upon key policy documents, referring to the public mental health focus in Scotlands mental health policy, and indicate how policy and practice on recovery have been evaluated in that context. We then explore the value of critical dialogue by exploring the potential limitations of the case for recovery by considering hope and the medical model as examples of themes in recovery policy and practice. In light of this analysis, we argue that while the policy and its implementation might be understood as a good strategy for addressing major issues in mental health, it is bad rhetoric to the extent that it limits argument, and therefore practical deliberation, about recovery. In conclusion, we discuss the implications of our argument for mental health practitioners, for whom a critical stance on health policy is a necessary resource.

Quality assurance and the role of a national organisation involved in credit rating

This paper presents a critical analysis of a national organisation involved in credit rating, focusing on credit rating as a quality assurance issue. The organisation ‐ The SCOTCAT Health Studies Group (SHSG) ‐ began with an ethos of self‐help and mutual aid. It now inhabits a world sited ambiguously between, on the one hand, professional and fee‐for‐service imperatives and, on the other hand, an emergent Government‐sponsored rhetoric of transparency and cooperation for life‐long learning. The paper stems from our concern that issues of quality may be compromised by these imperatives and tensions. We have used the metaphor of SHSG as a “life form” to facilitate exploration of its origins, structure, and place in a wider context, noting limits in the metaphor’s power to illuminate these matters. The paper addresses issues which SHSG must face, as an organisation having members from both the professional (nursing) and the higher educational domains must face; particularly when the two worlds it bridges are changing. The analysis focuses on four themes: evolution, co‐operation, confidence, and mutual recognition of quality. Each theme has a reflexive aspect. Linkages between the themes are discussed in light of the development of SHSG, and some general issues related to changes in inter‐institutional relationships are raised.