These notes were presented as a contribution at the UK health workers’ meeting in Bristol in May 2026. You can read the minutes of the meeting here.
Introduction
Talking about mental health services, in the same way as about health services in general, we should approach the issue from two different dimensions:
- We have to address the dimension of what kind of services are provided. What kind of mental health interventions, what approaches and practices, what theories and paradigms are implemented, what’s the purpose of these and what impact do these have on the service recipients.
- We have to address the conditions of those working in those services: the labour that is put in place to make these services functional, operational, “productive” and effective, as well as the question of who runs and controls the services.
As socialists, communists or anti-capitalists we should be dealing with these two dimensions of the matter, not in a hierarchical way necessarily. The former however can be determined significantly by the latter, and the latter cannot be seen or fought separately from the wider labour and social movement.
Context of Mental health services in Manchester – underfunding, ICBs, s75 agreement and local authority, funding deficit
A number of issues characterise the mental health (MH) services in Manchester for many years now. Even the mayor Andy Burnham, a very popular political figure lately, has admitted that MH services in Manchester have been underfunded for more than 15 years now, though things don’t appear to be getting any better.
The General Manchester Mental Health Trust (GMMH) has had no strategic plan to address the specific needs of central Manchester. Manchester has some of the poorest wards in the UK with large ethnic minority communities, refugee communities and a vast transient student population. It has unique needs. Yet Manchester, receives less support and fewer services per capita than other areas in the city region, we are bearing the brunt of failed reforms. Central Manchester has the highest population density and the greatest mental health need, but has no local crisis provision and disintegrating community teams. People from diverse inner-city communities have been deprived of local services in the name of efficiency. Services have become increasingly inaccessible, unsafe and inequitable.
GMMH which was the new trust that took over the Manchester mental health services since 2017 has a very well established negative reputation of understaffed and underfunded services, poor leadership, unsafe practices, thousands of people on waiting lists without allocated care workers, numerous out of area beds in private hospitals, meaning millions of tax payers money for private corporations!
Thousands of people in urgent need of secondary community mental health care are receiving no care at all. Union investigations show that only 12.5% of people referred to Manchester’s CMHT are assessed and only 8% (of those referred) are offered a service. 78% of people under GMMH care do not have a key worker. The vast majority receive no meaningful support between crises. The transformation of MH services has been going on for several years now without any progress and with constant broken promises to both staff and service users and their families.
ICBs come to complement this downward trajectory by not providing any solutions to the problems – In 2023 a £97 million annual underinvestment in Greater Manchester mental health services was identified. Yet nothing has been done meaning that services are not adequate to meet the needs of the area.
And this is representative of the national context of funding cuts, years of austerity, decentralisation and devolution, so we shouldn’t lose the focus from the central government, its neoliberal policies and the focus and trajectory of the British ruling class and private market.
Issues in mental health services (CMHTs, staffing, preventable deaths, hospitals)
The Trust was under special measures from NHS England until November 2025, but there hasn’t been any real change in actual terms during that period and since then.
The situation remains dire. People with severe mental illness in Manchester are dying at twice the rate of those elsewhere in England. Greater Manchester has the highest number of coroners’ warnings in the country (this is based on national statistics and released evidence). Mental health spending across the region is still below the national average, despite much higher need.
Since GMMH took over Manchester’s services in 2017, things have gone backwards. There are fewer local services, less continuity of care, unsafe wards, and communities left without support. Staff and families talk about their burnout, risk, and fear.
This is clearly not a functioning system.
The 2022 BBC Panorama documentary from an undercover journalist- staff into Edenfield Unit (secure MH hospital) exposed abuse, bullying, unsafe and humiliating treatment of service users and staff, toxic culture within staff, staff not feeling safe to speak up, and of course all this under the nose of senior managers who did what they could to cover up what was going on in the hospital. That led to a huge local and national outcry about the condition of MH services, the outdated and inhumane practices and the terrible conditions of “treatment” that patients were receiving in a place supposed to be for “care and safety”. GMMH was put under NHS England supervision and on special measures for 3 years (not anymore), though doesn’t appear much to have changed, at least in the field. Some incidents might have reduced but serious concerns and issues remain.
I think that the trade unions failed to challenge this to the level and severity that it needed and still needs, apart from some exemptions which are described below.
The unions should have been at the forefront of this fight, should have grabbed that opportunity to confront and put pressure on the Trust and the local government and should have connected with workers in other Trusts that have had similar scandalous exposure of bad practices. However, not much was done at that stage, everything was dealt with by the formal national regulatory procedures and internal investigations, which in my opinion are oftentimes part of the problem.
The mental health crisis in Manchester is not a matter of poor communication – it’s the result of years of underinvestment, centralised management, and political failure (locally and nationally). While people talk about strategy, families are still losing loved ones to preventable harm.
Disputes and industrial actions (EIS, junior doctors, porter drivers) – junior doctors strikes controversy
Over the last five years that I’ve been working with GMMH I personally have not been part of any industrial action or strike, because it hasn’t happened. Unison in CMHTs balloted once for strike, but didn’t get over the threshold of attendance, RCN voted for one strike 3-4 years ago, that was around the pay rise in NHS (AfC), but the strike and picket line attendance was very slim.
The only service that actually went on strike fighting for improvement of the service, increased funding and staffing and raised the issue of patient safety, preventable deaths and hospitalisation, including staff overstretching, burnout and working conditions, were the EIS (early intervention in psychosis) teams in Manchester. They took industrial action for six months, numerous days of strike and picket lines, coordinated by members of Unison and Unite. Reports from those who were part of this show that collective fights, that involve the union members and not just the executive teams of the unions, will get support from other sectors and services, from other campaigns and from the wider society once the political issues come to the fore and not just the economic demands of wages. That’s what happened with the EIS’s strike, they spoke and consulted with their service users, their families and carers, and that’s why they managed to push further and get the best possible result they could get. They won almost a million pounds in extra investment for the 3 EIS teams across Manchester, translated to 22 new full time substantive jobs.
When there is organisation on the ground and when you put pressure on everyone responsible, from the local authority, the ICBs, NHS England, local MPs, and central government, and when this goes public on the media, radio etc, then the chances of having and achieving wins are higher and this increases workers morale and persistence as well. That’s what helped the EIS strike to win the fight.
This year Driver Porters GMMH went on strike over the regrading of their wage category. The dispute started three years ago, the Trust initially accepted the step up to Band 3 with back payment, but then suddenly they decided to go for another review of the contracts and paused the back pay. All driver porters went on strike with a 100% vote for strike and attendance for several weeks until they won their demands and back pay from 2024.
Currently there is a dispute for the Workers visa campaign. Also ongoing is a potential collective grievance over understaffing, huge caseloads and hundreds (if not thousands) service users on waiting lists at Central Manchester Mental Health Trust.
Other voices in mental health sector – CHARM, No to Palantir (Manchester ICBs haven’t accepted the Palantir so far)
Outside the trade unions there are of course voices that try to make a difference and bring about change in MH services in Manchester. One initiative that has really managed to speak out and make public many of the failures and problematic attitudes of GMMH is CHARM (communities for holistic, accessible and rights based mental health). A grassroots campaign started from families and carers, left-leaning progressive local people who have managed to bring together service users, their families and mental health professionals and have significantly and persistently managed to confront GMMH and the local ICBs, advocating and campaigning for improved and alternative mental health services.
CHARM is pressing for:
- A pause on GMMH’s restructure until proper consultation takes place
- A public inquiry into preventable deaths and unsafe care
- A rights-based, democratic approach to rebuilding mental health services
Way forward – What mental health services? What approaches? From whom and for who? What’s the alternative?
Theoretical perspective
Mental distress, psychosis and common feelings of anxiety, depression and everyday misery, and isolation, etc are in the vast majority of the cases a product of the oppressive, exploitative and highly demanding society we live in, which is controlled, managed and regulated by the capitalist infrastructure, and it’s further exacerbated by the neoliberal management of it. It’s the pressures at the workplace, the demands in every aspect of our lives, in a context of individualisation, alienation and complete indifference to what’s going on around us. Of course there’s much more to that but this can give an idea from which perspective we’re talking about.
And mainstream psychiatry is a vital part of the wider apparatus that tries to control and suppress those who do not fit in the status quo, those out of the “normal” behaviour.
A turning point for psychiatry in terms of “fixing” the workforce was the use of psychiatric drugs. These drugs help maintain individuals’ productivity, alleviate distress, and of course for suppressing those who do not fit within this system.
Pharmaceutical companies are billion-dollar businesses, and the needs of the pharmaceutical industry can influence diagnostic systems – that is, to a certain extent, fabricate diagnostic entities to channel drugs to those suffering from them.
Similarly, although psychotherapy can be useful and necessary, at the same time it may involve the individualisation of problems (or the problems of the individual) and adaptation to a socially dead-end situation, or it may even be conducted in a manipulative manner by the “therapist”. So it’s crucial to have a clear stance and position on this as well.
Best practices regarding medication and psychotherapy must be a priority for the patient advocacy movement, their families, and mental health professionals. For wider and more structural changes in MH and healthcare services though and for more radical and revolutionary shifts to these issues, we require broader political shifts, which cannot be won without the wider mass workers movement for better, universal, publicly owned services and for the fight to get them under workers control. It requires a different kind of organisation of the workers, in the workplaces and in the society in general.
Common features of these alternative approaches to psychiatry included a critique of mainstream psychiatry as an institution of the bourgeois superstructure, a departure from biological reductionism and the grounding of the phenomenon of mental suffering in its social roots, the rejection of repressive methods and the adoption of therapeutic techniques that promoted equality in the therapeutic relationship and focused on the individual suffering from the condition rather than on the condition itself, and against the logic and practice of the asylum. Community work and the politicisation of the issue of mental health and its connection to the struggles of the labor movement.
And in order to build a more liberating, equal and emancipatory mental health sector we need to study and learn from the past examples where these were attempted and actually worked.
The example of Trieste, where services are open, community-based, and non-coercive – showing that a rights-based approach can work in practice. The Clinique de la Borde in France was another example of a non-hierarchical, democratic model of psychiatry and psychotherapy.
To conclude, it is important to note how the concepts of the community approach and psychiatric reform can however be co-opted and hijacked by the system in order to get it under its control, as is often the case with the content and breadth of demands when the movements advocating for them are in decline. Franco Basaglia (Italian leader of the anti-psychiatry movement in the 60s-70s) seems to have recognized this possibility and stated that the community model is not an end in itself. Instead, he framed the issue of deinstitutionalization within a three-part framework:
anti-institutional struggle – practical transformation – politicisation
