Residential Mobility, Mental Health and Welfare Reform
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UNIVERSITY OF SOUTHAMPTON FACULTY OF SOCIAL, HUMAN AND MATHEMATICAL SCIENCES Geography and Environment Residential mobility, mental health, and welfare reform by James Lowe Thesis for the degree of Doctor of Philosophy June 2016 UNIVERSITY OF SOUTHAMPTON ABSTRACT FACULTY OF SOCIAL, HUMAN AND MATHEMATICAL SCIENCES Geography and Environment Thesis for the degree of Doctor of Philosophy RESIDENTIAL MOBILITY, MENTAL HEALTH, AND WELFARE REFORM James Atholl Lowe This thesis qualitatively examines the interplay between service users’ residential mobility and mental health and assesses the ways in which each is influenced or determined by the other. Twenty-five service users in England were over a period of eighteen months interviewed in depth about their experiences of both residential mobility and mental health. These interviews were conducted against the backdrop of the on-going austerity-driven reforms to the welfare state that have witnessed the rapid promulgation of policies designed to spur service user entry into the formal labour market, via the use of restrictions on continued eligibility for particular sickness, disability, and housing benefits, and reductions in their monetary value. Evidence from the interviews is used to test two of the primary models through which the residential mobility patterns of service users have been explained: displacement from unstable lodgings resulting in circulation through disparate residential settings; and entrapment in low quality accommodation in predominately deprived areas. The thesis finds evidence of both scenarios, and reports on the negative health experiences encountered therein. It demonstrates that the extent to which residential circumstances have a negative impact on mental health rests upon whether service users feel unable to exercise any control over their residential choices. The exercise of which is being further compromised by a hastily reformed system for determining on-going eligibility to welfare benefits and a wider retrenchment of the services and facilities around which users have often orientated their lives. Here, invasive and ineffectual medical assessments destabilise service users and threaten a reduction in income, enforced changes in accommodation, and the rupture of their carefully calibrated wellness strategies which, in the absence of wider service provision, are increasingly emplaced in and around users’ own homes. The findings raise considerable questions about the operation of the welfare system and its impact for service users’ health and residential stability. DECLARATION OF AUTHORSHIP ....................................................................... 4 Acknowledgments ................................................................................................ 5 Chapter 1. Introduction: Mental health service users, residential mobility, and welfare reform ................................................................................................ 7 1.1. Background to the research. Why does it matter? ............................................. 7 1.2. The research project .............................................................................................. 9 Part One: Review chapters ................................................................................. 11 Chapter 2. Places, people, policy, practices: mapping mental health geographies. A review of the literature. ............................................................ 13 2.1. Introduction .......................................................................................................... 13 2.2. Quantitative geographies of mental health ........................................................ 15 2.2.1. The ecology of mental illness: the Chicago School and after .......................... 16 2.2.2. Social causation and the ecological tradition .................................................. 17 2.2.3. Social selection processes: spatial filtering into the ‘urban core’ .................... 20 2.2.4. Summary ......................................................................................................... 21 2.3. The ‘political-economy’ of mental health geographies .................................... 23 2.3.1. Deinstitutionalisation, the ‘public city’ and the rise of the service-dependent ghetto ......................................................................................................................... 23 2.3.2. From the service dependent ghetto to a landscape of despair ....................... 27 2.3.3. Summary ......................................................................................................... 29 2.4. Qualitative mental health geographies .............................................................. 30 2.4.1. Re-orientating mental health geographies: the ‘new’ qualitative framework ... 31 2.4.2. Mental health geographies of recovery and resistance ................................... 33 2.4.3. Mental health geographies of exclusion .......................................................... 37 2.4.4. Summary ......................................................................................................... 39 2.5.1. Introduction and the mobilities ‘turn’ ................................................................ 40 2.5.2. Geography and mobilities ................................................................................ 42 2.5.3. A ‘politics of mobility’ ....................................................................................... 45 2.5.4. Health geography and (im)mobility .................................................................. 47 2.5.5. Mobility and mental health ............................................................................... 50 2.5.6. Mental health and homelessness .................................................................... 54 2.5.7. Being housed, being homed: geographies of home ........................................ 58 2.6. Conclusion ............................................................................................................ 61 2.6.1. The three eras of mental health geography .................................................... 62 2.6.2. The foundations for the present study ............................................................. 62 Chapter 3. Cut adrift? Mental health service users and the receding welfare state ...................................................................................................................... 67 3.1. Introduction .......................................................................................................... 67 3.2. Contemporary UK welfare reform ....................................................................... 69 3.3. Ideological underpinnings? ................................................................................ 73 3.4. Individual benefit changes .................................................................................. 77 3.4.1. Out of work sickness benefits: from Incapacity Benefit to Employment Support Allowance .................................................................................................................. 77 3.4.3. Housing benefits .............................................................................................. 87 3.5. Research implications and conclusions ............................................................ 91 Chapter 4. Research design and implementation ............................................ 93 4.1. Introduction .......................................................................................................... 93 4.2. Research aim and questions ............................................................................... 93 4.3. Conceptualising the methodological framework .............................................. 95 1 4.3.1. Qualitative interviewing in human geography .................................................. 96 4.3.2. Researching the lives of persons with mental health problems ...................... 97 4.3.3. The interview and mental ill-health .................................................................. 98 4.3.4. Personal positioning: activist, or observer and reporter? .............................. 101 4.4. From conception to implementation ................................................................ 103 4.4.1. Sampling and selection ................................................................................. 103 4.4.2. Ethical considerations ................................................................................... 107 4.4.3. Research framework and tools ...................................................................... 110 4.4.4. Analytical strategies ...................................................................................... 111 4.5. Summary ............................................................................................................. 114 Part Two: Empirical chapters ........................................................................... 115 Chapter 5. Mental health service users and their experiences of residential mobility .............................................................................................................. 117 5.1. Introduction to research findings ..................................................................... 117 5.2. Evidence of residential mobility within the research timescale .................... 118 5.2.1. Mobility as a result of precarious housing situations