Responsibilisation of caregivers in depression: the limitations of policy-based evidence

Abstract

The principle of family and carer involvement is scattered throughout much recent mental health policy. Inspired by Bacchi’s ‘what’s the problem represented to be’ approach to policy analysis, we consider guidelines relating to depression in the UK and Denmark, two examples of European health systems which have undergone reforms based on neoliberal principles effectuating austerity politics. The analysis shows how carer involvement recommendations in depression guidelines reflect a responsibilisation agenda rather than a sound evidence and that the policies represent the problem to be a potentially risky patient along with consequential bureaucratic risks of involving the caregiver. In order to put the political agenda into perspective, we outline qualitative research on family life with depression which we argue could have informed ‘evidence-based’ guidelines. This research emphasises the complexity of family life with depression in which the origins of depression, maintaining factors, family context, pathways to treatment, treatment models and other routes to recovery all interact in a way that means the requirement for ‘carer involvement’ as simplified in current guidelines is naïve at best. We consider the gap between evidence and policy and note that carer involvement recommendations reflect a failure to understand depression within a context of complex dynamic family relationships.