Monday, December 24, 2012

A more humane approach to mental health

Originally posted on University of Liverpool website as "The Liverpool View":
and re-posted on the Huffington Post:

Mental health is back in the News again, with Ed Milliband calling it the ‘biggest unaddressed health challenge of our age’ and the Schizophrenia Commission report condemning the current state of care.
The Labour leader went on to call for greater understanding and investment in a problem that “blights the lives of millions”, and costs the UK billions of pounds in lost business and NHS costs. This builds on a recent House of Commons debate in which MPs spoke movingly of their own psychological problems … as well as calling for radical new approaches in our thinking.
Reliance on medical approaches
In Parliament, MPs Charles Walker and James Morris both questioned our reliance on medical approaches, and linked mental health to economic and social circumstances. Charles Walker MP pointed out that the number of prescriptions for antidepressants had doubled from 1998 to 2009, and asked: “Were all of those 40 million prescriptions necessary? Of course they were not”. Walker went on to state very clearly that: “We can talk about medical solutions to mental health problems, and of course medicine has a part to play. In reality, however, society has the biggest part to play. This is society’s problem”.
James Morris MP made a similar point: “We must also examine whether our approach to tackling the problem is fit and appropriate for the 21st century. Our approach to mental illness over a number of decades has been based on what I would call the psychiatric model. The model has medicalised mental illness and treated it as something to be dealt with using drug-based therapies”

 “It is clear that someone who has been made suddenly unemployed might feel miserable and hopeless as a result”

Research, including research conducted here in Liverpool, backs this up. The Greek Ministry of Health has reported a 40% increase in deaths from suicide over the same timescale and our colleagues Ben Barr and David Taylor-Robinson have demonstrated how 1000 deaths here in the UK can be specifically attributed to the economic crisis.
This has several profound implications. It means that our psychological well-being is as much a problem for politicians as for health professionals. And it means we need to think differently about mental health itself.
It’s obvious how the economic downturn could affect our mental health. It’s clear that someone who has been made suddenly unemployed might feel miserable and hopeless as a result. These feelings might be so bad that they begin to interfere with other aspects of that person’s life, and it may be that they would benefit from some kind of professional help and support.
But it makes little sense to describe their distress as an illness or a disorder. And we need to apply social and psychological – not medical – solutions. This means focussing on prevention and early intervention, on a ‘life-course approach’ and reducing inequality and tackling stigma. 

“Our thoughts, our emotions, our behaviour, and therefore our mental health, is largely dependent on our understanding of the world; our thoughts about ourselves, other people and the future” 

Our thoughts, our emotions, our behaviour, and therefore our mental health, is largely dependent on our understanding of the world, our thoughts about ourselves, other people and the future. Biological factors, social factors, circumstantial factors – our learning as human beings – affect us as those external factors impact on the key psychological processes that help us build up our sense of who we are and the way the world works. 
Good mental health is a consequence of how we make sense of and understand the world, primarily our social world. And how we make sense of and understand the world is largely determined by our experiences and upbringing.
Mental health services should be designed and commissioned to that end. We should simply drop the language of ‘disorder’ and think about we can help people fulfil their potential and maximise their personal well-being.
A more rational and humane approach
That means working with our medical colleagues, of course, but it means we should be commissioning and delivering much more fully integrated services. We should be linking with Jobcentre Plus employment advisers who are delivering what are effectively wellbeing interventions for people.
We should be working with the education services. And we should be working with the physical health services. We should be working with employers, there’s plenty of evidence that interventions aimed at improving people’s wellbeing, not curing their mental illnesses but improving people’s wellbeing is productive for employers.
Evidence-based psychological therapies will be a key part of this picture, but we need a much more thorough-going psychosocial revolution in mental health care.
It’s great that mental health is back in the news; and discussed in more positive terms than ever before. This is an opportunity not only to press for greater understanding and investment in science and care, but also to argue for a more rational and humane approach to the problem.


  1. Good article. Thank you. As society itself becomes more and more dysfunctional it seems inevitable that more and more will be labelled "mentally ill", simply because they are trying to express their need for a stable society in which to live.
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  2. I wonder if the ecomonmical downturn had not occurred, whether the subject would have been raised in Parliament? Of cause social and economical factors lead to depression, although unemployment, and recession are far from the only factors.

    If more emphasis was put on addressing the social factors, such as bullying, and abuse, less people would fit into the catergory of mentally-ill.

    Prevention being more cost-effective - financially, mentally, and physically - than the cure.

    To blame society, reminds me of the chicken-and-egg theory...

    Society is a reflection, of the structures in which binds it.

  3. Another social factor is that, with unprecedented finncial pressure on couples to have two incomes and on single parents to work, plus people retiring later; there are less people with both time and energy to be looking out for friends and neighbours or able to spend time talking with them if they observe them struggling. I feel most of us are so overstretched we are at more risk of poor mental health ourselves and less able to help each other.

  4. Well Said! This article takes us back to the point raised earlier in this chapter. Poverty is a major key player in mental heath distability. Unfulfilled financial needs and inability to meet basic needs are proofing more difficult thereby leaving a high population of people depressed psychological unstable.

  5. Thank you for this extremely 'user-friendly' article. Another stakeholder to be put on the list: insurance companies. A friend of mine is having a sleep-walking problem; doctors suggest CBT but the insurance doesn't cover this . . . however, the insurance does cover anti-depressants.

  6. "Charles Walker MP pointed out that the number of prescriptions for antidepressants had doubled from 1998 to 2009, and asked: “Were all of those 40 million prescriptions necessary? Of course they were not”." - It brought me a thought about painkillers. It's very common thing to use them. They say that "we should not tolerate pain. But it was not a usual thing years ago. May it be that there's a natural tendency that we should not tolerate distress nowadays? Of course, we should struggle with these emotions, mostly to predict them, but when we have already felt like that...should we tolerate distress?

  7. nice article...

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    1. Psychosocial therapies for me, goes a long way to sooth certain levels of our mental distress and not antidepressants or psychiatric models. It's not very necessary to depend on medication alone to lead a fulfilled live where economic downturn, sudden loss of job take toll on the society. I think it's time to change the way we think.

  8. You make some good points about provision of support for mental health. I would like to know more about how that support can best be delivered. For example, what needs to be facilitated by a clinical psychologist, and what interventions could be delivered by other grades of health professional or even volunteer peer supporters. When I say interventions, I mean everything from group CBT, to walking or art groups with an awareness of mental health.

    And although just about everyone agrees that more mental health services need to be available, it is going to be a long time, if ever, before they are available to everyone. How can the NHS work with the private sector, and how can people who can afford to pay for private therapists be supported and guided towards finding the right kind of therapy for them and their particular issue?

  9. If we need to solve our world's social, financial and environmental problem. I think one of the most important problem is that we lost our connection with nature. We are living in the big city that establish with cement.

  10. I think many of us become sad and disillusioned in life because we are 'programmed' to believe that material possessions will bring us happiness, unfortunately this is far from the truth. We are so busy 'chasing the dream' that we end up living a nightmare.

  11. I think many of us become sad and disillusioned in life because we are 'programmed' to believe that material possessions will bring us happiness, unfortunately this is far from the truth. We are so busy 'chasing the dream' that we end up living a nightmare.

  12. Interesting how economic issues could affect our mental health

  13. Thank you thank you thank you.
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    I agree wholeheartedly with your comments professor.
    I have been saying this for some time myself and have endeavoured to approach schools, pupil referral units and specialist autistic units. There is a huge knowledge gap regarding this in schools. Also my clients are getting younger as parents do not want to take anxious children to the GP for medication. They are looking to more natural holistic therapies.
    I am reiki master/teacher.

  14. Indeed, it is our interepretation of things that matters the most for it directly affects our emotions and behaviors intrapersonally and interpersonally.


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  17. Excellent article, I look forward to the GP's sending me to a walk in clinic were I can sit down and be reassured through speech, rather than drugs.

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