Promote Health and Well-being

Services should be equipped to address the full range of their clients' social, personal and psychological needs and to address both prevention and recovery. Where individual therapy is needed, effective, formulation-based, psychological therapies should be available to everyone and delivered by qualified, competent professionals. Decisions about the provision of services should be based on a person's specific problems and on the best evidence for the effectiveness of the intervention, and guided by individual formulations rather than diagnosis.

The alternative to traditional, disease-model, mental health care that I'm outlining rejects the notion that we are (or should be) 'treating illnesses'. 'Diagnosis' is an inadequate method for describing the complex pattern of needs experienced by people in the real world, and medical accounts of 'aetiology' (medical language for causes) are misleading in attempting to explain their origins. We shouldn't make the error of assuming that our business is to 'treat illness'. Worse, with regard to social and personal problems - stressful and vulnerable employment conditions, financial austerity, social deprivation, inequalities, trauma, crime, abuse and bullying - it is wholly wrong to be aware of such threats to our wellbeing, but then wait until the early signs or 'symptoms' of distress to emerge before offering help. And of course it is inappropriate to have to rely on medication and other biological 'treatments'. But rather than merely complaining, we need to set out an alternative. So what should we do?

We should promote practical psychosocial services whose aim is to promote well-being and personal agency. That means employing community workers such as social workers, psychologists and social pedagogues (this is a role more common in Central and Northern Europe, where social pedagogues are trained in education and social psychology, and use practical educational approaches to help address a wide range of practical social welfare issues, especially for young people1). Such services would offer greater access to one-to-one psychotherapies of various kinds. But, vitally, they would offer primarily social solutions in the first instance. We must not make the mistake of assuming that this would mean replacing fantastic, caring, effective hospital services with trivial and ineffective social services that ignore 'real illnesses'. As we've seen, 'mental health' services simply aren't caring and effective, the disease- model approaches don't actually work very well, and social approaches are both most appropriate and most effective.

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