Policies to support well-being
The main thrust of this book is to set out a new vision for mental health care whereby we move away from a 'disease-model' approach. The alternative vision that I'm offering includes a clear plan for the delivery of a range of therapeutic services. These must include one-to-one therapies, group-based therapies, novel forms of delivering therapy (for example online) and wider 'systemic' interventions such as family therapy. All these kinds of interventions aimed at helping people, families and groups to address those problems that adversely affect their mental health should be key parts of that vision. These interventions should be squarely based on a psychosocial ethos, and delivered by a broadly psychosocial multidisciplinary team. That would be a radical change. But these kinds of interventions are only part of the solution.
Decisions made by politicians and policymakers have dramatic impacts on all areas of well-being.6 These decisions therefore have great potential for both good and ill. Obviously, political decisions can affect our wealth, and can perhaps have more impact on inequalities in wealth. That's important, because as we saw earlier, our well-being is much more closely linked to economic equality than to average economic performance.7 Politicians in the UK also have particularly important roles in decisions about our health services: because of the unique status of our National Health Service, the decisions made by politicians have a direct effect on provision. But politicians also have a crucial role in determining our well-being through their role in changing other key social systems. Laws and related policies profoundly affect our relationships. The divorce laws, laws on same-sex marriage, pre-nuptial agreements, child-care arrangements, pension laws, benefits regulations and rules for flexible working practices all impact on relationships, and are all matters for politicians. Politicians and government departments have very significant responsibilities in shaping education and employment practice. Most education is state-funded in the UK and therefore politicians and civil servants are responsible for the range, quality and equity of education. Employment law is also very significant, and taxation rules, rules on benefits and investment decisions by government - as well as the more fundamental health of the economy - all impact on the quality of our employment and will therefore affect our well-being. Through the laws it chooses to enact, the government even affects important spiritual aspects of our lives: the role of religion in our political and cultural life, the interpretation of human rights as they apply to freedom of speech and expression. Similarly, issues related to our arts, culture and leisure are, of course, matters for government, not least through planning and investment decisions. Crime and criminal justice matters are, of course, quintessentially matters for legislators. And, finally, of course, politicians have a key role in drawing up policies and strategies in the arena of mental health. Taken together, these policies have the potential to impact profoundly on our mental health, both for good and ill.
As Pat Bracken and Dinesh Bhugra have pointed out, simplistic biomedical disease models of mental health ignore these issues. Since a person's problems are characterised as 'symptoms' of 'illness', rather than as understandable human responses to social circumstances, all these aspects of well-being, the policy decisions related to them, and the links between social circumstances and mental health are ignored or minimised. In a psychosocial model, however, these issues are integral to a full understanding of our well-being and our emotional and psychological lives.
Every responsible mental health professional believes that we should aim to prevent, rather than merely 'treat', mental health problems. This suggests that social and even political changes might be the most important targets for intervention. For example, we know that poverty is associated with mental health problems.8 There is something grindingly awful about living each day knowing that you are unable to provide for your children's needs. All politicians aim to address poverty, but measures to reduce or eliminate poverty, especially childhood poverty, would be hugely beneficial for our mental health. However absolute income is not the only important issue. An effective way to improve our mental health would be to reduce inequality in society. We need to work together to eliminate abuses in childhood. Teachers, social workers, community nurses, GPs and the police should all try to identify and then respond to early warning signs that children might be exposed to sexual, physical or emotional abuse or neglect. Teachers and youth leaders have a role in addressing bullying in school and leisure settings. Our political leaders should also work towards less discriminatory societies, through both social and legislative actions. And, finally, many recreational drugs are associated with mental health problems. Although alcohol is unquestionably the most serious substance-related public health issue, cannabis and other recreational 'drugs' have also been associated with mental health problems. Both legal and illegal drugs are subject to laws that control their supply and use. There is clearly a role for politicians in passing legislation that could protect our health, strengthen our community, maintain our well-being and prevent mental health problems. However, in this book I'm concentrating in particular on the need for different policies regarding the delivery of mental health services, both in terms of legislation and in terms of the commissioning of services.