Services should be equipped to address the full range of people's social, personal and psychological as well as medical needs. Teams should be multidisciplinary, democratic and aligned to a psychosocial model. This would involve a greater reliance on psychological therapies, and suggests that many nursing and medical colleagues should consider retraining. This model also implies a new role for consultant psychiatrists: as expert colleagues, but with leadership of multidisciplinary teams determined by the skills and personal qualities of the individual members of the team. In a psychosocial model of mental health and well-being, there would be no assumption that medical psychiatrists would retain their current authority and status.
A genuinely psychosocial approach to service delivery would mean increased investment in the full range of professionals able to deliver therapeutic services that address people's genuine problems and their root causes. The service would offer help with a spectrum of psychological difficulties rather than only those deemed 'mental health problems'. Nobody would be 'diagnosed'. There would be a major emphasis on prevention. We need to be able to address such issues as divorce, marital difficulties, unemployment, stresses at work, financial difficulties, illnesses in family members, crime (both as a victim and as a perpetrator, when caught up in the criminal justice system), assaults, bullying, and childhood abuse. Clearly we need to offer psychological therapies, because we know that the way that people make sense of and respond to events is important, and the opportunity to talk through what has happened and how it has affected us is vital. But we also need to offer much more practical responses. As Anne Cooke put it: 'It's no good just mopping the floor and leaving the tap running'. So mental health and well-being services should need to work with the criminal justice agencies to ensure both protection and justice - investigating and preventing assaults. Because marital separation is a major source of emotional stress, we should ensure that there is sufficient support for people going through separation or marital difficulties, such as mediation services, support for single parents, and practical, legal and emotional support for people in difficulty in their relationships. Because unemployment is a major source of distress, we should aim for full employment, and certainly do what we can to protect people from the emotional and economic impact of unemployment. Many jobs are themselves sources of stress, however. We should aim to ensure equitable and supportive employment practices, including employee relations, a living wage, decent terms and conditions and appropriate employee representation. We should engage with employers to address workplace stresses and offer people who are out of work practical, as well as emotional support. Services such as Citizens Advice, debt counselling agencies and Victim Support are vital to help people in financial difficulties, victims of crime and people dealing with a range of other traumatic life events. We should ensure that any mental health and well-being services are fully integrated with other social services that support families and parents in difficulty. It also means working with teachers and educational psychologists in schools, and it means supporting a network of children's services. We should not only offer emotional support, and counsel people in financial difficulties, we should also offer people practical help and financial advice. We should support people in negotiations with benefits agencies to ensure people have the financial support that they deserve, and we should be prepared to engage with financial systems (such as 'pay-day loan' companies) that conspire to keep people indebted. Recreational street drugs can prove a threat to people's mental health and well-being, and so we should ensure that mental health services have intimate links to services that help people who have problems with drug use. Clearly, providing these services properly will entail significant change. Many of these issues are currently largely ignored, and most are ill-coordinated. Apologists for the present systems will argue that all these services are currently part of the care offered to clients. The experiences of those who have passed through the system would tend to suggest otherwise.
The adoption of a 'psychobiosocial' model for the provision of services would have significant implications, as colleagues and I have contended for a while.1 As I have argued throughout this book, services would be planned on the basis of need and helping people find 'real-world' solutions that work for them, rather than providing 'treatments' according to diagnostic categories. Where residential care is necessary, completely new residential units, operating according to wholly different rules would replace 'hospitals'. This would mean that services would fully embrace the recovery approach; people would not be 'treated' for 'illnesses', but would be helped to regain a better quality of life. The people who use, or have used, the services would be intimately involved in their development and management as well as in the actual provision, with 'expertise by experience' highly valued. The therapies, interventions and services would be guided by individual formulations drawn up collaboratively between the service user and the professionals involved.
In such an approach, there would continue to be an emphasis on specialist teams, but they would be planned and organised on the basis of psychosocial rather than medical principles. As a psychologist, I am naturally likely to argue this, but psychologists should be prepared to offer consultation and clinical leadership. Medicine would remain a key profession, but with emphasis placed on a return to the key principles of applying medical expertise as it assists a multidisciplinary team in the understanding of someone's problems and offering help, rather than on an unquestioned assumption that doctors should lead clinical teams. Nurses should diversify from attending to the medical treatments prescribed by doctors, and develop increasing competencies in psychosocial interventions. Occupational therapists and social workers should see their roles develop and strengthen. We should be open to new possibilities; it would be particularly valuable to employ people skilled in practical issues such as finding employment or training, managing finances and caring for children. Finally, we should see the increased and explicit employment of peer professionals, people with lived experience of mental health problems. Personal experience of mental health problems should even actively be seen as a desirable characteristic in colleagues, rather than an exclusion criterion.