A Manifesto for the Reform of Mental Health and Well-being Services
The need for reform in mental health services is acute, severe and unavoidable. This demands nothing less than a manifesto for reform.
A spectre is haunting our mental health services. Recent scientific advances in understanding human psychology have revealed traditional 'disease- model' thinking about mental health to be profoundly flawed, and far- reaching changes are required in how we plan and commission services. Our present approach to helping people in acute emotional distress is severely hampered by old-fashioned and unscientific ideas about the nature and origins of mental health problems, and vulnerable people suffer as a result of inappropriate treatment. Radical remedies are required.
Taking its lead from physical health care, the current mental health care system currently 'diagnoses' our emotional, behavioural and psychological problems as 'illnesses', and is largely based on the idea that they arise primarily from brain abnormalities. The hope has been that eventually 'biomarkers' (physical signs) and biological causes (preferably genetic) will soon be found. This 'disease model' underpins too much of modern mental health care and has had profound and damaging effects.
It has led to inappropriate and harmful treatment. For many people, the only or main treatment currently offered is medication. Whilst useful for some people, recent research suggests that in general, the helpfulness of medication has been overestimated. Evidence is also accumulating that psychiatric medication can have dangerous adverse effects (side- effects) especially when taken long term.
It has prevented effective help and treatment. The disempowering idea that they are passive recipients of medical treatment for a disease has interfered with people's ability to help and support themselves and each other. It has diverted resources away from effective sources of help such as listening and psychological therapy services, and practical help to improve life circumstances.
It has led to alienation between staff and service users. When people are experiencing huge distress and fear that their sanity, even their life, is threatened, empathy and compassion are central to any attempt to help. The 'disease model' locates problems within the individual and leads staff to see people's behaviour and distress as irrational rather than as potentially understandable. This reduces professionals' ability to listen, empathise and show compassion. Service users' experiences are disregarded and their stories unheard. People often experience services as inhumane and avoid them. Only in mental health is there a 'survivor movement' - survivors not only of distress but specifically of the services supposedly established to help them.
It has necessitated widespread use of coercion. Mental health law has traditionally been based on the disease idea. Service users who see their problems differently and do not wish to take drugs have been seen as 'lacking insight' and have often been detained and administered drugs by force. Many thousands of people each year are detained in hospital and treated against their will. There is good reason to believe that these numbers could be reduced hugely if services adopted the approach outlined below.
It has diverted resources from efforts at prevention. The current approach to mental health care focusses attention almost exclusively on individual 'pathology' as the source of problems and as the focus for professional efforts. New knowledge about the role of life circumstances will lead to much more effective programmes of prevention, comparable to the effects on physical health of public health interventions such as the purification of drinking water.
The time has come for a wholesale reform of mental health services. We must move away from the 'disease model', which assumes that emotional distress is merely symptomatic of biological illness, and instead embrace a model of mental health and well-being that recognises our essential and shared humanity.