Mental Health

mental health; mental illness: how should we respond?

Lynne Friedli

Fair Deal for Mental Illness Debate: Socialist Health Association

Coventry16th May 2009

Socialist Health Association [email protected]

This being human is a guest house.Every morning a new arrival.A joy, a depression, a meanness,Some momentary awareness comesAs an unexpected visitor.Welcome and entertain them all.Even if they’re a crowd of sorrows,Who violently sweep your houseEmpty of its furniture.Still treat each guest honourably.He may be clearing you out for some new delight.The dark thought, the shame, the malice,Meet them at the door laughing,And invite them in. (Jelaluddin Rumi, 1207-73)

During these months something had matured in meAll I’d to do was let it flourish.Just to have grown enough to accept my destiny.

Every pretty blouse I put on a kind of celebration.I feel so light and radiant and cheerful.In suffering we share our loss with all creation.

No admittance to Jews. The air I breathe is mine.That man cycling on Beethovenstraat,His yellow star of David a crocus in the sunshine.

Such ripening strength. Gone the Bohemian waif.I want to be there at every front.I don’t ever want to be what they’ll call ‘safe’.

from Etty Hillesum by Micheal O’Siadhail



Dimensions of mental health

Mental health

(capital)

Emotional resources e.g. coping style,

mood, emotional intelligence

Cognitive resources e.g. learning style,

knowledge, flexibility,

innovation, creativity

Social skills e.g. listening, relating, communicating, co

operating

Meaning and purpose e.g. vision, goals,

connectedness

If I am not for myself, who will be for me? And if I am only for myself, what am I? If not now, when?

Outcomes associated with positive mental health

A worthwhile goal in itself and leads to better outcomes:• reduces prevalence of mental illness• physical health: mortality/morbidity• health behaviour• employability, productivity, earnings• educational performance • crime / violence reduction• pro-social behaviour/social

integration/relationships• quality of life


Promoting mental health: two routes


Public mental health

•Self efficacy•Autonomy•Individual

responsibility•Health behaviours• Money economy

•Volunteering•CBT

•Collective efficacy•Social responsibility•Wider determinants

•Social solutions•Core economy

•Timebanks•Social prescribing

A disembodied psychology which separates ‘what goes on inside people’s heads’ from social structure and context Critical Psychology Forum


Policy context and current debates..

• Decline of family/community/quality of life• Culture of materialism and consumerism• Plight of poor, dependent and ‘non-productive’• Capacity of public services, lack of trust and

democratic deficitenvironmental instability

psycho-social instability

Social recession

Economic/fiscal policy

If “being poor” once derived its meaning from being unemployed, today it draws its meaning primarily from the plight of a flawed consumer.

Zygmunt Bauman

Mental health and recession


Untangling the determinants

• Individual skills and attributes

• Material resources

• Inequalities in distribution of resources


I do worry about this emphasis on individual psychology; You can’t separate thoughts, feelings, self esteem, motivation from the material circumstances of people’s lives. Is it great to be positive? Maybe people are right to be pissed off.”

Positive steps interviews

Towards a mentally flourishing Lanarkshire

[email protected]

Not ‘every family in the land’

Findings from 9 large scale population based studies:

• Material and relative deprivation• Childhood socio-economic position• Low educational attainment• Unemployment• Environment: poor housing, poor resources,

violence• Adverse life events• Poor support networks

(Melzer et al 2004; Rogers & Pilgrim 2003; Stansfeld et al 2008; APMS 2007)

Cycle of invisible barriers:• Poverty of hope, self-worth, aspirations

Mental health and deprivation

Mental Health in Relation to Income Inequality

Developed from: Pickett KE, James O, Wilkinson RG. Income inequality and the prevalence of mental illness: a preliminary international analysis. Journal of Epidemiology and Community Health 2006; 60: 646-7http://www.equalitytrust.org.uk/why/evidence/mental-health

Index of: Life

expectancy, Math &

Literacy, Infant

mortality, Homicides,

Imprisonment rate, Teenage

births, Trust,

Obesity, Mental illness, Social mobility.

Correlation: r=0.81, p < 0.0001(excl USA: r=0.79, p < 0.0001)

Wilkinson RG, Pickett KE The Spirit Level 2009

Health and Social Problems in Relation to Inequality


Index of: Life

expectancy, Math &

Literacy, Infant

mortality, Homicides,

Imprisonment rate, Teenage

births, Trust,

Obesity, Mental illness, Social mobility.

Correlation: r=0.81, p < 0.0001(excl USA: r=0.79, p < 0.0001)

Wilkinson RG, Pickett KE The Spirit Level 2009

Health and Social Problems in relation to average incomes (GDP per capita

US$ ppp)



“...the Greeks and Romans lived, I suppose, very comfortably though they had no linen. But in the present times, through the greater part of Europe, a creditable day labourer would be ashamed to appear in public without a linen shirt, the want of which would be supposed to denote that disgraceful degree of poverty which, it is presumed, nobody can fall into without extreme bad conduct. Custom in the same manner has rendered leather shoes a necessary of life in England. The poorest creditable person of either sex would be ashamed to appear in pubic without them”

(Adam Smith Wealth of Nations 1776 cited in Zaveleta 2008)

Resilience, health assets and capabilities

• Resilient places

• Resilient communities

• Resilient individuals


Distribution of resources

Quality of relationships

Policy responses to misfortune

Valued social role

‘To value the contribution of those whom the market excludes or devalues and whose genuine work is not acknowledged or rewarded’

Edgar Cahn

(the ecology of)Relationships matter

• Mental health is produced socially

• Presence or absence of mental health is above all a social indicator

• Social as well as individual solutions


Tend to the social and the individual will flourishJonathon

Rutherford


The quality of policy responses to misfortune

• We are all vulnerable and dependent

• We’re all in this together

• Collective efficacy

• ‘Other regarding’ agency

‘Belonging' : trusting in the benefits of human solidarity and in the institutions that arise out of that solidarity

Zygmunt Bauman

What would a fair deal look like?

• Reduce economic inequalities i.e. Mind the gap• Include social outcomes: the quality of

relationships matters• Valued roles and multiplicity of meanings• Treat people experiencing problems with respect:

vulnerability and dependency are part of the human condition, not a mark of moral failure


Resources, relationships, meaning, respect


A (wider) framework for effective action

Opportunities for meaningful

activity: education, training, volunteering

Mental health

and Mental Capital

Reduce poverty

and the impact of poverty

Respectful policy responses to misfortuneQuality of

social relationships

(family, schools,

workplace, communities

)Reduce material

inequalities

And what I shall endure, you shall endureFor every atom belonging to me as good belongs to

you......Walt Whitman

Build capacity for collective

action (collective efficacy)

Copyright ©2008 BMJ Publishing Group Ltd.

Krieger, N J Epidemiol Community Health 2008;62:1098-1104

Figure 1 (A) Pyramid of capitalist system. Issued by Nedeljkovich, Brashick and Kuharich, for the International Workers of the World (IWW), 1913.18





Mental Health

Health & Medicine

mental health mental

connectednesssocialist

dimensions of mental

social structure

mental illness debate

guest house

consumerism plight of

coping style