Academic journal article International Journal of Clinical and Health Psychology

The End of Mental Illness Thinking?

Academic journal article International Journal of Clinical and Health Psychology

The End of Mental Illness Thinking?

Article excerpt

There is a powerful movement in train, which is seeing old ideas in mental health being replaced as new scientific advances, including in epigenetics (Toyokawa, Uddin, Koenen, & Galea, 2012), neuroscience (for example in child development) (Riem et al., 2013) and psychological understanding of cognitive mechanisms underlying mental distress (Susan & Edward, 2011). Mental health is increasingly understood as a public health issue (World Health Organisation, 2010) and research on income inequality has clearly shown the link with expressions of mental distress (Wilkinson & Pickett, 2010). This paper addresses one aspect of this change, in which we advocate abandoning the outdated 'disease model' of mental distress and the development of new ways in which we can bring together all the elements of a person's experience in order to help them most effectively, and follows the publication by the Division of Clinical Psychology of the British Psychological Society on classification of behaviour (Awenat et al., 2013).

The United Kigdom context

Due to the impact of austerity on communities and services across the whole of the Unted Kingdom, mental health services are under severe stress and increased pressure. The governments programme of 'health service liberation' (Department of Health, 2010) has changed the way that services are funded. Power has shifted to doctors working in community settings and away from centralised decisionmaking. The people who use services have been put at the heart of policy making and every other part of the system is being told that there is to be ''no decision about me without me''. Budgets for social care have been dramatically reduced and mental health service funding has been curtailed. The traditional near monopoly of the National Health Service is being replaced by a much more mixed economy of providers. Many services are being put out to tender and are starting to be provided by Non-Governmental Organisations (NGO's) and private for profit companies. These changes have been highly problematic but also have resulted in significant challenges to historic patterns of practice and have brought forward new providers and new ways of working. The government agenda of 'Parity of Esteem' which is designed to increase equity of resources between mental and physical health care services has helpfully highlighted the very significant reduction in life expectancy for people very serious mental health difficulties (Royal College of Psychiatry, 2013).

There has been a consistent demand, by those who experience distress, for more psychologically based mental health care (Hicks et al., 2011). In England this has resulted in a new programme of psychologically driven care. More people are now seen in the improving access to psychological therapies programme (IAPT) than are seen in secondary mental health care (IAPT, 2012). This programme has in large part been lead by Clinical Psychology. The programme was initially for people with anxiety and depression in the community but has since developed a range of service redesign arms into the areas of psychosis, long term physical conditions, and mental health services for children and young people.

The service user and recovery movements have been gaining political strength and maturity (Centre for Mental Health, 2003). Peer recovery workers and recovery colleges are becoming commonplace. In the latter you do not need to take on the identity of a patient to receive support and guidance to manage whatever the issue that is causing concern and distress. The whole basis of expert professional practice and power is being questioned in new and challenging ways.

The Diagnostic and Statistical Manual version 5 (DSM-5) debate

The recent DCP contribution to the debate concerning DSM-5 (Awenat et al., 2013) has been to release a statement calling for a very different approach; one that does not deny the importance of biology and physical factors but which calls into question the extent to which disease based models have led us up a conceptual and practice blind alley. …

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