Academic journal article Social Alternatives

Towards a Mental Health Model of Practice: Highlighting the Scaffolding That Can Really Help People

Academic journal article Social Alternatives

Towards a Mental Health Model of Practice: Highlighting the Scaffolding That Can Really Help People

Article excerpt

A grouping of theories and mental health clinical practices are outlined that may help clients to make restorative improvements in their lives. Client-centred partnerships, clinician self-reflection and contextual awareness are key features of the scaffolding needed for a mental health model of practice. The group of explanatory ideas relating to the client's experiences are: attachment, developmental, systems, neurobiological and psychoanalytic theories, where it is recognised that each have their own limitations as stand-alone theories. Further, the theories need to be located in a power analysis of broader factors which impact on people's lives. Failure to do so could result in mental health practice colluding with socially unjust and discriminatory power dynamics in mental health systems. Collectively, these theories, when employed through a power sensitive and reflective partnering approach, can provide a way to enable people's sense of normalcy and wellbeing and thereby resist being labelled and treated as mad.

Introduction: The Politics of Helping

The paper presents the progressive view that mental health clients' symptoms reflect early life attempts to survive and adapt in circumstances of loss and trauma, are historically (in their life process) functional, and are context specific for each person. What is needed to help people seeking mental health care is very personal within a political context, including the helping context of the public mental health system. The construction of human suffering and trauma as mental illness (Bloom 2000: 67) may have the effect of misunderstanding how what really helps people has many similarities and has a normalcy about it within a recognition of personal needs and differences. The literature is replete with analyses of the danger of pathologising and medicalising responses to life events (Thompson 2011: 125). This dominant approach to helping can show as a tendency to blame the victim (Baum 2014: 79) and focus helping almost exclusively on the person diagnosed as mentally ill separated from their socio-cultural and political context. For example, Mental Health Acts exclusively focus on individuals deemed to have a mental illness with no recognition given to the social and political nature of mental illness or the contested nature of what constitutes mental illness and appropriate responses (Repper and Perkins 2009: 120).

Further, the omission of the influence of the contextual dimensions of the helping situation can make invisible the discriminatory nature of state sponsored responses to mental illness. This is evidenced by the stigma attached to the people seeking (Millen and Walker 2001: 89) and giving help (MHCA 2011), and the poor resourcing of mental health systems of care in Australia (MHCA 2005: iv). This omission of the contextual influences of helping can have many implications for the person, including that they can experience further harm and trauma from the help givers. This dynamic is an abuse of professional and managerial power and is known as 'social iatrogenisis' where the system meant to help people actually does not help (Sartorious 2002: 1470) but rather causes a secondary level of trauma. This is recognised by Sullivan who uses the more political language of 'metadiscrimination' (1999: 5) to describe health workers' biases against their clients. Thus, accounts from mental health survivors of the discrimination, loss and harm they experienced in state run mental health facilities (O'Hagan 2009: 198) need heeding. Their experiences collectively show the power dynamics that need to be addressed in the micro-helping practices with people and in the often discriminatory cultural norms and structural biases of society.

Many personal accounts of secondary trauma are recorded in public reports with the theme being the 'injustice and despair' experienced by people seeking help as well as their carers (Mental Health Council of Australia [MHCA] 2005: III). …

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