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Improving mental health as a positive mediator of socially progressive change

Updated: Dec 18, 2020

Hello all!

Please allow me to introduce myself, my name is Matty Caine and I am Founder/CEO of First Person Project C.I.C., a non-profit social enterprise specialising in providing socially progressive mental health workshops and operating across the Liverpool City Region. I run this organisation alongside my good friend, Johnathan Ormond-Prout, who is our Executive Director and an invaluable source of wisdom, determination and direction.

Who are we?

I’m a very proud Mental Health Nurse; I have experience spanning over a decade in a variety of clinical and strategic leadership positions in NHS mental health services, the private and third sectors. In 2019, I founded the First Person Project C.I.C. - we are a community interest company which provides coaching and action support workshops with the aim of creating stronger communities, improving mental health and well-being for all. We champion proactive and prevention focused action, drawing upon a variety of approaches to achieve our aims. We work with people to collaboratively build community networks and positively impact upon many areas, including: asset development, resilience building, decreased need for mainstream services, improved social support and inclusion, reduced exclusion and improved employment opportunities.

Why do we need to exist?

Mental health and illness is equally, if not more, of a socio-political issue than it is a biological one. Mainstream mental health services tend to minimise this idea in favour of a predominantly biomedical approach, which attempts to reduce the natural complexity of an individual down to a simplistic problem to be treated, usually with medication or another well-meaning intervention, such as talking therapies. This approach has been well-critiqued as ineffective and potentially harmful; it isolates the individual as the primary sum of health, when good mental health is actually rooted in community and social cohesion, it is not the unilateral responsibility of the individual or the professional system which endeavours to provide care.

The personal consequences of the medical model of mental health are multi-fold, many of which are beyond the scope of this blog and will be covered in future, however the organisational implications of this approach should not be overlooked. NHS mental health services are shaped by the dominant clinical model, this has been shown, both directly and indirectly, to affect waiting times, result in poorer treatment outcomes, produce variable rates of rehabilitation or recovery, invoke traumatisation leading to extended or additional use of already depleted services, affect staff recruitment and retention, contribute to a falling uptake of professional mental health training, as well as patient dependency and containment. These issues, as well as many others, have been highlighted as key areas to be addressed within current national mental health strategy for the National Health Service, with recommendations made regarding the need for partnerships with third sector services to achieve these strategic aims. The global Coronavirus pandemic has compounded the aforementioned issues and put unprecedented strain on mental health services - this is forecast to persist well into the future. Many commentators have expressed concerns regarding Coronavirus, the development and exacerbation of mental health problems, as well as the inefficiency in existing systems to manage current and future demand; they present an opportunity to improve mental health services through reconfiguration and re-design, thereby promoting a need for new socially-focused practices which reduce disparities and increase inter-connectedness within communities.

Political considerations

Mental health policy in the United Kingdom is underpinned by a bio-medical understanding of mental health and illness, whereby pathology and deficit-based approaches dominates the public and professional understanding. Current mental health policy uses a narrow medical definition and monolithic interpretation of mental health, as a consequence the public can accept and internalise a medical model of mental health, leading to a dependency upon the services which are based upon this failing model; services which are floundering because they cannot meet both the demand and the complexity challenge, thereby creating a situation where nobody prospers. Mental health services enable this dependency through reliance upon this approach, by both professionalising and monopolising mental health, thereby perpetuating a cycle of over-promise and under-delivery of institutional solutions - resulting in poorer outcomes and financial/resource implications, as aforementioned. Furthermore, the current mental health service landscape of chronic under-funding, rationing of key services, cost-efficiency measures, as well as the unprecedented impact of COVID-19 serves only to compound matters further, leading to discontent and disenfranchisement amongst the workforce of today, as well as casting doubt into the minds of the potential mental health professionals of tomorrow.

Developing personal capacity and promoting social capabilities

The variety of complex factors presented offers a significant threat to mental health services as currently configured, in response to this it has been suggested that mental health services should be informed, not by a pathogenic policy, but by a salutogenic one, which addresses the social determinants of mental health and promotes the capacities of communities to improve their own mental health and well-being - such an approach is described as asset or capabilities based. Complex, adaptive problems require more than a simple, linear intervention to address them; asset and capabilities based approaches in mental health focus upon strengths and not deficits, working to define what makes us healthy, rather than what makes us ill. This creates a wider spectrum of diversity, making it more difficult to measure and generalise, therefore less favourable with policy makers and thus less able to disrupt the dominant model.

According to the health asset development literature, an asset is any factor or resource which enhances the ability of an individual and/or community to develop and maintain health and well-being. Health and well-being assets are located at individual and communal levels, they can be realised and mobilised through action, participation and connectedness; they support the reassessment and re-definition of social values, norms, relationships and aid prospective collaborations. Individual factors include improved self-esteem, resilience, social coherence, a sense of control and a sense of purpose. At a community level assets can include relationships between family and friends, support networks, a sense of safety and social cohesion. Table 1 compares asset-based approaches with a deficit-based approach:

Turning threat into opportunity – working together to ensure a mentally healthier society

The attainment of positive mental health outcomes for individuals and communities falls beyond the scope of NHS mental health services within the sphere of current practice, the solution to addressing mental health challenges and widening inequalities is anchored in challenging socio-economic and environmental factors. Despite well-intentioned efforts, the shortcomings of the treatment-centric approach favoured by mainstream mental health services means that they cannot address these complex issues independently, therefore public sector services must adapt to include asset-based approaches as an integral and complementary part of service delivery. The key factor underpinning the success of an asset-based approach is engagement, with the target population, the political forces and the leaders of mainstream services, this enables an identification of mutual goals and an understanding of key criteria, which can then aid in the application of this approach. The prior exercise of defining the key terms and expectations will support the generation of methods to evaluate asset-based practices, generating evidence of effectiveness, which are robust and resilient enough to demonstrate not only improved outcomes, but also value for money.

Public institutions and mainstream mental health services have assets that can be used to improve health and well-being, however as discussed, these assets are often used simply to meet immediate needs, or deficits, rather than to develop and sustain the things that make people healthy. An assets-based approach should not be viewed as an alternative to mainstream services, moreover, in light of current economic and resource constraints, it offers an opportunity for public services to work in more collaborative and less transactional ways - thereby transforming their relationship with communities and supporting the attainment of better outcomes in relation to mental health and well-being. Asset/capabilities based approaches de-centralise mainstream mental health services, without demeaning them, to place the community at the heart of all interaction and efforts.

"We cannot seek achievement for ourselves and forget about progress and prosperity for our community... Our ambitions must be broad enough to include the aspirations and needs of others, for their sakes and for our own."

Cesar Chavez

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