What service users want to change in mental health policy. Peter Beresford in The Guardian.
What service users want to change in mental health policy
Policymakers have failed, with thinking on mental health 50 years behind physical health. So we asked those with lived experience how to fix the problem
Service users want a social model of mental health, as the medical model can lead to over-emphasis on drug treatment.
UK mental health policy is in disarray. It’s a message coming from all quarters – even former care minister Norman Lamb is now condemning practices such as shunting people in crisis across the country in search of beds – a policy for which he was responsible when in office.
But the issue is not only about a failure to achieve parity with physical health in terms of vastly inferior funding. Mental health policy now lags behind its physical health equivalent by perhaps 50 years in terms of innovation and effectiveness.
We need new thinking, and that does not seem to have been forthcoming from policymakers of many political colours. Instead, as a new Joseph Rowntree Foundation study suggests, we might do better to turn to the ideas and lived experience of mental health service users and their organisations.
These are set out in a new report of a national project, of which I am one of the authors, based on speaking to more than 80 mental health service users. Most felt professionals and the public interpreted mental health issues through a narrow medical model, seeing the problem primarily in the individual. They saw this approach as inherently stigmatising and damaging, and associated it with an unhelpful over-emphasis on drug treatment.
The idea of “recovery” has become a guiding principle for UK mental health policy and provision in recent years. For the report, we asked service users what they thought about it.
Participants had mixed views on whether it was helpful for service users. Most felt that the idea could be helpful, but that the policy as implemented is not.
Many felt it perpetuates a medicalised individual model of mental health and is not based on listening to service users.
There were strong feelings that the idea, which was supposed to be user-led, has been hijacked by a narrowly framed government policy, which puts increasing responsibility on the individual to deal with their difficulties. Its central aims were seen as saving money, cutting services and getting people off benefits and into paid work, regardless of how helpful or realistic that was for them. Many highlighted how welfare reform policies undermine whatever positives mental health policy and practice still offers.
Mental health service users were divided about whether the social model of disability could helpfully be extended to their experience. But most felt that social approaches to mental health, which take account of the whole person and wider societal issues affecting them, would be the most helpful. Some felt such social approaches needed to be incorporated more widely in medical practice. They valued a holistic or combined approach which takes account of both the individual and their social circumstances.
Findings highlighted the complexity of service users’ views, their reluctance to impose monolithic interpretations on their experiences and desire to take account of both personal and social issues. So, for example, while some preferred the language of “madness” over “mental health”, others were uncomfortable with it.
For the future, service users call for more funding for mental health, redistributed to smaller user-led and community based initiatives. They want to see social approaches to distress incorporated much more in policy, services, preventive and early intervention work and professional training; more value place on their experiential knowledge and more user involvement in research. They want to see a different approach to welfare reform based on supporting people to make the most of their lives, rather than having to demonstrate incapacity. They offer a blueprint for truly modernising mental health thinking and policy.
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