Mental illness and social and
recovery models
Does mental illness have a place in
social and recovery models in
peoples’ lived experience?
Helen Barnes
Combining the strengths of UMIST and
The Victoria University of Manchester
Social and recovery mandates for
mental health education
Policy models
‘Mental wellbeing is influenced by …genetic
inheritance, childhood experiences, life events,
individual ability to cope, and levels of social support,
as well as…adequate housing, employment, financial
security and access to appropriate health care’
‘Being in work and having social contacts is strongly
associated with improvements in health and wellbeing’
‘ A shift from pathology, illness and symptoms to
health, strengths and wellness’
‘Individuals…can transcend limits imposed by both
mental illness and social barriers to achieve their
highest goals and aspirations’
(DoH 2001, SEU 2004, DoH 2010, Mahler & Tavano 2001)
Combining the strengths of UMIST and
The Victoria University of Manchester
Mental health: social causes and
social solutions
Policy barriers to recovery
•Confidence to access mainstream
•Attitudes mental health staff
•Social discrimination
‘Stigma …the greatest barrier to social inclusion and
recovery…for people with mental health problems’
Policy solutions
Building a meaningful and satisfying life whether or not
there are symptoms and difficulties
‘Paid employment gives people a sense of their own
worth… and gets them out of their illness’
‘When people are involved in decisions that affect their
lives, their self esteem and self confidence rise in turn
improving their health and wellbeing
(SEU 2004,NIMHE 2005, CSIP 2007a, DoH 1999, SEU 2004)
Combining the strengths of UMIST and
The Victoria University of Manchester
Mental illness – key to the problem
‘Mike has the potential for violence. Innately he is a
very sweet and kind person. But because of the
disease, he gets very paranoid. His disease has
made him a danger to others’
HENCE ‘A person with severe mental illness is one
to be feared and kept out of their communities’
•Mental illness – disease, deficit, abnormal
•Dehumanising – ‘other’
•Uncontrollable
•Unpredictable, violent
•Not tackling the root cause
•Professional power and expertise
Bartlett & Sandland 2007, Rusch et al 2005, Desai 2003, Beecher
2009, Manktelow 2002, Bailey 2002)
Combining the strengths of UMIST and
The Victoria University of Manchester
Mandates for mental health
education
Medical model – diagnosis, containment,
medical treatment
VERSUS
Social & recovery model – whole systems:
social, psychological, economic interventions
•Social inclusion v segregation
•Successes, strengths v deficits
•Rights v discrimination
•Personalisation, aspiration, participation v
professional domination
(CSIP 2007b NIMHE 2005 DoH 2006 DoH 2009 Bogg 2008)
Combining the strengths of UMIST and
The Victoria University of Manchester
Historical legacy – social ideas of
mental health concerns
Enlightenment 1700s
HUMAN = REASON – intelligence, perception,
thought, consciousness
CONTROL OF EMOTIONS BODY ENVIRONMENT
‘Capacity to formulate and pursue plans which are selfdetermined’
ANIMAL = UNREASON – body emotions environment
CONTROLLED - EMOTIONS BODY ENVIRONMENT
THUS people with mental health problems ‘Without
that power by which we are distinguished from the
brutal class of animal creation’ (Robinson 1729)
TO
Genetic biomedical model – Deficit, ‘Other’
(Scull 1983 Stainton 2002 Doerner 1989 Barham & Hayward 1991)
Combining the strengths of UMIST and
The Victoria University of Manchester
Historical legacy – social ideas of
mental health concerns
Consequences for people with mental health
issues
•Aliens – not citizens
•Segregation and incarceration – 19th century asylums
Moral treatment – 1700’s
AUTONOMY the basis of:
•Wellbeing – control over life and environment
•Citizenship - rights and responsibilities
•Social order – coping and morality
Moral treatment sought to re-educate into the discipline
and skills of rational citizenship
TO ‘Restore to the world a sober self-determining
citizen’
(Ingleby 1983, Scull 1983)
Combining the strengths of UMIST and
The Victoria University of Manchester
Historical legacy – social ideas of
mental health problems
Social ideas
People with mental health problems lack
rationality
THEREFORE
They are sub-human and like animals
Public ideas today reflect this
•‘Subhuman’
•‘Very different (from us)’
•‘Amoral’
TO
Stigma of mental illness
Originally viewed as a ‘disease of rationality’
(Crossley 2001 Furnham & Rees 1988, Rusch 2005 Kendell 2001)
Combining the strengths of UMIST and
The Victoria University of Manchester
Legacy of history today
Autonomy and reason as its base ‘still
valued…as the proper basis for social,
economic and political relations, almost as
much as it was in the Enlightenment’
Recovery model in policy
‘Move from dependency to…personal control of
symptoms’ ‘live a life beyond illness’
•Access mainstream work, social participation
•Self-management symptoms, discrimination
•Responsible – ‘active agent’ problem-solving:
Cognitive behavioural therapy key approach
•Self-directed support – control own life, care
(Harris 1999 Shepherd 2008, DoH 2010, SEU 2004. DoH 2006)
Combining the strengths of UMIST and
The Victoria University of Manchester
Recovery - service user and
recovery perspectives
‘Recovery is a deeply personal unique process of
changing ones attitudes, values, feelings, goals,
skills and roles. It is a way of living a satisfying,
hopeful and contributing life, even with the limitations
caused by symptoms caused by illness. Recovery
involves the development of new meaning and
purpose in ones' life as one grows beyond the
catastrophic effects of mental illness’
Stigma the main barrier and service user concern
‘Society’s responses in terms of stigma and
discrimination… can be the most harmful’
Resilience the key
(Shepherd et al 2008, SEU 2004, Tew 2005, DoH 2010)
Combining the strengths of UMIST and
The Victoria University of Manchester
Does everyone share this lived
experience?
Autonomy as a value?
•A Western European, Anglo-cultural value
•A value of more advantaged groups
Autonomy and resilience as a possibility?
•Person-change capacity-building interventions
resulting in relapse v benefit for people with
more/less severe mental health problems
•People with advantaged histories more likely
to enter and sustain employment than those
with less advantaged histories
(Lago & Thompson 1996, Taylor 1995, Goldberg 1985,
Shepherd et al 1989)
Combining the strengths of UMIST and
The Victoria University of Manchester
Alternative experiences
Perspectives on recovery
‘My understanding of recovery is basically you’re
feeling all right’
Getting better = 100% feeling less ill
Perspectives on ‘impairments’
‘Impossible to ignore impairments’
‘Impossible to describe to someone who had never
experienced it, and difficult to appreciate for those
with no lived experience of mental distress’
Life experiences – more severe, persistent
concerns
•Disadvantaged backgrounds
•Poor care, abuse, neglect as children
(Pitt et al 2007, Perkins & Meddings 2002, Lester & Tritter
2005, Castle 1985, Jenkins 2009, Kings fund Centre 1997)
Combining the strengths of UMIST and
The Victoria University of Manchester
Alternative experiences – social
citizenship AND health concerns
Experiences of barriers and concerns
Barriers to work study (1)
•12/15 – symptoms would interfere with work
Barriers to work study (2)(3)
•Employer attitudes 83%
•Mental health concerns 80%
•Employer attitudes, benefits, health, skills – 66%+
Primary & secondary care study
•Social, benefits, occupation 60%
•Safety to self 69% Psychotic symptoms 52%
Social participation study
•Mental health symptoms a major barrier
Quality of life study
•Symptoms 19% variance in quality of life
(Marwaha & Johnson 2005, Secker 2001a, Secker & Gelling
2006, Secker 2001b, Qureshi et al 1998, UK700 Group 1999)
Combining the strengths of UMIST and
The Victoria University of Manchester
So does mental illness have a place
within social models?
Disease models
•Genetic model: deficit - Poor Laws
•Physical illness model: mind - NHS 1946
•Disease of body or mind is one - Today
Disease of body or mind as one
•Pain and effects on functioning = disease
•Mental capacity, distress and behaviour
•Physical symptoms – e.g. fatigue, physical pain
with depression
•Biochemical changes associated with physical
and mental health conditions
WITHOUT OLD IDEAS – NO STIGMA
(Kendell 2001, Pedlar 1999 Warner 2003)
Combining the strengths of UMIST and
The Victoria University of Manchester
So does mental illness have a place
in social models?
Social models need not negate illness
Social model of disability perspectives
Impairments besides social barriers affect
functioning: pain, fatigue, difficulty, distress
Stress, inequalities and vulnerability
*Genetic predisposition – e.g. heart disease
*Emotions stress inequalities TO biochemical
processes underlying symptoms
EG Long-term conditions and inequalities:
44% SES 5 v 28% SES 1 – Long term illness
(Mulvany 2000, White 2003, Warner 2003, Baggott 2005)
Combining the strengths of UMIST and
The Victoria University of Manchester
So does mental illness have a place
within social models?
What do post-genetic illness models offer?
Welfare state
Needs ‘universal and no fault’ (Doyal & Gough 1991)
Stress vulnerability as impact of environments
coincided with emancipatory movements 1970s ‘public issues’ ‘private pain’ (Becker & McPherson 1997)
Alternative moral model
Recognition of ‘human suffering’ ‘human worth’ TO
‘moral rights and entitlements’ (Chamaz 2006)
= Moves towards SOCIAL JUSTICE
NHS 1946,Disabled Persons’ Act 1986,DDA 2005
Inequalities and health
Health is a social justice issue (Bywaters 2008)
Combining the strengths of UMIST and
The Victoria University of Manchester
Responding to the whole person
Theory for practice – emancipatory, social
justice, critical realism, social stress
PEOPLE HAVE AUTONOMY BUT ARE ALSO
AFFECTED BY BIOLOGICAL & SOCIAL WORLDS
Service user –‘Relate to me as a person in my illness’
Emancipatory response - ‘Relating to the whole
person in their total social context’
BY Tackling the ‘conditions leading to or hindering the
self-realisation of individuals and social groups’
What are the conditions?
Human being = mind, body, emotions, environment
‘Shaped by the world around them’ BUT ALSO
‘creative beings’
(Houston 2001,Schwartz & Meyer 2010, Barham & Hayward 1991, Lloyd
2002, Humphries 2005, Shaw & Middleton 2007, Ward 2000)
Combining the strengths of UMIST and
The Victoria University of Manchester
Responding to the whole person
Outcomes of whole person approach
Community of interest and reduction of social
stressors – independence and symptom reduction
Relief of symptoms – social participation, mental
capacity
Person-centred relationship – a human being:
engage with services
Motivation for treatment – relief of social stressors
reduced need for ‘self-medication’: drug users able
to seek treatment
Specialist social care & ethical relationship –
Mental health outcomes, autonomy, quality of life
(Quilgars 1998, Qureshi et al 1998, Pedlar 1999, Secker 2002,
Elward 1992, Bjorkmann & Hanssen 2000)
Combining the strengths of UMIST and
The Victoria University of Manchester
Responding to the whole person
Respond to autonomy and vulnerability
The felt world combines feelings, thoughts and
bodily process into a vital structure’
•Address poverty, abuse, inequalities, health
conditions as basis for empowerment
•Challenge discrimination
•Respond to pain and distress
Professional-service user relationship
•Service user is expert on their experiences
•Professionals share knowledge-base related to
experiences
*Negotiate care plan addressing medical, social,
psychological barriers to aspirations
(Hughes & Paterson 1997, Dominelli 2009, Ward 2000, Priestley 1998.
Shaw & Middleton 2007)
Combining the strengths of UMIST and
The Victoria University of Manchester
References and contact
References and information on different aspects of
the presentation available in separate handout
[email protected]
Lecturer in Social Work
School of Nursing Midwifery and Social Work
Combining the strengths of UMIST and
The Victoria University of Manchester