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About this book

Mental distress is not exclusive to any particular group but touches the lives of people in all societies and walks of life; one in four of us will be affected by it in our lifetime. Yet the field of mental health is complex – fraught with differences in understanding and experience, variations in service provision, political agendas and professional discourses.

This wide-ranging book explores a range of themes in the development of mental health policy and practice, in order to promote critical reflection and enhance understanding. Drawing on an international evidence base, it explores the historical, legal and socio-cultural dimensions of mental health, including:
Anti-discriminatory practice and the ethical tensions posed by legislation, particularly in relation to safeguarding and human rights
Trends and concerns in the field of child and adolescent mental health
The gender, ethnicity and age-related dimensions of mental ill-health
The challenges posed by dual diagnosis and faced by families and carers.

International Perspectives on Mental Health offers a multi-dimensional view of mental health and wellbeing, with the aim of opening up debate and inviting a more holistic conception of the field. It is required reading for students of mental health on professional and academic courses, as well as for practitioners in the health and social care field.

Table of Contents

Introduction

Introduction

Abstract
As authors, we all have substantial experience of working in the broad arena that comprises the mental health field, and our purpose in writing this book is to trace the development of current theory, policy and practice by looking at historical frameworks, at power relationships and at how knowledge in this complex and highly charged area has evolved. Over time, we have watched the ebb, flow and circularity of a variety of trends and we want to draw attention to the importance of maintaining a constructive, but questioning, outlook. As part of this process, we acknowledge the insights of Peter Beresford when he speaks out about how people’s complex experiences and feelings can all too easily be compressed to ‘fit’ into neatly labelled boxes, how all these boxes can carry with them negative and disempowering connotations and how basic human needs, relating to hope, to meaning and the need to make interpersonal connections, can all too easily be overlooked.
Barbara Fawcett, Zita Weber, Sheila Wilson

Mental Health: An Overview

Frontmatter

Chapter 1. Historical Moments in Mental Health: From Straitjackets to the Streets

Abstract
History, according to Liam Clarke (2004), is not the past, but rather versions of the past. When we apply this premise to the history of madness, psychiatry, power and knowledge, it is clear that there is not just one version of the past, but many. Historical moments, just like contemporary situations, are clearly embedded within socio-cultural contexts and the importance of context cannot be overstated. It cannot be assumed, for example, that given the social, political, cultural and infrastructural differences between countries, similar responses to interventions will follow (Beukens et al., 2004). Bracken and Thomas (2001), two leading psychiatrists, reinforce this point when they state that ‘Contexts, that is to say social, political and cultural realities, should be central to our understanding of madness’ (2001: 727).
Barbara Fawcett, Zita Weber, Sheila Wilson

Chapter 2. Constructions of Mental Illness: From the Past towards the Future

Abstract
As we have seen in Chapter 1, interpretations of mental health and the policy and practice landscape have been fraught with tensions and debates. These relate to different conceptualizations about what constitutes mental health or mental well-being and, in turn, mental ill-health or mental distress. Returning to the emphasis placed by Bracken and Thomas (2001) on the centrality of context, policy and practice can be seen to be influenced by how mental distress and mental ill-health and illness are constructed at any particular point in time. As a result, terms such as mental health, mental distress, mental illness, mental disorder, mental health problems and the associated challenges posed remain contestable.
Barbara Fawcett, Zita Weber, Sheila Wilson

Chapter 3. Legal and Ethical Dilemmas in Mental Health

Abstract
It is clear that mental health legislation differs from nation to nation and in the United Kingdom, as well as in Australia, from country to country and from state to state. In Western nations particularly, mental health legislation is underpinned by psychiatric definitions and by medicalized frames of reference. As a result, terms such as ‘mental disorder’ and ‘mental illness’ predominate and tend to be uncritically utilized within the laws relating to mental health. It is also significant that mental health legislation has always been one of the most controversial areas of the law. As a result responses range from those who regard it as a means of safeguarding those who are vulnerable and out of control, to those who critique it for being overly paternalistic, for operating in a discriminatory and oppressive manner and for eroding basic human rights. Whatever the perspective taken, mental health legislation plays a pivotal role in the complex arena of mental health and mediates between the state and the individual, with considerations relating to the protection of both featuring significantly. It also provides the overarching framework for the provision of services, and although dealing particularly with involuntary admission and treatment, it can also provide the means for ensuring that minimum standards are maintained in both hospital and community settings.
Barbara Fawcett, Zita Weber, Sheila Wilson

Mental Health across the Lifespan

Frontmatter

Chapter 4. Children’s Matters

Abstract
As we turn to consider issues relating to children and mental health, it is clear that the promotion of good mental health in children and the prevention of mental ill-health are areas which are subscribed to by all. However, statistics show that mental ill-health is affecting younger and younger children on a worldwide basis, and it is notable that in the United Kingdom approximately 20 per cent of children are diagnosed as having a mental health condition in any given year (The Office for National Statistics, UK, 2005). In Australia, the figure is around 14 per cent (Mindframe, 2009). Mental ill-health in childhood is increasingly being linked to problems which manifest themselves in adolescence and also adulthood in terms of social exclusion. These are seen to include poor interpersonal relationships, self-harm, erratic employment patterns as well as offending behaviour. It has been estimated that the cost of responding to these areas is rising, and it has been suggested that the expenditure on public services used through to adulthood by individuals with troubled behaviour as children is ten times higher than the average (Social Exclusion Unit, UK, 2005; Fraser and Blishen, 2007; Australian Social Inclusion Board, 2010).
Barbara Fawcett, Zita Weber, Sheila Wilson

Chapter 5. Trying Times for Adolescents: Fight, Flight or Compliance?

Abstract
As we have seen in Chapter 4, recent research in both the United Kingdom and Australia has provided a range of statistics which show that increasing numbers of young people are experiencing mental distress (Meltzer et al., 2000; Green et al., 2005; The Mental Health Foundation, 2007; Commonwealth of Australia, 2009). The World Health Organization has estimated that globally one in eight young people is given a mental health diagnosis and one in 20 is regarded as experiencing behavioural, developmental or emotional difficulties (WHO, 2005).
Barbara Fawcett, Zita Weber, Sheila Wilson

Chapter 6. Adults: The Terrain of Mental Ill-Health

Abstract
As we have seen with children and young people, recent statistics in the Western world show an apparent rise in the number of adults experiencing mental ill-health. For example, the NHS Confederation (2009) indicates that the proportion of the adult English population diagnosed with a mental disorder has increased from 15.5 per cent in 1993 to 17.6 per cent in 2007. The Mental Health Foundation (2009) equates this to 1 in 6 people in England suffering from a common mental health problem, and their report also draws attention to depression and anxiety rising by a fifth amongst middle-aged women. Similarly, the Australian Bureau of Statistics (ABS) (2009) indicates that in 2007 45 per cent of Australians aged between 16 and 85 years had at some point in their lives experienced mental ill-health and that 1 in 5 Australians have been diagnosed with a mental disorder. The types of mental disorder alluded to in these surveys range from psychotic diagnoses such as schizophrenia and bipolar disorders, to depression and anxiety, to substance use disorders. Whilst more women than men are reported as experiencing anxiety disorders, more men than women meet the criteria for substance use disorders. Over the last few decades, general trends have shown the predominance of women over men in mental health statistics. However, recent figures produced by the ABS (2009) are pointing to a changing trend with more men than women being diagnosed with a mental disorder during their lifetime and to this often being alcohol related.
Barbara Fawcett, Zita Weber, Sheila Wilson

Chapter 7. Older Women and Men and Mental Health: Turning Around the Stereotypes

Abstract
As we have seen throughout this book, health, which includes mental health and well-being, can be seen to be a multidimensional and holistic concept which incorporates a range of factors. These clearly relate to socio-economic influences, life course outcomes and quality of life issues. In addition, older women and men generally have to contend with additional matters which can include the deaths of contemporaries and changing life patterns. These, in turn, can be affected by levels of social and financial security and the accessibility of community and family support. Older people can also fear both increasing incapacity and perceived lack of capacity which can result in a loss of control over what happens to them.
Barbara Fawcett, Zita Weber, Sheila Wilson

Mental Health Landscapes

Frontmatter

Chapter 8. The Case of Dual Diagnosis

Abstract
The concept of ‘dual diagnosis’ has gained considerable currency within clinical psychiatric practice in Western nations, particularly in Australia, over recent years. In this chapter, we both recognize the operational identity that ‘dual diagnosis’ has acquired in the current climate and also scrutinize what can be regarded as an expansion of psychiatric diagnostic criteria into territory which is both social and marginalized. We therefore explore definitional issues as well as consider the overall implications of this framework. As part of this process, we examine the tensions that arise in relation to service user or consumer perspectives and the challenges posed for socially orientated understandings of mental health.
Barbara Fawcett, Zita Weber, Sheila Wilson

Chapter 9. The Upside/Down of Caring: Families in Mental Health

Abstract
The terminology that surrounds caring relationships and the roles occupied by those who take on or who are ascribed the role of ‘carer’ can be seen as both descriptive and constructive. ‘Caring’ can describe what a person does as well as draw attention to a concept which is given meaning through policy documents, practice directives and as a result of a variety of interactions between family members. Caring within families can refer either singly or collectively at different points in time to the presence or absence of emotional ties, to notions of duty that members have for each other and to the provision of a range of forms of support or assistance. ‘Caring’ can also imply the operation of power imbalances and carry with it the assumption that certain members are more competent than others. In this chapter, we review ‘caring’ in the context of mental health, mental distress and illness, and we explore a number of diverse perspectives, drawing from individualized as well as socially orientated understandings of mental health.
Barbara Fawcett, Zita Weber, Sheila Wilson

Chapter 10. Anti-Discriminatory Practice in Mental Health

Abstract
Throughout this book, mental well-being and mental ill-health have been viewed as dynamic and constructive and as open to a range of understandings and meanings which reflect context, the constantly changing interaction between an individual and their environment and the ways in which these are interpreted. As part of this process, the influence of a range of perspectives, with some clearly being much more dominant and informing what we take for granted than others, has been reviewed. In this chapter, we particularly consider the role of professionals and appraise the significance of operating principles associated with anti-discriminatory and anti-oppressive practice and critical reflection. We also review the concept of social inclusion and the opportunities and constraints that this social policy platform has brought to the arena of mental health and well-being. In the light of this discussion, we consider a form of spatial analysis linked to social entrepreneurship which, given its basis in anti-oppressive and anti-discriminatory practice and critical reflection, has the capacity to inform community-orientated responses to mental health.
Barbara Fawcett, Zita Weber, Sheila Wilson

Concluding Remarks

Abstract
In this book, we have paid considerable attention to historical, social and ideological contexts and to the importance of intertwined power and knowledge frameworks. As part of this process, we have highlighted the ongoing influence of modernist ways of thinking in the mental health arena. The prevailing concern with managing ‘risk’, determining capacity and prescribing particular forms of practice can be clearly associated with a continuing modernist preoccupation with the establishment of certainty. Modernist ways of thinking can also be identified in the still-prevalent tenet that although social, cultural and environmental factors should be taken into account, it still remains possible to identify and separate mental illness or mental disorder from these aspects as well as from the experiential knowledge of those experiencing mental distress. It is also notable that a search for certainty can all too easily serve to blur the identification of the beneficiary. Accordingly, it can become increasingly unclear as to whether ‘risk’ refers to risk to the public from an individual experiencing mental distress, is associated with protecting an individual perceived as vulnerable from possible harm (with this increasingly being defined solely in physical rather than in holistic and emotional terms) or is employed as a means of protecting professionals or agencies from the repercussions of a particular decision. In this book, we have drawn attention to the pitfalls of a quest for certainty and have argued that uncertainty is a viable option as are a range of understandings of mental well-being and distress which at times take issue with, and at other times complement, dominant views.
Barbara Fawcett, Zita Weber, Sheila Wilson
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