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About this book

This key text book presents a critical overview of the main theoretical perspectives relevant to mental health practice and argues that no one theory provides a comprehensive framework for practice. By examining traditional models of mental health, as well as new, it challenges some of the accepted views in the field and illustrates the importance of recognising the contribution, strengths and limitations of the range of different ideas.

Part of Palgrave’s Foundations of Mental Health Practice series, this is indispensable reading for any one studying or working in mental health, whether as a nurse or social worker.

Table of Contents

Traditional Models of Mental Health

Frontmatter

1. Bio-Medical Perspectives

Mental Illness as Disease: The Medical Model
  • The cornerstone of the medical approach to mental health problems is the making of a diagnosis. A diagnosis is only possible if one accepts that there is such a thing as mental illness. The medical approach dominates the practice of psychiatrists.
  • The term “mental illness” implies disease. It suggests that there is something wrong and that there has been a fundamental change from normal functioning.
  • The medical model is applied to mental health problems in the same way as it is applied to physical health problems. The medical model supposes that psychiatric disorders are diseases with distinct pathologies, courses and outcomes and that psychiatry is a branch of medicine.
  • The medical model further supposes that the causes of mental illness are in the last analysis biochemical, though the pathway to such biochemical disturbance may well involve social and psychological factors as well as biological.
  • The medical model holds that the making of a diagnosis, and the prescription of medications based on that diagnosis, are reasonably exact sciences.
  • The medical model has weaknesses and is open to criticism. Proponents of the medical model counter that there is good, though incomplete, evidence for their approach and that treatments based on the model are demonstrably effective for some individuals with mental health problems.
Gavin Davidson, Jim Campbell, Ciarán Shannon, Ciaran Mulholland

2. Psychological Perspectives on Mental Health Problems

  • Psychological models do not rely on diagnosis; rather, they attempt to understand an individual’s problem in the light of their history and context and in the light of psychological theories about human functioning.
  • Psychological models allow for multiple causes of mental health problems (biological, social and circumstantial), but privilege an understanding of dysfunctional psychological processes.
  • Much psychological research focuses on childhood adversity and poor early attachment as an important cause of mental health problems.
  • Myriad different schools of therapy and psychological thought have developed over the years, each focusing on different psychological processes involved in mental health problems and each attempting to manipulate those processes in order to resolve mental health problems.
  • What many schools have in common is providing a formulation of a client’s difficulties. A formulation draws on psychological theories and research in order to provide a structure for describing a client’s distress, how it developed and how it is being maintained.
  • The major schools of psychological thought include behaviourism, cognitive behavioural therapy and psychodynamic theories. Other important contributions have been made by person-centred theories, systemic therapy and Gestalt therapy.
  • Historically these theories have evolved either from empirical scientific traditions (behaviourism) or from mental health clinics and hospitals (psychodynamic theories).
  • The evidence base supporting psychological therapies presents a complex picture. There is evidence for various therapies, but typically with respect to specific clinical populations and presentations.
Gavin Davidson, Jim Campbell, Ciarán Shannon, Ciaran Mulholland

3. Social Models of Mental Illness

  • Ideas of mental illness and health are constructed and reproduced in different historical epochs and are contingent upon social, political and economic factors.
  • The concept of discourse is central to theories about how mental health professionals think and behave.
  • A number of sociological ideas, notably social causation, societal response, social construction and social realism help reveal the social contexts of many mental health problems.
  • Aspects of these sociological ideas can be used to explore the interface between the identities of individuals and communities, and how processes of diagnosing and labelling occur.
  • New ideas on social capital can help practitioners consider more holistic approaches to dealing with the mental health needs of individuals, families and communities.
  • There is a need for practitioners to commit to a more critical, reflexive approach to understanding relationships of power between professionals and service users.
Gavin Davidson, Jim Campbell, Ciarán Shannon, Ciaran Mulholland

Challenging Existing Models of Mental Health Theory

Frontmatter

4. Service User-Led Perspectives

  • There are a variety of definitions and terms for those who use mental health services, including ‘service user’, ‘consumer’, ‘patient’, ‘client’, ‘survivor’, ‘expert by experience’ Each of these terms connote types of roles and relationships within mental health systems.
  • Historically, the voice of the service user has rarely been heard. However this has, to some extent, changed in recent years. Service users and service user movements have been more active in challenging discrimination, stigma and the power of professionals.
  • In the UK in particular a number of policies associated with personalisation have been introduced. These are designed to devolve power and resources from the State to service users and carers. There is disagreement about how successful personalisation has been, with contrasts between collectivist and consumerist approaches.
  • Recovery approaches are increasingly being used to plan and inform mental health systems. They imply that the views of service users are more prominent. As a result professional power is challenged and new forms of care and treatment are sought by service users.
  • These changes to policy and practice with, and for, mental health service users imply a change in professional attitudes and behaviour. This chapter concludes with an argument for more holistic, inclusive practices that engage more fully with service user views.
Gavin Davidson, Jim Campbell, Ciarán Shannon, Ciaran Mulholland

5. Critical Psychiatry Perspectives

  • Critical psychiatry perspectives have developed in response to concerns about the dominance of bio-medical perspectives and have been influenced by service user perspectives.
  • In contrast to anti-psychiatry perspectives which tend to reject bio-medical explanations, critical perspectives suggest a bio-medical approach to mental health is necessary but insufficient to understand people in their cultural, social and economic context.
  • They argue that the promise of modernism to solve all problems through reason, logic, science and technology, has led to unrealistic expectations of psychiatry and an expansion of its scope beyond its evidence base. It is suggested that the limitations of psychiatry should be acknowledged.
  • People’s subjective experiences, stories, interactions and contexts are central to understanding and responding to mental health problems.
  • Critical psychiatry perspectives also developed in response to concerns about the increasing use of coercion and compulsory powers in mental health care, especially in community settings, and there are emerging debates about the interaction between mental health and mental capacity law.
  • These ideas overlap with critical perspectives on disability in general, especially the social model of disability and, more recently, the United Nations Convention on the Rights of Persons with Disabilities and critical disability theory.
  • The evidence base for critical psychiatry perspectives is built on research on the limitations of traditional bio-medical understanding and treatment, and findings about the effectiveness of more positive, inclusive, narrative, systemic, ethically focused approaches to mental health care.
Gavin Davidson, Jim Campbell, Ciarán Shannon, Ciaran Mulholland

6. Religious and Spiritual Perspectives on Mental Health

  • There is considerable and credible evidence that religion and spirituality are positively associated with measures of well-being for many people.
  • It is likely that such a positive association is due to a number of different factors. Religion promotes healthy behaviours and practices. It is a good source of social support. Religious beliefs may both promote resilience to mental health problems and encourage positive and helpful coping strategies following adversity.
  • Often mental health interventions are secularised religious/spiritual practices (e.g. meditation). There is good evidence that this is effective for a range of mental health problems.
  • However, while in studies of groups the majority seem to be helped by religious beliefs and practices, a significant minority report finding religion and spirituality unhelpful and often harmful to their mental health.
  • Often the same experiences (e.g. depression or hallucinations) can be viewed from a religious/spiritual perspective and from a mental health perspective.
  • While mental health services have traditionally been secular, religious and spiritual experiences remain important to service users. There are non-intrusive spiritual/religious assessments and interventions that can be undertaken within ethical guidelines, while respecting the client’s worldview.
Gavin Davidson, Jim Campbell, Ciarán Shannon, Ciaran Mulholland

7. Integrated Perspectives

  • Medical doctors generally approach concepts of health and illness by utilising the “medical model”.
  • Psychological models of mental health problems do not rely on diagnosis but instead attempt to understand an individual’s problem in the light of their history and context, informed by psychological theories about human functioning.
  • In recent decades sociological theories have become increasingly influential in the way mental health services are perceived, designed and delivered.
  • Critical or post-psychiatry perspectives acknowledge the centrality of service user perspectives and social inclusion. Service user movements have had a major impact upon service delivery and professional practice.
  • Ideas about the role of religion and spirituality are helping us to understand how some service users and practitioners “live” the human experience.
  • All of the perspectives outlined in the earlier chapters have something to offer but all have limitations. This chapter explores the potential of a range of integrated perspectives to provide a framework for mental health practice.
Gavin Davidson, Jim Campbell, Ciarán Shannon, Ciaran Mulholland

Conclusion

Conclusion

We now wish to reflect upon the rationale for, and structure and content of, the book. It was our intention from the start to take a critical view about what mental illness and health means to a range of stakeholders, including policy-makers, professionals, service users and the wider public. Each of the chapters uses a range of sources to summarise the knowledge base in these chosen areas, but at the same time challenging taken-for-granted ideas. In doing so we hope we have persuaded you that the world of mental health, whether experienced by service users and their families, or in the practice of professionals, is indeed complex and characterised by ambiguity and uncertainty. Yet, at the same time we hope that the book points to policy and practice that is optimistic and focused on issues of well-being and empowerment.
Gavin Davidson, Jim Campbell, Ciarán Shannon, Ciaran Mulholland
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