Older Mind Matters

Drawing the line: mental health and ill-health

The World Health Organization constitution defines health as:

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

This definition was first set out in 1946 and has been unchanged since. It presents an idealized vision of health and implies that people living with chronic illness or disability cannot be ‘healthy”.

I have similar reservations about the WHO definition of mental health:

“Mental Health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”

Which of us can put our hands on our hearts and say we have realized our potential? And if we include working “productively and fruitfully” in the definition, where does that leave people with no jobs or who have retired?

And what about mental ill-health (or what we used to call mental illness or psychiatric problems or some people today might call mental health problems)? The stigma jumps from term to term and linguistic re-labelling doesn’t escape it. Some people have reservations about psychiatric diagnosis – isn’t it just labeling? The Mental Health Foundation says (see link):

“Mental health problems are usually defined & classified to enable professionals to refer people for appropriate care & treatment. But some diagnoses are controversial and … people are too often treated according to or described by their label.”

I have reservations about the term mental health problems – some mental illness is severe and has far-reaching impacts on a person’s life - I suspect that including serious illness under this umbrella risks trivializing it. And if we aspire to parity between mental and physical illness (as the Royal College of Psychiatrists does, and NHS England too) then surely we should be prepared to bite the bullet and refer to mental illness as … mental illness. By using weasel language I fear that we reinforce stigma (but then I’m from Yorkshire where we come straight out and say it). Parity requires mental health and physical health to be equally valued.

I have some concerns about modern psychiatry:

1. are we over-inclusive? – do we include as “mental health problems” experiences which fall within the normal range (whatever that might be – and that’s the real problem)? So, for example, do we medicalise misery, by calling the unhappiness, which is part of the human condition, depression? (Read about trends in anti-depressant prescribing in a Quality Watch Focus On report here.)

2. do we acquiesce with using diagnosis to distort services/ access to care? I heard recently from a General Practitioner that social services had refused to assess an older person with memory problems and difficulties in daily living until this individual had a diagnosis of dementia established. Shouldn’t we challenge this? Services should surely be based on need (ok maybe I’m naïve).

3. do we lose sight of the wonderful variety of people and experiences which might be regarded as “normal”?

4. Do we think about people’s strengths as much as we emphasise their deficits? I wrote about resilience in June 2011 (see link) and I still think we don’t help people to think about (or maybe strengthen) the resources they have to draw on in their lives.

How could we put sense back into the system?

1 comment (Add your own)

1. Dave Jolley wrote:
Drawing a line

So we have concepts of health and illness, stigma, labelling and parity. In summary – the sickness of our time.
I have not been troubled by the WHO definition of health. It has stood for a long time – perhaps saying that it has stood the test of time. People find it useful because it is simple, positive and takes a holistic approach across three dimensions of being. We might want to ask about the fourth – spirituality. But not to quibble.
In the same way, the high level description of Mental Health meets its purpose. It seems to me that attempts to revise these definitions would draw upon too many hours of too many people and too much paper to justify any minor improvements. Best to run with what we have and take the extremes which might follow their interpretation, with a pinch of salt: Life is never going to be perfect.
At Willow Wood Hospice last week we hosted the fifth teatime ‘network’ meeting for anyone on the locality interested and involved in dementia care. The meetings have been a revelation in terms of who comes and what is said in this informal tea-with-cake setting. Someone said ‘I go to lots of meetings about dementia and services, but we learn most coming here’. Thinking aloud we identified at least seven formal arenas where people in Tameside and Glossop are brought together to plan and agree and advise on approaches to dementia care. They all feed into a system of commissioning and implementation, budgets and standards. The beauty of our teatimes is they talk of what we can do, are doing and will encourage others to do – derestricted. We can do it in people’s homes, in care homes and in hospital. There is no need for forgiveness. It just works
It has to be a splendid thing that the health of the world population has progressively improved since 1946 – moving toward the ambition of global health as defined and measured by increased life expectation. We are glad of that and will see more of it.
The fact that many people have a limited understanding of mental health, mental illness and spiritual matters may be best accepted as a working ‘given’. Approaches aiming to improve physical health and social conditions will have positive impacts on mental health too.
In every way I agree that what we and our services should be doing is assessing need of individuals and responding to those needs in a personalised, acceptable and tailored way. Coats, shoes and trousers designed for a protocol-conceived incarnation of ‘dementia’, ‘depression’ or ‘paranoia’ will not give comfort or style to anyone

Tue, January 13, 2015 @ 5:57 PM

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