Monday 12 December 2011

Social model solutions to mental health

It's not rocket science to understand the psychosocial model (strictly
the spirtuobiopsychosocial model but that makes me sound crazy). The
psychiatrists and psychologists have dominated treatment. The social
model rarely gets applied to treatment.

Now before I sound too crazy let me explain poorly. The biospychosocial
model also asks for changing society as well as affecting individual
neurobiology and psychology. The psychiatric and psychological paradigms
work int he same way the medical field usually works: changing the
individual to heal or normalise them. The social paradigm requires the
change of society and culture as a priority of healthcare.

Now that's crazy and that's why NICE didn't include my comments about it
in this year's Equality Forum report. How the hell do doctors and
healthcare professionals change society to better outcomes and reduce
disability?

I use two examples to illustrate the potential of this way of thinking.
Time to Change is the first. It is the world's largest (per capita)
anti-mental health stigma and discrimination campaign in the world. It
was started by a coalition of organisations and initially funded with
National Lottery and Comic Relief money. Now it is largely funded by the
Deparment of Health. They're not tasked nor measured on changing
disability and social outcomes but they may inadvertently be doing it. A
large part of the disability and distress is caused by stigma and
discrmination. Making mental illness more acceptable and helping people
to work and live normal lives in accepting communities is beginning to
be achieved by the Time to Change campaign.

The other example of the progress is mobility disability over the last
century or two. Wheelchairs replaced crutches and now there's a
wheelchair which can go up stairs. This is conventional treatment.
Legislation means that large public buildings and workplaces also need
to be wheelchair accessible. This was a demand placed on society to
provide equality of access. It costs organisations a lot of money to
adhere to this duty but it means we live in a more equal society and the
exclusion faced by people with mobility disabilities is reduced.

The problem is coming up with more of these. Perhaps the change in
dementia treatment away from killing the patients because of their
challenging behaviour to asking carers and care home workers to
understand this behaviour is normal could be a direction of social
change in mental health. The same may be true for other conditions where
behaviour is considered aberrant, for example autism. Psychiatric or
psychological model perspective would seek to change the individual. The
social model treatment seeks to treat the other factors which affect the
individual and are also part of the pathology described by the
psychosocial model.

There can be other forms of social treatment too. There are social
treatments which change the systems in society which create disadvantage
and disability. Let's take mania and debt. It is very easy for a person
experiencing hypermania to get a loan. The ease and availablity of
credit without a basic check of the individual's state of mind at the
time is high and this is good because it is a personal freedom. However
people can make poor financial descisions when in states like mania or
when suicidal. This is from my personal experience.

My personal experience is also what happens after the risky decisions.
There are the consequences of financial risks and loans. bipolar is
characterised by periods of extreme mania which can involve reckless
spending then lows which make it hard for a person to work. When they do
work their income goes on paying of their debts which leaves them in
poverty. This all contributes to the misery of mental illness. The
impact of bad, problem and crisis debt is a person's credit record is
ruined so when they're well or in a depressed stage they face financial
exclusion as well as poverty.

Linking up the credit system with the mental health system could help as
long as freedom of information, confidentiality and financial rights
were preserved. My example would be my first hospitalisation. I took
out a £10,000 load I didn't need, had crazy business ideas, lost a well
paid corporate job and ended up under section. I didn't need the loan
and I was mentally ill when I was fired from my job. If the systems
linked up the loan could have been cancelled (i.e. repaid back
immediately because I was in a psychiatric ward shortly after taking the
loan out). It would be a simple way to reduce the disadvantage in life
created by debts racked up during a period of mental illness. If
psychiatric services were thinking more about preserving a patient's
life outcomes they could have spoken with my employer so I could
continue my job when I got better. None of that happened.

Social model thinking is vital to really bettering life outcomes and
what is core to the disability component. It is still very new though
and there is still a dearth of ideas.

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We It comes in part from an appreciation that no one can truly sign their own work. Everything is many influences coming together to the one moment where a work exists. The other is a begrudging acceptance that my work was never my own. There is another consciousness or non-corporeal entity that helps and harms me in everything I do. I am not I because of this force or entity. I am "we"