Social Perspective in Understanding Mental Distress - Essay Example

Social perspective in understanding mental distress and the ways in which this can inform practice Introduction The perception of mental health and mental distress in a society is shaped by the popular culture in that society which includes everyday language, art, and the media and the professional discourse such as social work and psychiatry. The interaction of the two produces a powerful fusion of both common sense and scientific concepts that can be hard to unravel. This paper explores the social model of addressing mental distress with a focus on the rational for championing such a model and its application. The social model theory Mental illness is almost universally understood as a disturbance in one or more areas of human functioning involving feelings, thoughts and behaviors. Several theories explaining mental illness exist and differ depending on the discipline concerned. The medical model is underpinned by the belief that mental health diagnosis involves the accurate naming of an objective disease process. The medical model is meant to provide practitioners with answers and certainties modeled on the scientific paradigm. But this system does not always provide objective professional judgement (Karben 2011). The medical model heavily relies on the interpretation of human emotions and behavior with the diagnosis being influenced by subjective attitudes and beliefs. Most psychiatrists do not willingly admit the uncertainty surrounding the diagnosis as psychiatry is not an exact science. The uncertainty of the medical model has exposed it to challenges and dissent from within and outside the profession with many contesting the validity of the medical model of mental illness. Most sociologists and dissident practitioners contend that the emotions and behaviors called symptoms and illnesses by psychiatrists should not be treated as pathological medical phenomenon; rather they are manifestations of socio-political forces that shape the lives of human beings (Karben 2011). Therefore, the process of categorizing people as mentally ill should be social rather than a medical means of pathologising emotions and behaviors deemed as unacceptable by society. While mental distress is real, mental illnesses are not entities as the medical model portrays them. Moreover, critics argue that formal classification and diagnostic systems are subject to limitations based on the methods used to create them, and psychiatric diagnosis is related to astrology as both systems attempt to define behavior and predict future events (Karben 2011). The social model of mental distress bases its explanations on independent life events that trigger breakdown such as isolation or violence and social forces linked to class like unemployment and poverty. These factors precipitate mental distress by linking it to issues of inequality, oppression and powerlessness (HMG 2009). Research indicates that most medical health service users see their difficulties as more rooted in the context of their life experiences rather than being symptoms of an illness. The services provided by mental health professionals tend to be too narrow and fail to engage with the priorities of the patients. The results of various researches show that the services that most mental health service users value most are in harmony with people’s normal living arrangements as well as social securities such as employment, housing and meaningful occupations. These findings made researchers conclude that mental health service users’ needs are best framed in personal and social rather than medical terms (HMG 2009). Proponents of the social model argue that the social model expands society’s understanding of mental distress beyond the narrow approach of treating symptoms. It provides a framework that is useful in defining the experiences of people in mental distress by enabling and supporting their recovery. While this model does not take an anti-psychiatry/medication approach, it refuses to privilege the medical model. It endorses a wide range of varying perspectives on mental health. Sociologists argue that lay diagnosis is the first step in establishing the person in mental distress as abnormal (HMG 2009). The social model approaches mental health assessment by first understanding the values as well as the facts of each case of mental illness. The practitioner looks beyond the individual’s condition by evaluating the environmental aspects of the case, such as family and friends. The practitioner takes into account the economic, socio-political and environmental factors that influence the patient’s condition. For example, a patient’s condition may be a response to problematic life experiences and, therefore, the distress might be a form of internalization of the stressful experiences. A favorable solution to the patient’s condition would require integration of the various dimensions of the patient’s life experiences (HMG 2009). The holistic method of mental health assessment requires critical analysis on the part of the practitioners. It takes into consideration the various personal and agency values and perspectives that influence the patient’s condition. The model requires practitioners to listen to mental health patients and their care-takers, and taking their views into consideration when designing a solution. The designed solution should be a partnership approach that is genuinely user-centered and empowering (Tew 2005). Society’s attitudes to people with mental distress Practitioners in the field of mental health need to realize that they do not practice in a moral or political vacuum. This is important for the development of an understanding of the relationship between mental distress and the wider society. The manifestation of mental distress can be frightening and disturbing for those experiencing it, those working with the patient and for those close to the patient (Tew 2005). Data accessed from the Department of Health, UK, indicates that fear and sympathy are common attitudes of society to people with mental distress. Society usually expresses sympathy towards the mentally distressed people while simultaneously supporting measures that effectively stigmatize and exclude such people from the rest of society. This indicates that people’s attitudes towards mental health problems are very complex and contradictory (Tew 2005). Official figures in the UK indicate that around 49% of the population knows somebody with mental illness while only 7% admit that they have experienced mental distress in their lives. 23% said that they would be reluctant to admit receiving psychiatric treatment to their friends. The survey, therefore, indicates that even though mental distress is common statistically, people tend to distance themselves from it. This might be an indication of taboos or fear around mental distress (Gould 2010). Gould in his longitudinal survey of mental illness found that, despite official integration into the society, alienation and exclusion practices towards mentally distressed patients were common place with acceptance being only rhetorical at best. A 2007 survey by the department of health UK found that there was prejudice across a wide variety of indicators including lack of equal consideration in employee recruitment and the believe that mentally ill people were more prone to violence. Therefore, any progressive political and social development programs meant to ameliorate the conditions of the mentally distressed in society must overcome the powerful ideological barriers imposed by the society (Gould 2010). People’s reluctance to admit mental health problems is rooted in their fear of the material consequences of exposure in the forms of oppression, inequality and discrimination. Social inequality affects the mentally ill in the form of social exclusion which creates distress while the tagging of mentally ill patients promotes punitive excluding policies and unfavorable public moods (Gould 2010). While popular culture and the media to some extent portrays the mentally distressed as unpredictable, violent and dangerous; research indicates that these themes are often exaggerated and are in stark contrast with evidence indicating that mentally ill patients are more likely the victims of violence. An obvious consequence of such stereotyping is that people avoid seeking professional help for their mental illness for fear of the stigma associated with the illness (Gilbert 2010). Research by Gilbert indicates that the stigma associated with mental distress is a major obstacle to better care and the improvement of the quality of life the patients live. It is, therefore, important for mental health practitioners and policy makers to challenge negative and damaging language, attitudes and representations in order to develop and implement non-stigmatizing and accessible mental health care (Gilbert 2010). There is evidence suggesting that mental health professionals and service providers may contribute to stigmatization through diagnostic labeling and through the process of providing treatment and services. For example, some researchers have questioned the appropriateness of the use of diagnostic labels on mental distress patients (Gilbert 2010). Social model in practice One method of implementing the social model to support mentally distressed people is social prescribing. Social prescribing involves devising mechanisms for linking patients with non-medical sources of support within the community. These sources of support might include sports, physical activity, learning new skills and employment opportunities. Such programs help patients develop alternative responses to mental distress, and improve access to mainstream services and opportunities. Social prescribing when used for people with mental distress, is associated with a wide range of positive outcomes, which include cognitive, emotional and social benefits. According to Gilbert, It is an especially effective way of reducing social exclusion (Gilbert 2010). The broad holistic framework of treatment, provided through social prescribing by emphasizing personal experiences, social conditions and relationships, is more compatible with lay understanding of mental health and mental distress than the conventional medical model. Therefore, society is more embracing of the social model compared to the medical model (Stickley and Bassett 2008). Tackling social exclusion of people with mental distress is fundamental to achieving improved quality of life for mental health service users as it aids recovery and leads to improved clinical outcomes. Several researchers have emphasised the importance of social networks, acceptance, friendships and opportunities to participate in and enjoy the full range of activities enjoyed by ordinary members of the society as critical to recovery for mentally distressed people (Stickley and Bassett 2008).  The Department of Health has shaped the government policy towards the prevention of ill health by increasing the range of interventions available to patients and promoting partnerships between health sector and social sector service providers. In particular, the “our health, our care, our say” policy formulated in 2008 decrees that information prescriptions can be given to all patients with a long-term condition or social health need in consultation with a social or health care professional. Information prescriptions guide people to relevant and easily accessible sources of information to allow them to feel secure, in control and more able to manage their condition while maintaining their independence. Social prescription can facilitate the implementation of information prescription programs and especially in helping patients address social determinants of mental illness (Stickley and Bassett 2008). The NICE guidelines of 2004 on managing anxiety and depression include self-help and self-management approaches in treating mental distress. These guidelines emphasize holistic approaches in treating mental illness. The guidelines recommend regular trials to test the efficacy of a wide range of social support interventions for socially isolated and vulnerable patients with depression. The guidelines emphasise social intervention approaches for people with mild and moderate depression through counseling, problem-solving therapy and CBT (cognitive behavior therapy) (Stickley and Bassett 2008). For people with chronic depression, the guidelines propose a combination of treatments with a focus on social support factors that may ameliorate their difficulties. Patients who may have been out of work for long periods may require special help to return to work as work provision is associated with positive outcomes in patients suffering from depression as the patients have access to a structured routine for each day, social contact and develop self-esteem as a result of such inclusion. Befriending is also recommended for patients with chronic depression as an adjunct to psychological or pharmacological treatment. Befriending is provided through trained volunteers who contact the patients every week for two to six months (Walsh 2004) Benefits of the social model Social intervention measures have been associated with positive outcomes among frequent attenders by tackling underlying issues of frequent attendance. Frequent attenders are patients who consult their GP more than 12 times a year and represent over 15% of the average GP’s workload. Walsh argues that frequent attendance is associated with unresolved mental health issues with depressive symptoms being a major predictor of frequent attendance (Walsh 2004). A review of literature by Stickley and Bassett on evidence for self-help interventions for mental distress patients found that several benefits could be derived from the use of self-help materials based on CBT approaches. They suggested that self-help materials were safer when supported by a healthcare professional. Stickley and Bassett also found out that bibliotherapy had a high patient acceptability and that patients continued to improve over time with low relapse rates. Bibliotherapy is cost effective though its efficacy dependent on the type and quality of the book, the motivation and the application of the user (Walsh 2004; (Stickley and Bassett 2008)). Walsh provides evidence in support of mental health benefits of physical activity. He argues that physical activity improves the quality of life for mental health patients, prevents the occurrence of mental illness and improves the mental well being of the general public. Exercise is an effective remedy for ameliorating negative symptoms of schizophrenia, depression and anxiety. Exercises are also a useful strategy for coping with hallucinations (Walsh 2004). Walsh asserts that there is evidence of arts and creativity ameliorating the condition of mental distress when used in social intervention. Arts related activities include painting, writing, music, poetry, drama and dance. Participation in arts improves self-esteem and self-worth and is an important resource for promoting social inclusion and strengthening communities. Several studies have associated creative activities with positive mental health outcomes. The benefits are related to the development of self expression and self esteem as well as providing opportunities for social contact and participation. A qualitative study by friedli on young African and Caribbean men in East London found strong support for arts and creativity opportunities as a means of ameliorating mental distress. Arts and creativity were projected as protective factors against racism and discrimination (CSIP 2008; (Walsh 2004)). Several researchers have associated volunteering with mental health benefits with the older volunteers more likely to gain psychological benefits from voluntary work than younger people. Volunteering has been associated with positive outcomes like enhanced mental health and reduction in depression and depressive symptoms. In a review of 37 studies, Walsh found that 70% of older volunteers scored higher quality of life measures than those peers who did not volunteer. For those patients who received social intervention through volunteer work 85% indicated improvement as a result of having more contacts, which reduced isolation (CSIP 2008; (Walsh 2004)). Conclusion Even though the occurrence of mental distress is common in most societies, most patients experiencing mental distress are subjected to isolation and stigmatisation due to the misconception that they are crude and violent. The medical profession has not helped the situation as they are likely to use unpleasant tags while serving patients with mental distress. The social model aims at engaging mentally ill persons by helping them build relationships and establish contacts that allow them to fully participate in routine activities done by healthy people. This form of holistic intervention is more compatible with the understanding of lay citizens and gives them an opportunity to serve mentally ill patients. Bibliography: Karben, K., 2011. Social Work and Mental Health. Cambridge: Polity Press HMG, 2009. No Health Without Mental Health London. Accessed on 22nd Feb, 2013 www.dh.gov.uk/en/Aboutus/Features/DH 123998 Tew, J. (ed) 2005. Social Perspectives in Mental Health. London: Jessica Kingsley Press Gould, N., 2010. Mental Health Social Work in Context. London: Routledge Gilbert, P., 2010. The value of everything: Social work and its importance in the field of mental health, second edition. Lyme Regis: Russell House Publishers CSIP., 2008. Social prescribing for mental health – a guide to commissioning and delivery. Accessed on 22nd Feb, 2013 from: http://www.mhne.co.uk/files/MHNE126.pdf Stickley, T., and Bassett, T., 2008. Learning about mental health practice. Hoboken, N.J.: Wiley; Chichester: John Wiley [distributor] Walsh, M., 2004. Introduction to sociology for health carers. Cheltenham : Nelson Thornes Read More