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?

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