Redefining mental health

Do we need mental health support to manage our personality quirks and eccentricities?

A leaflet popped through my door a few weeks ago, and given that the general election was only a few days away, I assumed it was another election flyer.

I was about to bin it when I noticed that it was from our local mental health trust. It was information about a service – improving access to psychological therapies (IAPT). Stressed? Anxious? Low mood? If I needed help, I should consider talking to a therapist, it said.

The types of problems the service can help with include anxiety, obsessive compulsive disorder, panic attacks, phobias, and post-traumatic stress disorder, with different treatment options available.

So I read on about accessing the service. ‘If you feel unhappy and it is having a negative impact on your quality of life, there are three things you can do:

• Talk to your GP about a referral
• Refer yourself directly to the service
• Book a place on one of the free stress control classes.'

I was struck by two things: it is good to see that there is much less stigma attached to mental health these days and that the waiting time for appointments is only two weeks, less than for many routine GP appointments, and the possibility of seeing a variety of professionals once screened, including psychological wellbeing practitioners, cognitive behavioural therapists, counsellors and advocates, is interesting.

But I know that NHS mental health providers have slashed beds and staff levels as they cope with real-term funding cuts and the soaring cost of sending patients hundreds of miles away for treatment.

This concerns me, as does the fact that what many would consider ordinary problems, such as feeling low, anxious, forgetful or panicky, have been turned into mental health disorders.

Maybe that is not surprising considering we are regularly told that one in four of us will experience a mental health problem. I have struggled to understand how this could possibly be true, but think the explanation lies in the fact that mental health categories have been inflated to embrace a wider span of the population, including a third of children according to Surviving Identity: Vulnerability and the Psychology of Recognition by Kenneth McLaughlin.

In researching material for his book, McLaughlin compared four editions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). This showed that diagnostic categories have tripled, but the thresholds of what count as disorders have fallen.

So children who might have once been described as awkward, aggressive, fidgety, lacking concentration and generally immature, are now regularly diagnosed with conditions such as attention deficit hyperactivity disorder (ADHD). Many are consequently medicated, and schools are no longer expected to manage them without additional support.

Even the embarrassment of meeting people has been categorised as a ‘social phobia’, and is now included in the DSM-5.

In the leaflet, the solution to the problems listed is professional help. There is no mention of turning to family or friends, except when recommended as a possible solution once assessed by a professional.

It is a shame that so many of our various behaviours, sadnesses, quirks and eccentricities – considered part of life’s rich tapestry in a more tolerant and understanding past – are now labelled medical disorders. And that we are told we need professional help to manage them.

Meanwhile, there is a desperate shortage of professional psychiatric support for people with severe and enduring mental health problems.

Perhaps much of what IAPT seeks to ‘help’ with should be reconsidered, and resources diverted to where the needs are greatest?

First published here June 1st 2015