Report finds support for efforts to find a social model of mental distress

Most mental health service-users are still deeply divided about identifying with the social model of disability, but still favour moving away from the medicalised attitude of professionals and towards a more “social” approach, according to a new report.

The user-led research aimed to investigate how a more “social” approach to thinking about mental distress could be developed, in the face of the traditional medical model that dominates the views of both the public and professionals.

Most of the service-users interviewed for the report said they believe that the medical model approach leads to an “over-emphasis on drug treatments”, and is “stigmatising and damaging”.

Although the government has pledged to secure “parity of esteem” for mental health with physical healthcare, there is concern at a growing crisis in services, an increasing use of compulsory treatment, a large number of service-users in prison, a low number with jobs, and “continuing high levels of suicide and self-harm”, the report says.

The report says that the big mental health charities like Mind, Rethink and the Mental Health Foundation (MHF) need to look “much more critically” at their insistence on sticking to “medical understandings of mental distress which many service users ?nd damaging and unhelpful”.

It also says that mental health system survivors interviewed for the research gave a “very mixed response” to the anti-stigma campaigns like Time to Change, which have secured “major public and political interest”.

The report, From Mental Illness To A Social Model Of Madness And Distress, was funded by the Joseph Rowntree Foundation, and was published this week by two service-user organisations, Shaping Our Lives (SOL) and the National Survivor User Network (NSUN).

The report was written by four researchers with personal experience of the mental health system: Peter Beresford, Rebecca Perring, Mary Nettle and Jan Wallcraft.

They conclude that “social approaches” are likely to have “massive traction with mental health service users/survivors, but not if they are narrowly based on the social model of disability”.

Views on the social model – which argues that disability is caused by barriers in society – are still “polarised”, six years after the first stage of the research project concluded that “further discussions about more social approaches to mental health were needed”.

Mental health system survivors are “particularly divided” about the social model idea that disabled people have an impairment that is separate to the disability they face. 

The report, launched at a joint NSUN and SoL event in Birmingham yesterday (8 June), says: “There is an irony in that disabled people developed the social model to escape from the prevailing medicalised individual model of disability, but for some survivors, the concept of impairment feels like a re-imposition of a medical model on them which treats their experience like a physical or chemical problem.”

One survivor told researchers: “I wouldn’t accept that I have an impairment or a disability, because I feel that my problems are caused by childhood… and a dysfunctional family.

“That doesn’t mean that I am now disabled, I think that’s a nonsense for me, it makes no sense.

“But it does mean that I have mental health needs and that I can’t engage in the workplace in the way that other people can for various reasons.”

But many survivors still believe it is “possible and helpful” to support the broader disabled people’s movement, while “retaining their own distinct identity as mental health service users”.

One said: “I strongly agree, because so far all social justice work (which is a crucial part of the social model) has been undertaken by physical disability activists.

“Mental health has been riding on its coat tails. I do identify as disabled.”

One of the suggestions that came from participants in the research was that a bene?ts system based on a social approach would “reduce rather than reinforce stigma and the negative stereotyping of mental health service users and challenge rather than add to the hostility and discrimination they face”.

They also highlighted the importance of moving towards a system which “values people experiencing distress and their potential contribution, for example, through voluntary work and community involvement”.

One of the report’s recommendations is for “adequate and secure funding” for smaller, user-led organisations, which tend to encourage the involvement of service-users and “show a greater understanding” of social approaches to explaining mental distress.

Beresford (pictured), SOL’s chair and emeritus professor of social policy at Brunel University, said he believed the research showed the need for survivors to be given opportunities to work together to reach an understanding about a new model.

He said that psychiatric provision was still largely stuck in the past, with a “medicalised” approach.

He said: “All the talk [from professionals] is, ‘We will get it cracked with bio-medical or related approaches’… and it ain’t working.

“I still think the lesson of the last decade is we are on the wrong track and that is what people are saying here.

“They do feel we need a much more social model and we need to move away from a narrow bio-medical one.”

And he said that the big mental health charities like Mind, Rethink and MHF needed to think again about their own approaches.

He said: “Mind has got close to government, for example in relation to policy formation.

“All of those organisations are signed up effectively to a biomedical model of distress which people we have spoken to now on two occasions… say is inherently problematic.”