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A Manifesto for Psychological Health and Wellbeing
Abstract
Traditional thinking about mental healthcare is profoundly flawed, and radical remedies are required. Our present approach to helping people in acute emotional distress is severely hampered by old-fashioned and incorrect ideas about the nature and origins of mental health problems, and vulnerable people suffer as a result of inappropriate treatment. We must move away from the ‘disease model’, which assumes that emotional distress is merely a symptom of biological illness, and instead embrace a psychological and psychosocial approach to mental health and wellbeing that recognises our essential and shared humanity. The need for reform in mental health services is acute, severe and unavoidable. This demands nothing less than a manifesto for change.
... These critical approaches systematically problematize the field of mental health and contemporary assumptions about practices, priorities, and knowledge bases, which have dominated understandings of and responses to mental distress (Cohen, 2018). While there is variability in the critical mental health literatures, as it informs this analysis, we challenge biomedical, individualized, and reductionist understandings of mental health with increased focus on the context for mental distress including living conditions, personal relationships, histories of trauma, and the systems within which people live and work (Bracken et al., 2012;Kinderman, 2017;LeFrançois et al., 2013;Malcoe & Morrow, 2017). Analysis was informed also by the researchers' positionality working in EMS systems and academic training related to mental health informing the existing experience, familiarity with EMS culture, and prior assumptions of the researchers to this work. ...
Despite behavioral health emergencies (BHEs) representing a significant percentage of calls for service, very little is known about how frequently personnel receive training, satisfaction with the training, and relative confidence in BHEs. Further, despite a significant body of evidence pointing to stigma as a factor influencing outcomes in health care, the prevalence of stigma and the impact of training or personal experience on reducing stigma are underexplored. In this study, we sought to describe the frequency and type of behavioral health training received by emergency medical services (EMS) personnel, the perceived adequacy of the training, the relative confidence in treating patients with behavioral health concerns, and how training and personal experiences may influence stigmatizing views related to behavioral health. A convenience sample of American EMS personnel was invited to complete a survey that included both standardized measures and open-ended questions exploring the frequency and type of training related to BHE, mental health stigma, and personal experiences with BHE. A total of 512 respondents completed the survey. While respondents reported training in BHEs during their initial training, recertification, and during continuing education as well as high levels of satisfaction with training, training did not appear to influence stigmatizing views. Personal experiences were significantly related to lower levels of stigma. Qualitatively, participants reflected on themes around communication, safety, and changes in training. These findings, while exploratory, demonstrate that while participants have received training on BHEs, the current training does not appear to mitigate the stigma against those with mental health concerns. Implications for future educational efforts are discussed.
... Psychological health involves a normal emotional, behavioral, and social maturity of a person (Kinderman, 2017). This simply means that such an individual can function optimally in the society. ...
Purpose: Psychological health has been reported as an important factor influencing individual’s various behaviors, activities, happiness and performance. This study examined burden of care, social support and emotional intelligence among caregivers of mentally ill patients as correlates of psychological health Materials and Methods: The research sample included two hundred (200) caregivers that were selected from the Federal Neuro-psychiatric hospital Yaba, Nigeia, using simple random sampling. They were individually administered the Zarit Burden Interview (ZBI), multidimensional scale of perceived social support (MSPSS), emotional intelligence scale (EI) and General Health Questionnaire. The study adopted a correlational design. A multiple regression analysis was used to analyze the data. Four hypotheses were tested using statistical package for social sciences version 23. Findings: The results indicate that there was significant inverse relationship between burden of care and psychological health (r= -.643, df = 200, p<.01). Also, there was positive significant relationship between emotional intelligence and psychological health (r= .172, df = 200, p<.05). There was significant positive relationship between social support and psychological health (r= .322, df = 200, p<.01). Finally, caregivers’ burden of care, emotional intelligence and perceived social support jointly predicted psychological health (R2 = 0.44, F (3,196) = 51.63, p < .01). Burden of care (β = -.595, t=-10.64, p<.05) and perceived social support (β = .210, t=2.39, p<.05) were significant independent predictors of psychological health. While emotional intelligence (β = .052, t=0.61, p>.05) found to have no independent significant prediction on the psychological health. The findings of the study were discussed and it suggested the need for caregiver education and support programs. Recommendation: The study recommends that family support groups should be created for assisting caregivers and advocating for the promotion of their well-being in society.
... Potential medicalization of everyday problems in living. Despite aiming for cultural validity, the ICD-like the DSMremains rooted in a medical model, which critics believe overattributes mental distress to individual afflictions at the expense of social-cultural explanations (Kinderman, 2017). By making criteria more inclusive, diagnostic manuals do risk medicalizing everyday problems (Paris, 2015). ...
Various researchers have been developing alternatives to the Diagnostic and Statistical Manual of Mental Disorders (fifth edition; DSM–5). However, most clinicians are too busy to keep up with progress on these alternatives. Therefore, this article serves as a “primer” for clinicians by introducing four alternatives to the DSM–5 that are currently garnering significant attention: International Classification of Diseases (10th and 11th editions), Psychodynamic Diagnostic Manual–2, hierarchical taxonomy of psychopathology, and power threat meaning framework. The research domain criteria research initiative is also briefly discussed. The basics of each alternative system are presented and their primary strengths and weaknesses identified. All four systems show promise but have significant obstacles to overcome before they can be deemed viable substitutes for the DSM–5.
... The call made by psychologists and scholars to abandon the "Disease Model" of Mental Health and move to a "Psychosocial Model" abundant in the extant literature (Allsopp et al., 2019;Awenat et al., 2013;Bakker, 2019;Bentall, 2014;Deacon, 2013;Goldacre, 2014;Guerin, 2017;Hengartner & Lehmann, 2017;Kinderman, 2017;Middleton, 2015;Pemberton & Wainwright, 2014;Timimi, 2014) can no longer be ignored. Current traditional biomedical models that use categorical diagnostic approaches to mental health, such as those codified in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-created by the American Psychiatric Association (APA), and the International Classification of Diseases (ICD)-developed by the World Health Organization (WHO), have wielded a strong legacy in academic research, the mental health industry, and society at large (Dalgleish et al., 2020). ...
This article offers a transdiagnostic framework for the prevention and treatment of mental health by reducing early psychopathology. The framework supports the contention that the time has come to retire dominant categorical classification systems of mental disorders (e.g. DSM and ICD), and the current prevailing biomedical model of mental illness by moving to a psychosocial model of psychopathology. This entails reclaiming and integrating the long-standing legacy of psychology with recent advances in neuroscience and related disciplines. To this end, this conceptual paper synthesizes and integrates the extant literature and empirical findings, takes a scientist-practitioner stance, and draws on recent developments in transdiagnostic approaches to mental health, psychotherapy integration and advances in modern attachment theory. The advantages of this approach are that: 1) Clarifies the existing confusion surrounding the myriad of different interventions available; 2) Enables consistent funding guidelines from healthcare and community education systems; 3) Is more likely to have a greater positive impact for most people; 4) Reduces general psychopathology risks in childhood; 5) Avoids the challenge that prevention is less successful in later life; 6) Better addresses the stigma associated with mental illness; and 7) Maximizes the efficiency of interventions.
... Exposure to people, their values and attitudes, influences feelings towards those individuals forming a subjective norm about their behaviours, which can influence behaviours alongside attitudes (Ajzen & Fishbein, 1977, 1980Ajzen, 1991). In addition to raising awareness, researchers need to determine the demographic predictors of mental health awareness (Jorm, 2000) to inform tailored mental health interventions to promote help seeking (Kinderman, 2017). ...
Recent evidence suggests that attempts to tackle mental health stigma in athletes should include psychological theory to understand the competitive sport environment. Using the Theory of Reasoned Action (TRA), the aim was to determine what demographic and psychological factors predicted mental health stigma among athletes. Athletes (n = 471) completed a questionnaire, and a multiple linear regression analyses was conducted, specifying demographic (e.g., gender), psychological (e.g., norms) and moderating variables (e.g., sport type) as predictors of stigma-related intentions to socialise with individuals who are living with a mental health condition. TRA models explained a significant amount of variance for intentions, in which knowledge about and exposure to individuals with mental health conditions significantly predicted better intentions. Further, athletes competing in team sports, particularly females, had stronger intentions. This was the first study to explore mental health stigma using the TRA. Findings can inform the development of mental health awareness programs for athletes.
This study examined the widely held belief that a disease view of mental disorder reduces stigma. Behavioral and self-report measures were used to assess 55 male students' treatment and attitudes toward another, whom they believed either to be a typical student or to have a history of mental disorder. The mental difficulties were characterized in either disease or psychosocial terms. The results indicate that the way in which mental disorder is represented does have an effect on behavior and on some aspects of evaluation. In general, the disease view did not improve attitudes, except in terms of blame. It did, however, tend to provoke harsher behavior. In contrast, the psychosocial view induced treatment no different from that toward normal others. The results provide little support for the claim that regarding the mentally disordered as sick or diseased will promote greater acceptance and more favorable treatment.
Non-communicable diseases have been established as a clear threat not only to human health, but also to development and economic growth. Claiming 63% of all deaths, these diseases are currently the world’s main killer. Eighty percent of these deaths now occur in low- and middle-income countries. Half of those who die of chronic non-communicable diseases are in the prime of their productive years, and thus, the disability imposed and the lives lost are also endangering industry competitiveness across borders.
A series of editorials in this Journal have argued that psychiatry is in the midst of a crisis. The various solutions proposed would all involve a strengthening of psychiatry's identity as essentially 'applied neuroscience'. Although not discounting the importance of the brain sciences and psychopharmacology, we argue that psychiatry needs to move beyond the dominance of the current, technological paradigm. This would be more in keeping with the evidence about how positive outcomes are achieved and could also serve to foster more meaningful collaboration with the growing service user movement.
To determine whether English regions worst affected by the economic recession in the United Kingdom in 2008-10 have had the greatest increases in suicides.
Time trend analysis comparing the actual number of suicides with those that would be expected if pre-recession trends had continued. Multivariate regression models quantified the association between changes in unemployment (based on claimant data) and suicides (based on data from the National Clinical Health Outcomes Database).
93 English regions, based on the Nomenclature of Territorial Units Statistics level 3 groupings of local authorities at county level and groups of unitary local authorities.
Men and women with a record of death from suicide or injury of undetermined cause in 2000-10.
Number of excess suicides during the economic recession (2008-10).
Between 2008 and 2010, we found 846 (95% confidence interval 818 to 877) more suicides among men than would have been expected based on historical trends, and 155 (121 to 189) more suicides among women. Historically, short term yearly fluctuations in unemployment have been associated with annual changes in suicides among men but not among women. We estimated that each 10% increase in the number of unemployed men was significantly associated with a 1.4% (0.5% to 2.3%) increase in male suicides. These findings suggest that about two fifths of the recent increase in suicides among men (increase of 329 suicides, 126 to 532) during the 2008-10 recession can be attributed to rising unemployment.
The study provides evidence linking the recent increase in suicides in England with the financial crisis that began in 2008. English regions with the largest rises in unemployment have had the largest increases in suicides, particularly among men.
Although childhood abuse is a recognised risk factor for depression, post-traumatic stress disorder, and substance misuse, its role in the aetiology of psychotic disorder remained controversial. This is in part because the putative effect of childhood trauma on psychosis has been mostly evaluated by small, cross sectional, uncontrolled studies that raised methodological issues.
Papers concerning the association between childhood trauma and psychotic disorders (to November, 2011) were identified using a comprehensive search of PubMed, Psychinfo, and Scopus and analysing reference list of relevant papers. A narrative synthesis was used to summarise results.
An association between childhood abuse and psychotic symptoms was consistently reported by large cross sectional surveys with an effect ranging from 1.7 to 15. However, we cannot conclude that the relationship is causal as lack of longitudinal studies prevent us from fully excluding alternative explanations such as reverse causality. Gender, cannabis use, and depressive and post-traumatic stress disorder symptoms appear to moderate the effect of childhood trauma on psychotic disorders. However, specificity of childhood abuse in psychotic disorders and, particularly, in schizophrenia has not been demonstrated.
Although the association between childhood abuse and psychosis has been replicated, the etiological role of such early adversity has yet to be fully clarified. So far none of the studies reported support the hypothesis that childhood abuse is either sufficient or necessary to develop a psychotic disorder. It seems likely that any effect of childhood abuse on schizophrenia needs to be understood in terms of genetic susceptibility and interaction with other environmental risk factors.
Evidence suggests that adverse experiences in childhood are associated with psychosis. To examine the association between childhood adversity and trauma (sexual abuse, physical abuse, emotional/psychological abuse, neglect, parental death, and bullying) and psychosis outcome, MEDLINE, EMBASE, PsychINFO, and Web of Science were searched from January 1980 through November 2011. We included prospective cohort studies, large-scale cross-sectional studies investigating the association between childhood adversity and psychotic symptoms or illness, case-control studies comparing the prevalence of adverse events between psychotic patients and controls using dichotomous or continuous measures, and case-control studies comparing the prevalence of psychotic symptoms between exposed and nonexposed subjects using dichotomous or continuous measures of adversity and psychosis. The analysis included 18 case-control studies (n = 2048 psychotic patients and 1856 nonpsychiatric controls), 10 prospective and quasi-prospective studies (n = 41,803) and 8 population-based cross-sectional studies (n = 35,546). There were significant associations between adversity and psychosis across all research designs, with an overall effect of OR = 2.78 (95% CI = 2.34-3.31). The integration of the case-control studies indicated that patients with psychosis were 2.72 times more likely to have been exposed to childhood adversity than controls (95% CI = 1.90-3.88). The association between childhood adversity and psychosis was also significant in population-based cross-sectional studies (OR = 2.99 [95% CI = 2.12-4.20]) as well as in prospective and quasi-prospective studies (OR = 2.75 [95% CI = 2.17-3.47]). The estimated population attributable risk was 33% (16%-47%). These findings indicate that childhood adversity is strongly associated with increased risk for psychosis.
The recent drive within the UK National Health Service to improve psychosocial care for people with mental illness is both understandable and welcome: evidence-based psychological and social interventions are extremely important in managing psychiatric illness. Nevertheless, the accompanying downgrading of medical aspects of care has resulted in services that often are better suited to offering non-specific psychosocial support, rather than thorough, broad-based diagnostic assessment leading to specific treatments to optimise well-being and functioning. In part, these changes have been politically driven, but they could not have occurred without the collusion, or at least the acquiescence, of psychiatrists. This creeping devaluation of medicine disadvantages patients and is very damaging to both the standing and the understanding of psychiatry in the minds of the public, fellow professionals and the medical students who will be responsible for the specialty's future. On the 200th birthday of psychiatry, it is fitting to reconsider the specialty's core values and renew efforts to use psychiatric skills for the maximum benefit of patients.
Research indicates that the 'mental illness is an illness like any other' approach to destigmatisation has failed to improve attitudes. This study replicated, with 469 New Zealanders, previous findings that the public tends to reject biological and genetic explanations of mental health problems in favour of psychosocial explanations focused on negative life events. It also confirmed previous findings (contrary to the assumption on which most destigmatisation programmes are based)that biological and genetic causal beliefs are related to negative attitudes, including perceptions that 'mental patients' are dangerous, antisocial and unpredictable, and reluctance to become romantically involved with them. The amount of reported personal contact with people who had received psychiatric treatment was correlated with positive attitudes. It is recommended that destigmatisation programmes consider abandoning efforts to promulgate illness-based explanations and focus instead on increasing contact with and exposure t...
The recent discussions over the reliability, validity, utility, humanity and epistemology of psychiatric diagnosis have had wider implications than might at first sight be apparent. Diagnosis is, for many people, both the entry-point to services and the starting-point for public debate. Challenges to the scientific and professional basis for diagnosis, therefore, can have profound implications. Such is the dominance of traditional diagnostic thinking about mental health care that it is often wrongly assumed that there is little alternative – or that any possible alternatives would require lengthy and expensive periods of development. In fact, there is no present impediment to the development of new ways of thinking and delivering services, and especially no impediment to practical and scientifically valid alternatives to diagnosis.
Health professionals must enquire about issues such as low self-esteem when reviewing patients with acne.
This is a book. It will have to be ordered from the publisher, John Wiley, in New York.
This book, based on thirty years' research, goes an important stage beyond either of these ideas: it demonstrates that more unequal societies are bad for almost everyone within them---the well-off as well as the poor. The remarkable data the book lays out and the measures It uses are like a spirit level which we can hold up to compare the conditions of different societies. The differences revealed, even between rich market democracies, are striking. Almost every modern social and environmental problem---ill-health, lack of community life, violence, drugs, obesity, mental illness, long working hours, big prison populations---is more likely to occur in a less equal society. The Spirit Level goes to the heart of the apparent contradiction between the material success and social failings of many modern societies, but it does not simply provide a key to diagnosing our ills. It tells us how to shift the balance from self-interested 'consumerism' to a friendlier and more collaborative society. It shows a way out of the social and environmental problems which beset us and opens up a major new approach to improving the real quality of life, not just for the poor but for everyone. It is, in its conclusion, an optimistic book, which should revitalize politics and provide a new way of thinking about how we organize human communities. As the authors write, 'It falls to our generation to make one of the biggest transformations in human history. The role of this book is to point out that greater equality is the material foundation on which better social relations are built.' (PsycINFO Database Record (c) 2012 APA, all rights reserved)(jacket)
With the advent of community psychiatry, the pressure of care of the mentally ill will increasingly fall on the family and the community. In order for this transition to succeed, it is important to bear in mind the attitudes of the community and the caregivers. This article reviews the literature on public attitudes and suggestions are made for future research and lessons to be learnt from the experience in Northe America.
After decades of ignoring or minimising the prevalence and effects of negative events in childhood, researchers have recently established that a broad range of adverse childhood events are significant risk factors for most mental health problems, including psychosis. Researchers are now investigating the biological and psychological mechanisms involved. In addition to the development of a traumagenic neurodevelopmental model for psychosis, the exploration of a range of psychological processes, including attachment and dissociation, is shedding light on the specific aetiologies of discrete phenomena such as hallucinations and delusions. It is argued that the theoretical, clinical and primary prevention implications of our belated focus on childhood are profound.
Large, rare chromosomal deletions and duplications known as copy number variants (CNVs) have been implicated in neurodevelopmental disorders similar to attention-deficit hyperactivity disorder (ADHD). We aimed to establish whether burden of CNVs was increased in ADHD, and to investigate whether identified CNVs were enriched for loci previously identified in autism and schizophrenia.
We undertook a genome-wide analysis of CNVs in 410 children with ADHD and 1156 unrelated ethnically matched controls from the 1958 British Birth Cohort. Children of white UK origin, aged 5-17 years, who met diagnostic criteria for ADHD or hyperkinetic disorder, but not schizophrenia and autism, were recruited from community child psychiatry and paediatric outpatient clinics. Single nucleotide polymorphisms (SNPs) were genotyped in the ADHD and control groups with two arrays; CNV analysis was limited to SNPs common to both arrays and included only samples with high-quality data. CNVs in the ADHD group were validated with comparative genomic hybridisation. We assessed the genome-wide burden of large (>500 kb), rare (<1% population frequency) CNVs according to the average number of CNVs per sample, with significance assessed via permutation. Locus-specific tests of association were undertaken for test regions defined for all identified CNVs and for 20 loci implicated in autism or schizophrenia. Findings were replicated in 825 Icelandic patients with ADHD and 35,243 Icelandic controls.
Data for full analyses were available for 366 children with ADHD and 1047 controls. 57 large, rare CNVs were identified in children with ADHD and 78 in controls, showing a significantly increased rate of CNVs in ADHD (0·156 vs 0·075; p=8·9×10(-5)). This increased rate of CNVs was particularly high in those with intellectual disability (0·424; p=2·0×10(-6)), although there was also a significant excess in cases with no such disability (0·125, p=0·0077). An excess of chromosome 16p13.11 duplications was noted in the ADHD group (p=0·0008 after correction for multiple testing), a finding that was replicated in the Icelandic sample (p=0·031). CNVs identified in our ADHD cohort were significantly enriched for loci previously reported in both autism (p=0·0095) and schizophrenia (p=0·010).
Our findings provide genetic evidence of an increased rate of large CNVs in individuals with ADHD and suggest that ADHD is not purely a social construct.
Action Research; Baily Thomas Charitable Trust; Wellcome Trust; UK Medical Research Council; European Union.
Many anti-stigma programmes use the 'mental illness is an illness like any other' approach. This review evaluates the effectiveness of this approach in relation to schizophrenia.
The academic literature was searched, via PsycINFO and MEDLINE, to identify peer-reviewed studies addressing whether public espousal of a biogenetic paradigm has increased over time, and whether biogenetic causal beliefs and diagnostic labelling are associated with less negative attitudes.
The public, internationally, continues to prefer psychosocial to biogenetic explanations and treatments for schizophrenia. Biogenetic causal theories and diagnostic labelling as 'illness', are both positively related to perceptions of dangerousness and unpredictability, and to fear and desire for social distance.
An evidence-based approach to reducing discrimination would seek a range of alternatives to the 'mental illness is an illness like any other' approach, based on enhanced understanding, from multi-disciplinary research, of the causes of prejudice.
Licensed London taxi drivers show that humans have a remarkable capacity to acquire and use knowledge of a large complex city to navigate within it. Gray matter volume differences in the hippocampus relative to controls have been reported to accompany this expertise. While these gray matter differences could result from using and updating spatial representations, they might instead be influenced by factors such as self-motion, driving experience, and stress. We examined the contribution of these factors by comparing London taxi drivers with London bus drivers, who were matched for driving experience and levels of stress, but differed in that they follow a constrained set of routes. We found that compared with bus drivers, taxi drivers had greater gray matter volume in mid-posterior hippocampi and less volume in anterior hippocampi. Furthermore, years of navigation experience correlated with hippocampal gray matter volume only in taxi drivers, with right posterior gray matter volume increasing and anterior volume decreasing with more navigation experience. This suggests that spatial knowledge, and not stress, driving, or self-motion, is associated with the pattern of hippocampal gray matter volume in taxi drivers. We then tested for functional differences between the groups and found that the ability to acquire new visuo-spatial information was worse in taxi drivers than in bus drivers. We speculate that a complex spatial representation, which facilitates expert navigation and is associated with greater posterior hippocampal gray matter volume, might come at a cost to new spatial memories and gray matter volume in the anterior hippocampus.
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