Mental health and the social model (plus a bit of nonsense from the Guardian’s sub-editors) (updated)

For the past 10 years or so, my work has been in the area of disability rights, especially from a user perspective.

One of the great privileges of that work is observing the reactions of people – disabled and non-disabled people alike – when they are introduced to the Social Model of Disability, and how it affects their attitudes and everyday life in the subsequent weeks, months and years.

To recap: there are various models of disability. The two most common are the “medical” model and the “social” model.

The medical model focuses on the medical condition of a person – their impairment; their condition; their disease. And it looks for ways for these to be diagnosed, categorised and ultimately cured. What flows from the medical model of disability is typically a focus on someone’s physical or mental condition rather than the person themselves.

The social model of disability puts the person at the centre. It says that a person is disabled by society around them – not just physical barriers such as steps or revolving doors, but also by attitudes towards disabled people (such as pity, charity or fear). Though a disabled person still has an impairment (i.e. in the broadest sense their condition), what makes them disabled is not their condition, it’s society.

Many important things flow from this shift in thinking, and it’s how people approach this shift in thinking that’s such a great privilege to observe.

(For anyone who is interested in more about different models of disability and their implications this guide is an excellent introduction, and I’ve written at further length about this here.)

Why am I blogging on this now? It’s because there’s a fascinating debate at the moment about how the social model of disability (or other models) apply, or not, or some version of it, specifically to the area of mental health.

The latest manifestation of this debate is prompted by the division of clinical psychology (DCP), part of the British Psychological Society, who will be publishing a statement that calls for a “paradigm shift” in how mental health is understood.

(Update: here’s the statement (pdf)).

It’s great that this professional body is engaging in the debate in this way. It draws on a significant literature that mental health users/survivors and others have been writing for a considerable time – see, for example, this paper from the Joseph Rowntree Foundation from 2010 or pretty much anything on the social model from the Centre for Disability Studies at Leeds. This is also a significant theme that runs through the literature on recovery and mental health (such as these papers from the Implementing Recovery through Organisational Change project).

It will be interesting to see how the debate progresses, and good on DCP for going with it.

In their usual subtle contribution to the issue at hand, the Guardian’s sub-editors have called this a “battle” between the British Psychological Society and the Royal College of Psychiatrists. To ensure maximum helpfulness, the Guardian also poses the question “Do we need to change the way we are thinking about mental illness?” and asks people from both “sides” to argue either “yes” (clinical psychologist) or “no” (clinical psychiatrist).

In understanding this to be a debate that perhaps can’t be characterised in such black and white terms, below are 3 principles I modestly suggest it will be useful to keep in mind:

  1. It’s not an either/or between a social and medical way of thinking about mental health – these things are complicated, endlessly fascinating and subject to however people choose to perceive them from whatever their perspective might happen to be at any particular time
  2. Let’s ensure that all people have a chance to contribute to and define this debate: it’s particularly important – paramount, actually – that people with mental health conditions themselves are central to the debate, with professionals, family, carers and others all contributing
  3. We mustn’t forget that these debates – genuinely fascinating and important as they are – don’t always have an immediate impact on the lives of people with mental health conditions and their day-to-day experiences of public services. Alongside the theoretical debates, there is a lot we can all practically do to improve people’s experience of mental health services and their lives as part of their local communities.

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Man of letters & numbers; also occasionally of action. Husband to NTW. Dad of three. Friendly geek.

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