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Lynne Friedli
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mental health; mental illness: how should we respond?
Lynne Friedli
Fair Deal for Mental Illness Debate: Socialist Health Association
Coventry16th May 2009
Socialist Health Association [email protected]
This being human is a guest house.Every morning a new arrival.A joy, a depression, a meanness,Some momentary awareness comesAs an unexpected visitor.Welcome and entertain them all.Even if they’re a crowd of sorrows,Who violently sweep your houseEmpty of its furniture.Still treat each guest honourably.He may be clearing you out for some new delight.The dark thought, the shame, the malice,Meet them at the door laughing,And invite them in. (Jelaluddin Rumi, 1207-73)
During these months something had matured in meAll I’d to do was let it flourish.Just to have grown enough to accept my destiny.
Every pretty blouse I put on a kind of celebration.I feel so light and radiant and cheerful.In suffering we share our loss with all creation.
No admittance to Jews. The air I breathe is mine.That man cycling on Beethovenstraat,His yellow star of David a crocus in the sunshine.
Such ripening strength. Gone the Bohemian waif.I want to be there at every front.I don’t ever want to be what they’ll call ‘safe’.
from Etty Hillesum by Micheal O’Siadhail
Socialist Health Association [email protected]
Socialist Health Association [email protected]
Dimensions of mental health
Mental health
(capital)
Emotional resources e.g. coping style,
mood, emotional intelligence
Cognitive resources e.g. learning style,
knowledge, flexibility,
innovation, creativity
Social skills e.g. listening, relating, communicating, co
operating
Meaning and purpose e.g. vision, goals,
connectedness
If I am not for myself, who will be for me? And if I am only for myself, what am I? If not now, when?
Outcomes associated with positive mental health
A worthwhile goal in itself and leads to better outcomes:• reduces prevalence of mental illness• physical health: mortality/morbidity• health behaviour• employability, productivity, earnings• educational performance • crime / violence reduction• pro-social behaviour/social
integration/relationships• quality of life
Socialist Health Association [email protected]
Promoting mental health: two routes
Socialist Health Association [email protected]
Public mental health
•Self efficacy•Autonomy•Individual
responsibility•Health behaviours• Money economy
•Volunteering•CBT
•Collective efficacy•Social responsibility•Wider determinants
•Social solutions•Core economy
•Timebanks•Social prescribing
A disembodied psychology which separates ‘what goes on inside people’s heads’ from social structure and context Critical Psychology Forum
Socialist Health Association [email protected]
Policy context and current debates..
• Decline of family/community/quality of life• Culture of materialism and consumerism• Plight of poor, dependent and ‘non-productive’• Capacity of public services, lack of trust and
democratic deficitenvironmental instability
psycho-social instability
Social recession
Economic/fiscal policy
If “being poor” once derived its meaning from being unemployed, today it draws its meaning primarily from the plight of a flawed consumer.
Zygmunt Bauman
Mental health and recession
Socialist Health Association [email protected]
Untangling the determinants
• Individual skills and attributes
• Material resources
• Inequalities in distribution of resources
Socialist Health Association [email protected]
I do worry about this emphasis on individual psychology; You can’t separate thoughts, feelings, self esteem, motivation from the material circumstances of people’s lives. Is it great to be positive? Maybe people are right to be pissed off.”
Positive steps interviews
Towards a mentally flourishing Lanarkshire
Not ‘every family in the land’
Findings from 9 large scale population based studies:
• Material and relative deprivation• Childhood socio-economic position• Low educational attainment• Unemployment• Environment: poor housing, poor resources,
violence• Adverse life events• Poor support networks
(Melzer et al 2004; Rogers & Pilgrim 2003; Stansfeld et al 2008; APMS 2007)
Cycle of invisible barriers:• Poverty of hope, self-worth, aspirations
Mental health and deprivation
Mental Health in Relation to Income Inequality
Developed from: Pickett KE, James O, Wilkinson RG. Income inequality and the prevalence of mental illness: a preliminary international analysis. Journal of Epidemiology and Community Health 2006; 60: 646-7http://www.equalitytrust.org.uk/why/evidence/mental-health
Index of: Life
expectancy, Math &
Literacy, Infant
mortality, Homicides,
Imprisonment rate, Teenage
births, Trust,
Obesity, Mental illness, Social mobility.
Correlation: r=0.81, p < 0.0001(excl USA: r=0.79, p < 0.0001)
Wilkinson RG, Pickett KE The Spirit Level 2009
Health and Social Problems in Relation to Inequality
Socialist Health Association [email protected]
Index of: Life
expectancy, Math &
Literacy, Infant
mortality, Homicides,
Imprisonment rate, Teenage
births, Trust,
Obesity, Mental illness, Social mobility.
Correlation: r=0.81, p < 0.0001(excl USA: r=0.79, p < 0.0001)
Wilkinson RG, Pickett KE The Spirit Level 2009
Health and Social Problems in relation to average incomes (GDP per capita
US$ ppp)
Socialist Health Association [email protected]
Socialist Health Association [email protected]
“...the Greeks and Romans lived, I suppose, very comfortably though they had no linen. But in the present times, through the greater part of Europe, a creditable day labourer would be ashamed to appear in public without a linen shirt, the want of which would be supposed to denote that disgraceful degree of poverty which, it is presumed, nobody can fall into without extreme bad conduct. Custom in the same manner has rendered leather shoes a necessary of life in England. The poorest creditable person of either sex would be ashamed to appear in pubic without them”
(Adam Smith Wealth of Nations 1776 cited in Zaveleta 2008)
Resilience, health assets and capabilities
• Resilient places
• Resilient communities
• Resilient individuals
Socialist Health Association [email protected]
Distribution of resources
Quality of relationships
Policy responses to misfortune
Valued social role
‘To value the contribution of those whom the market excludes or devalues and whose genuine work is not acknowledged or rewarded’
Edgar Cahn
(the ecology of)Relationships matter
• Mental health is produced socially
• Presence or absence of mental health is above all a social indicator
• Social as well as individual solutions
Socialist Health Association [email protected]
Tend to the social and the individual will flourishJonathon
Rutherford
Socialist Health Association [email protected]
The quality of policy responses to misfortune
• We are all vulnerable and dependent
• We’re all in this together
• Collective efficacy
• ‘Other regarding’ agency
‘Belonging' : trusting in the benefits of human solidarity and in the institutions that arise out of that solidarity
Zygmunt Bauman
What would a fair deal look like?
• Reduce economic inequalities i.e. Mind the gap• Include social outcomes: the quality of
relationships matters• Valued roles and multiplicity of meanings• Treat people experiencing problems with respect:
vulnerability and dependency are part of the human condition, not a mark of moral failure
Socialist Health Association [email protected]
Resources, relationships, meaning, respect
Socialist Health Association [email protected]
A (wider) framework for effective action
Opportunities for meaningful
activity: education, training, volunteering
Mental health
and Mental Capital
Reduce poverty
and the impact of poverty
Respectful policy responses to misfortuneQuality of
social relationships
(family, schools,
workplace, communities
)Reduce material
inequalities
And what I shall endure, you shall endureFor every atom belonging to me as good belongs to
you......Walt Whitman
Build capacity for collective
action (collective efficacy)
Copyright ©2008 BMJ Publishing Group Ltd.
Krieger, N J Epidemiol Community Health 2008;62:1098-1104
Figure 1 (A) Pyramid of capitalist system. Issued by Nedeljkovich, Brashick and Kuharich, for the International Workers of the World (IWW), 1913.18
Socialist Health Association [email protected]
Socialist Health Association [email protected]
Socialist Health Association [email protected]
Socialist Health Association [email protected]