This assignment will discuss contemporary issues within mental health and how they influence people’s social wellbeing. Mental health has been one of the biggest debates within psychology since the very ancient civilisations. Starting from the meaning of mental health or mental illness, the physiological, biological and further implications that surround it to its perhaps over medicalised model and the way it has been perceived, stigmatised, and treated over time. (Roberts 2016). Taking the role of mental illness and putting it into context, historically, it could be argued that research has come a long way into ‘transforming’ the social norms that frame, control, and decide upon those classified as not mentally stable. (Roberts 2016).
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Mental health is defined as a state of well being in which an individual realises their own potential and how they cope with their normal stress of life. Mental health disorder can be defined as a health problem that can consequently affect how a person thinks, behaves, interacts with others and feels. Mental health problems include the mental ill health that can be experienced temporarily as a reaction to the stresses of life. Mental disorder causes considerable suffering to those experiencing them, as well as their friends and families. There are many mental health conditions such as schizophrenia, anxiety and depression. These conditions affect the way an individual processes thoughts. All mental health conditions impact on an individual social emotionally, behaviourally and socially, however a lot is on offer by way of treatment. During the 19th century in Britain, all patients were certified under lunacy laws. The fledgling profession of psychiatry was singularly preoccupied with segregating and managing lunatics. (Skull, 1979).
Understanding inequalities is also crucial in recognising the limits of what promoting positive mental health can achieve. Positive mental health does confer protection and advantage, but is does predominantly among those with equal levels of resources. In other words, among poorer people, those with higher levels of emotional wellbeing have better educational outcomes than their equally poor peers. However richer people generally do better still, regardless of emotional or cognitive capability. (Friedli, L. 2009).
In other words, among poor children, those with higher levels of emotional wellbeing have better educational outcomes than their equally poor peers. However, richer children generally do better still, regardless of emotional or cognitive capability
Mental asylums were put into place in the 19th century, as a means of isolating people who were exhibiting deviant behaviour from the rest of the ‘normal’ population. In the 19th century, physically sick men and women remained with their families and received treatment within their homes. Their communities showed significant tolerance for what they seen as strange thoughts and behaviours. Although some individuals seemed too violent or disruptive to remain at home or in their communities. Society demanded that the mentally infirm, disabled and criminally minded to be adequately locked away. Mental asylums were known for their horrendous treatment of the mentally ill, however the ultimate purpose in the reformation of mental asylums was to improve treatment for the mentally ill by providing humane and caring environment for them to reside. The mentally ill were treated inhumanely in the early mental asylums. Many of the treatments was extremely painful and evil for the patients. The asylums were really prisons and not centres for treatment. In the book ‘My Experiences in a Lunatic Asylum: By A Sane Patient’. Merivale, H explains that “death in utter solitude, save for the wardens by my side, whose duty it was or they interpreted it as such, some of them to hold me down and to jump upon me, or kneel on my breastbone, if I turned around or uttered any wandering word in bed.” (Merivale, H). In many mental asylums, patients were treated like animals, not humans such as the known famous “Bethlem Hospital’.
Bethlem hospital was a London landmark so famous that tourists would visit it. The name came to mean madness and chaos. Bethlem began as a religious order and was founded in the 13th century as a priory dedicated to St Mary of Bethlehem. This was Bethlem Hospital, more commonly known by its nickname ‘Bedlam’. It was also one of the very first to specialise in people who were called mad’ or ‘lunatic’. Over time, Bethlem began to specialise in caring for those who were incapable of caring for themselves, particularly those who were considered ‘mad’.
Due to the negative image that society placed on people in asylums, people within the system were stigmatized, by the ways in which people were perceived and treated not only by the medical society but also society itself. Mentally unstable patients were considered detrimental with regards to preserving the law, ethics and values of the community, and posed a threat to society prosperity. (Spandler 2007).
Leaving patients little to no means of communication and interaction with the rest of the population.Stigmatised individuals are viewed as inferior by society as a whole, and stigma is thus the outcome of interaction between the ‘deviant’ and ‘non deviant’. Society will see an individual’s identity through observation, interaction and communication. Mental health stigma can be divided into two types, which include: social stigma and perceived stigma or self stigma. As a result of stigma, it can cause people to feel many different emotions as well as feeling isolated, low self esteem, distress and hopelessness.
Stigma and identity are then linked: any attribute that is discrediting and thus devalues an individual’s social identity.
Studies show evidence suggesting that welfare regimes, political ideologies and associated power relationships all influence health and notably, that contact with public welfare that transmits or reproduces stigma and humiliation has a significant influence on health and wellbeing. (Friedli, L. 2009)
Criteria on what construed deviant was subjective to deviant behaviour and was linked to disobedience to social norms, rather than considering the individuals perspective, feeling, as well as the extent of psychological desires caused by the situation. (Spandler 2007).
Continuing through the mental health timeline in the mid 20th century approaches to mental health were significantly different which in turn lead to a deinstitutionalization movement. As a result many of the symptoms that surrounded mental disorders were diminished and those people could actually reintegrate into society without being considered dangerous anymore.
Over the recent years there has been an interest in the social aspects of mental health, in terms of seeking to understand and what may contribute to mental distress and what forms of support and interventions may be most helpful in assisting people to reclaim meaningful and socially valued lives. (Tew, J. 2011). The interest came from the patients, families and friends and from many of practitioners from across the spectrum, in turn this has been reflected in government policy initiatives such as the Mental Deficiency Act 1913. Mental defectives were created by the Mental Deficiency Act of 1913 and abolished by the Mental Health Act of 1959. In 1920 there were around 10,000 mental defectives in institutions in England and Wales; by 1946 that number had grown to nearly 60,000 with a further 43,000 under statutory supervision in the community. (Meanwoodpark 2018). Patients were divided into three categories: the ‘imbeciles’ and ‘idiots’ who today would be considered to have a learning disability and the more nebulous group of ‘feeble-minded’. It included people of average intelligence the ‘socially inefficient’ as they were called in those days. The Act embodied two key principles: separation from the community (hence the new ‘colonies’ established for their care, rather than asylums); and control (most clearly indicated by the name of the new regulatory body set up under the Act, the Board of Control). (ThePsychologist 2019).
In today’s society there is a huge debate around care versus control. Treatment should only be where the patient had significantly impaired decision making capacity and the use of compulsory powers must have therapeutic benefit for the patient. They argue that the purpose of mental health legislation should not be to detain people with mental health problems for whom no beneficial treatment can be found, and where no health benefit may result. It is greatly recognised that there are situations where there is necessity for detainment. Compulsory treatment (which can have a risk of side effects) may be seen as more controversial, but even so there remains widespread support or perceived need for this also demonstrated by the relatively high number of Community Treatment Orders.
Along the road to recovery there can be a tendency to see a social perspective as simply a concern with the practical issues that may impact on a person’s life such as social welfare in society. “While these may be important, there can be much more to a social approach- both in terms of developing frameworks by which to make sense of mental distress, and in devising strategies for promoting recovery and positive mental health” (Tew, J. 2011). Mental health promotion has been defined in a variety of ways. Common or recurring strands include the promotion of happiness, the right to freedom and productivity, the absence of mental illness, and the fulfilment of an individual’s emotion, intellectual and spiritual potential. (Pilgrim, 2014).
In mental health the word ‘recovery’ has a lot of different definitions and does not always refer to a person having a complete recovery from mental health problems in the same way that a person can fully recover from having physical health problems. An individual with mental health not only has to recover from the distress and trauma of psychotic experiences they also have to deal with social exclusion, discrimination, stigma and many more factors. The National Institute of Mental Health (2009) states that there is no single meaning of the concept of recovery for people with mental health problems, but a way to explain the recovery model isone of hope and that it is possible for a person’s meaningful life to be restored, despite serious mental illness. (NIHM 2019). The Mental Health Foundation (2007) states that the recovery process should provide a holistic view of mental illness that focuses on the person as a whole and not just their symptoms. They also believe that recovery from a severe mental illness is possible and it is a journey rather than a destination but it does not necessarily mean getting back to where a person was before their diagnosis recovery will happen in ‘fits and starts’ and, like life it has many ups and downs and it is very much influenced by people’s expectations and attitudes requiring a well organized support system.
There are two specific pieces of legislation that govern how people with mental health condition receive care and treatment they are; The Mental Health Act 1983 (updated by the 2007 act) and the Mental Capacity Act 2005, including the Deprivation of Liberty Safeguards. Mental health legislation is necessary to protect the rights of people with mental disorders who are a vulnerable section of society. The Mental Health Act sets out how a person can be admitted, detained and treated in hospital against their wishes and details safeguards which ensure patients rights are upheld. In February 2011 the government announced a new mental health strategy for England, “no health without mental health” which was introduced as there was an urgent need to strengthen the both provision of mental health care to people with physical illness and the quality of physical health care provided to people with mental health problems in general hospitals and primary care.
The primary prevention of mental illness can be distinguished from secondary and tertiary prevention. Secondary prevention refers to nipping mental health problems ‘in the bud’ following early detection. Tertiary prevention refers to lowering the probability of relapse in those with chronic mental health problems. (Pilgrim 2014). The distinction between promotion and primary prevention was used in two versions of an equation. Which include; incidence of mental Illness and promotion of mental health. It is noted that stress accounts for some of the difference in diagnosing between poorer and richer people. With the richer group having more buffering positive experiences. Those exposed to lower levels of personal and environmental stress are more likely to be mentally healthy.
In conclusion by taking into consideration the number of contemporary issues within mental health it can be argued that even though the situation has significantly been improved since the early asylums, there are still crucial concerns that needs to be challenged within psychiatry, phycology and sociology. Mental health should not just be a doctor’s responsibility but a holistic approach should be adopted.
Reference list
De Swaan, A. (1990) The Management of Normality. London. Routledge.
Fernando, S. (2014) Mental health worldwide: culture, globalization and development. Basingstoke. Palgrave Macmillan.
Friendli, L. (2009) Mental health, resilience and inequalities. [Online] [Accessed on 23rd March] Available at: http://www.euro.who.int/__data/assets/pdf_file/0012/100821/E92227.pdf
Meanwoodpark (2018) The Mental Deficiency Act 1913. [Online] [Accessed on 21st March 2019] Available at: http://www.meanwoodpark.co.uk/a-resource/the-mental-deficiency-act-1913/
Mentalhealth (2019) Recovery. [Online] [Accessed on 1st April] Available at: https://www.mentalhealth.org.uk/a-to-z/r/recovery
Merivale, H. (1878). My Experience in a Lunatic Asylum. London. Spottiswoode and Co.
NIHM (2019) The National Institute of Mental Health. [online] [Accessed on 1st April] Available at: https://www.nimh.nih.gov/index.shtml
Pilgrim, D. (2014) Key concepts in mental health. 3rd Ed. Los Angeles.
Roberts, M. (2016). Critical Thinking and Contemporary Mental Health Care: Michael Foucault, S “History of the Present”. Nursing Inquiry, 24. doi: 10. 1111/nin.12167.
Skull, A. (1979) Museum of Madness: The Social Organisation of Insanity in 19th Century England. Harmondsworth. Penguin.
Spandler, H. (2007). From Social Exclusion to Inclusion? A Critique of the Inclusion imperative in Mental Health: Medical Sociology Online, 2, 3-16. Retrieved from: https://docs.google.com/file/d/0B5cLat3gdm9NaHVOOWptQmM4RoE
Tew, J. (2011) Social approaches to mental distress. Basingstoke: Palgrave Macmillan
Thepsychologist (2019) Looking Back: Mental deficiency – changing the outlook. [Online] [Accessed on March 22nd 2019] Available at: https://thepsychologist.bps.org.uk/volume-21/edition-11/looking-back-mental-deficiency-changing-outlook
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