A New Approach to Psychological Distress

1. Recognise that psychological wellbeing can be improved with concrete, intentional action, both on an individual and at a policy level.

Psychological distress is often viewed as predetermined and unchangeable. Many people live with extremely unpleasant symptoms of anxiety or depression for many years without realising that it is not an inevitability. Although not widely known or understood, there are plenty of concrete, effective, evidence-based strategies for improving mental health, that favour intentional changes to decision making processes and strategies for managing difficult thoughts and feeling, over the use of psychotropic medication. At the moment, these strategies are typically only available via resource intensive, one-to-one therapists, currently accessed either privately at significant expense, or after several years on a waiting list. As a result of this, people often live their whole lives without accessing knowledge that could potentially have an immensely positive impact on their wellbeing.

2. Remove the influence of entrenched interests in the perpetuation of the status quo.

Mental health treatment in the UK today relies heavily on the prescription of antidepressant and antipsychotic medication. While pharmacological interventions do have their uses, their role as the primary treatment currently used by the medical establishment is based in several factors that have nothing to do with treatment efficacy (indeed, the majority of these drugs barely outperform placebo in clinical trials), and which impede the adoption of more meaningful strategies. One of these reasons is the lobbying influence of drug companies, who profit enormously from the widespread prescription of antidepressant drugs, and which constitute a large amount of money and influence that has the potential to lose out as a result of a disruption to the status quo.

The other is the attitude of the Royal Society of Psychiatrists (the body in the UK that is primarily responsible for treating mental health problems), which is a group of professionals for whom being viewed as medical doctors is important. While they recognise the role of social and psychological factors in the development of psychological distress, and the role of psychotherapy in its management, they often recommend this as an adjunct to the widely favoured pharmacological interventions.

The suggestion that perhaps the issues that they are tasked with treating are not well addressed with the drugs that they have made a central part of their strategy threatens both their identity as professionals and their role as the ultimate authority on the treatment of mental health problems. Indeed, if drugs are relegated to the side-lines in addressing mental health problems, then the psychiatrists surrender their authority in this area to the clinical psychologists, something that is clearly not in their interest.

3. Challenge the idea that mental health concerns are binary.

The current model treats mental health concerns as something that either exists in pathological form or does not exist at all. In order to qualify for a diagnosis, and therefore professional assistance in the management of psychological distress, it is necessary for the symptoms to be so severe as to cause significant disruption to one’s life. This completely arbitrary line must be crossed for the professional bodies that are responsible for managing mental health concerns to recognise that there is a problem.

The reality is that these official diagnoses represent the culmination of years’ worth of maladaptive behaviours, socioeconomic stressors and unwittingly unhealthy psychological habits, all of which could be addressed much earlier on in the process, saving a significant amount of distress, time, money and effort. The impact of allowing these things to fester cannot be overstated, as the effects of severe, un-addressed mental health struggles reverberate through families and communities, and across generations. Indeed, the personality disorders – which represent some of most severe and intractable of mental health disorders – typically result from abuse and trauma in childhood, something that is often not the result of parents being “bad people”, but simply parents who are not coping with struggles of their own.

4. Invest resources in programs designed to prevent psychological issues from developing in the first place.

In order to make concrete progress in addressing this issue, it is important for there to be a shift in the attitude towards mental health problems. Crucial to this is the recognition that out of the many factors that impact on an individual person’s mental health, there are some things that they cannot control, for which the government is responsible; and some things that they can control, for which the government should provide support and education.

The things that are not under an individual’s control are the practical factors that impact on any one person’s likelihood to find themselves on an upward path of education, growth and self-sufficiency. These are the things that some people take for granted, but which for many people feel impossibly out of reach. Examples are quality, affordable education; opportunities for fairly paid work; and a robust safety net to catch people from falling too far when things go wrong.

The things that are under a person’s control are the small choices that they make, which over time can have a huge impact on a life’s trajectory. As a rule, if one’s model for decision making is to be swept up by emotion and impulse, then this will result in unproductive and even self-destructive choices; however, if the model for decision making constitutes managing and accepting difficult emotions and making choices in alignment with a predetermined set of values, then growth and progress are much more likely to result. While very easily said, the latter is not easy, and is a skill that most people do not even know that they should have.

The government should introduce classes at school, designed with the same evidence-based principles used in therapy, to help us all manage our unavoidable humanness, with the goal of preventing the spiralling destructiveness of mental health problems before they arise.

 

 

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