1.2 Boundaries between mental health and illness
Activity 1: What is mental ‘health’?
What do you think it means if someone is described as ‘mentally healthy’? Think of all the different ways of describing ‘mental health’ you can and write them out on one side of a sheet of paper. For example, you might think that ‘feeling happy’ is one of the characteristics of mental health. Next, on the other side of the paper, write down all the different ways of describing people when they are not mentally healthy. As you write this list, consider whether you think that not being ‘mentally healthy’ always means that a person is in some way ‘ill’. Where do you think the dividing line between ‘ill’ and ‘healthy’ is?
Like our testers, your first list may have included some of the positive feelings people associate with mental health, such as feeling happy, content, calm or ‘stable’. Your second list might have included negative feelings, such as unhappiness, depression, confusion, distress, fear and anxiety, as well as some of the ‘symptoms’ associated with mental illness, such as ‘hearing voices’. However, you may also have noted that just having negative feelings does not in itself mean that someone can be described as ‘mentally ill’. Equally, you may have considered the idea that someone might feel perfectly well, but be considered mentally ill by those around them because of their behaviour. Furthermore, some of the so-called symptoms of mental illness are, in certain contexts, considered appropriate and ‘normal’. Hearing voices in a religious ceremony, for example, or during a seance, would not necessarily be regarded as out of place. This is what one of our testers said:
The cut-off point between being mentally ill and healthy is somewhat arbitrary as there is a continuum between, for example, being healthy and happy, and unhealthy and unhappy. Illness suggests treatment may or may not be required. I have a health condition which is treatable so I do not see that I am ‘ill’. I am indeed happy and cheerful so consider I am mentally healthy.
It's important to recognise that mental health issues affect everyone in that we all experience a degree of mental distress at some point in our lives, not least through bereavement or other major losses. However, it is also important to acknowledge that there are groups of people who have specific mental health needs at various times, who experience severe distress, and for whom labels can serve an important purpose. Labels such as a diagnosis can be important because they can help to secure access to services, treatment and support when needed.
Anyone who has experienced this illness (and it is an illness) will know what I mean when I say others have no idea how devastating it really is. Everyone suffers from some sort of ‘depression’ at one time or another, but to endure this lingering state for weeks or months on end is totally indescribable.
Read and Reynolds, 1996, p.35
Frequently, I am told that the drugs I take only suppress the illness without curing it. There is, they say, no cure for schizophrenia. And yet the state I am in at present is, I am convinced, as good as a cure. I have a nice home, a good job, no sleepless nights, no disastrous mood swings, no hallucinations, no confused or disordered thoughts.
Jameson, in Read and Reynolds, 1996, p.54
For these reasons, some mental health service users and carers actively prefer the label of ‘illness’, or specific labels such as schizophrenia or depression. In this course, the use of the term mental illness is usually avoided because it implies that people can be categorised easily and their distress ‘treated’ in the same way as a physical illness, such as diabetes or heart disease. The notion of treatment in mental health is contentious because, while some service users have positive experiences, many others with serious needs have negative experiences of compulsory admission to hospital and treatments such as medication, particularly when they are forced to take them against their will. The issues of power and rights are therefore central to discussions about mental health and illness, as illustrated by this quote from one service user:
I was on [an] intensive ward and I really had bad treatment there, although I was getting the medications on time. One time, one nurse came in the evening and, you know, we have our smoking area where I was smoking, and the nurse tells me to go to my room, you know … And I say ‘I'm not feeling sleepy, I don't wanna sleep – I wanna relax, sit down and smoke, or watch the telly.’ And they said the telly time – the telly have to be switched off by 12 o'clock. I said: ‘Fine, I just wanna sit, I don't wanna go to my room’. He said ‘Go to your room – I'm not gonna say it again – if I say it that last time you're gonna get [an] injection’ … Well I was struggling with them but – you know what I mean – they pulled me down and gave me [an] injection.
Keating et al., 2002
Because there is disagreement about how to define mental health and illness, the figures which attempt to measure the numbers of people who experience mental health problems at any given time vary considerably. One of the most frequently quoted states that one in four adults in the UK will experience some form of mental health problem at some point in their lives. The next information literacy activity focuses on finding out more about how many people experience distress and/or illness.
Activity 2: How many people experience mental health problems?
In this activity you will use the PROMPT criteria to find quality information about mental health from a number of websites. You will need to:
examine the PROMPT criteria which can be used to evaluate information;
find information about mental health and the number of people affected by mental health problems from a few organisations' websites;
use the PROMPT criteria to evaluate two of these websites.
You will work through the PROMPT criteria, a useful tool for evaluating the quality of information, using the printable PROMPT table linked below. You will use these criteria to evaluate at least two websites for organisations which support people affected by mental health problems. In looking at the websites you will also have the opportunity to find out more about mental health and the number of people affected by mental health problems.
Click to open the printable PROMPT criteria table.
Visit two websites
- Visit two of the following websites:
- Mental Health Specialist Library - National Library for Health
- BBC Health: Mental Health
- Mental Health Foundation
- Whilst you are looking at your chosen websites, find out as much information as you can about mental health and the number of people affected by mental health problems. Jot down any statistics you come across in the printable PROMPT table, linked above.
- Note the different language used, with some organisations focusing on mental illness and others on the broader category of mental health problems.
- Evaluate the chosen websites using the PROMPT criteria and complete the table provided.
This activity has introduced you to the PROMPT criteria, a tool you can use for evaluating all types of information, whether print or electronic. Having worked through this exercise, you may have found it time consuming and complicated. We are not suggesting that you will need to work through it all in detail each time you have a piece of information to evaluate. As you become increasingly familiar with the questions in the checklist, you will find that you can scan things very quickly and identify their strengths and weaknesses. It is about developing a critical approach which just takes a bit of practice. Poor presentation of a website can have serious consequences, particularly if as a result you can't find the information you want. Did you use the search facilities on the websites you tried? Did you find any of the websites particularly relevant? As you surfed some of the sites you may have noticed the different language used, with some organisations focusing on mental illness and others on the broader category of mental health problems.
Objectivity is a very important evaluation criterion when you are looking at websites. Many websites are owned by people who are selling products or services or who are trying to influence public opinion. The provenance criteria will help you identify whether the owner of the site is likely to have a vested interest in what they are communicating. The method criterion is only for use with research reports and data collection. As you were looking for information on the number of people affected by mental health problems, could you tell how the statistics you found were gathered and how up to date they were? It is easy to assume that all information on the web will be up to date. However, this is often not the case, but it can be quite difficult to find out how often websites are updated. Hopefully, having bookmarked the sites you found particularly helpful, you will use these as an excellent way to keep up-to-date with developments in the mental health field.