1.3 Approaches and models of mental health
In addition to language and perspectives, approaches and models each help provide an understanding of mental health.
Earlier you considered what a perspective is, and you will now go on to explore approaches and models. An approach is best understood as a way of dealing with a topic, while a model is a particular way of understanding an approach and which can be compared and contrasted.
Activity 4 Approaches to identifying mental ill health
Read the following descriptions of subjective and objective experience written by OU academics. As you are doing so split your thoughts into the two main approaches of subjective and objective and identify main concepts within each.
Reading B
Box 1 Subjective experience
There are two main approaches to identifying mental ill health. The first is to focus on a person’s subjective experience. That is, what does the person feel about, and how do they explain, their own mental and emotional state? This kind of subjective monitoring and reporting of our thoughts and emotions is an ongoing, everyday occurrence for most people, and is part of the way we construct and communicate a personal narrative about who we are and how we feel. As such, a person may be aware of the ups and downs they experience emotionally, and of the thoughts and feelings they find upsetting, uncomfortable or distressing. A person may also be aware that some of their behaviour choices – to drink alcohol to excess, use nonprescribed drugs, to work, or eat or sleep excessively, for example – may also be a way in which they express their underlying mental health problems. As such, it is necessary to find ways of facilitating and listening to a person’s own subjective account of their mental health and wellbeing in determining whether or not a mental health problem exists. This might mean an approach in which the practitioner gives someone time to talk, uses sensitive questioning or listens in an accepting, non-judgemental manner so that the individual can express themselves on their own terms.
Box 2 Objective evidence
The second approach to mental health problems is to seek more objective evidence of mental, emotional or psychological disturbance and abnormality. This kind of evidence tends to be sought by professional mental health workers following standardised medical or psychological procedures or using structured tests (Gelder et al., 2005).
Objective measures of mental health problems might include:
- scans to assess brain structure and functioning
- blood tests to rule out physical conditions, such as anaemia, that might share some characteristics with, for instance, depression
- neuropsychological tests that test memory or problem-solving skills
- other structured behavioural observations that focus on a person’s pattern of behaviour.
Objective evidence is often produced in the form of numerical and scientifically grounded results. As such, it does not directly take into account how a person feels or what they believe about their mental health and wellbeing. Given that a person’s own subjective understanding is relevant to whether what they are experiencing is a mental health problem, diagnosis of mental health problems tends to occur when both the subjective and objective evidence fit together to confirm a particular set or pattern of symptoms
Discussion
The world of mental health is filled with a wide range of perspectives and approaches. These can also have an impact on the way in which those experiencing mental ill-health may seek help.
An individual’s partner, friends, colleagues and family members play an important part in promoting and supporting their mental health and wellbeing. These are often also the people an individual will turn to when they first disclose or seek help for their mental health problems. The informal support provided by partners, relatives or friends within a person’s family and social network may be enough to help them.
Where this is not the case, a person may require assessment, treatment and support from one or more mental health services and the professionals who work within them.
Having explored perspectives and approaches in mental health, you will now go on to consider models.
Activity 5 Models of mental health
Listen to the audio of our four professionals introducing a range of perspectives starting with social, moving on to medical and psychological.
Make some notes on the different perspectives as you listen.
Discussion
Social perspective
There are three concepts discussed concerning the social perspective and model. You will have heard that social ideas of mental health are very important in understanding the lived experience and it is recognised that social contexts and factors have an impact on mental health and wellbeing. Although it is possible to understand how social events can lead to mental ill-health (a famous 1978 study by Brown and Harris about women is mentioned), causality is a difficult thing to decide.
The second aspect to consider is the notion of social responses or social theory – the concept that giving people labels because of mental ill-health can cause difficulty for them.
Last, there is the concept of social construction – the idea that behaviour and thought is socially constructed but changes in time. Ideas of mental ill-health are viewed differently in different societies. Social or critical realism and how we describe mental health focuses on the way in which language is used and understanding difficult realities are mediated by how professionals describe these experiences.
Medical/biomedical model
This perspective is discussed in terms of making a diagnosis using a collection of signs and symptoms. However, there are no tests of particular relevance and an example of a depressive illness is discussed. Having a diagnosis can have many benefits – for example, it might tell us something about causation, but this is also non-specific. Diagnosis does not exclude that there may be social causes; again, an example is provided – in this instance it may be that women living alone are more likely to become depressed, but there are also biological and genetic factors to take into account.
Diagnosis can also suggest an outcome and risks involved if not treated. It can provide some clarity and reassurance. However, diagnosis can also be problematic, as the process is generalised. There is also a risk that treatment may not work, which could be disappointing to the individual.
Psychological perspective
In this explanation it is suggested that psychologists are not particularly focused on what is ‘wrong’ or the causes of mental ill-health, they are concerned with processes that are internal to the individual and underlying distress in its various forms. Psychologists use various theories, such as attachment and cognition, to try to describe the distress, and there are lots of therapies available. The disadvantage of this approach is that it locates the problem within the individual and ignores societal and other adversities, which also need to be acknowledged. However, it can give the individual strength in being able to try to respond to their situation.
Spirituality is also mentioned, and an interesting discussion takes place about mental health services being secular. Religious and spiritual perspectives are hugely important and can promote healthy behaviours and provide support and meaning, although the opposite can also be the case, as issues such as the internalisation of shame can be unhelpful.
Core teaching point
Core perspectives underpin this course. These include three traditional models:
- social
- medical
- psychological
Other models, which are not discussed in this course, include the psychotherapeutic, religious, spiritual and biopsychosocial models.
Having considered how different perspectives impact on our understanding of mental health and in turn the language and models that exist, you are now going to take the opportunity to look back at how these perspectives may have developed over time in England and Wales.
OpenLearn - Mental health in society
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