# Transcript

SARAH VICARY

Shall we begin with introductions of you as authors, your current role and interest in mental health?

GAVIN DAVIDSON

My name’s Gavin Davidson. I’m one of the four authors of Models of Mental Health. In terms of my, sort of, background and role, I trained as a social worker in Liverpool in the early nineties and then worked as a social worker in mental health services until about 2008, and then moved to Queen’s University in Belfast. My current role is Professor of Social Care, but my focus is still very much on mental health. And in terms of my interest in that area, it’s probably mainly because of family experiences – my dad had mental health problems – and also then an interest in social justice and human rights, which are central to mental health, I think. And also the complexity of the issues is fascinating. In terms of the book itself, I led on the introduction and the critical perspectives chapter.

JIM CAMPBELL

My name is Jim Campbell. In terms of my professional background, I was a mental health social worker in Belfast in the 1980s. Around that time I also happened to be a part-time tutor for The Open University in Northern Ireland and Ireland. After completing my practice as a mental health social worker, I taught, as Gavin did, in Queen’s University Belfast. Then I went to Goldsmiths, University of London, and finally just recently retired as Professor of Social Work at University College Dublin. And my interest … long-standing interest is in the area of mental health social work, mental health law and also social work and political conflict.

CIARÁN SHANNON

My name is Ciarán Shannon. I am a consultant clinical psychologist. I’ve always had both clinical and academic roles and that’s very similar today. I’m a consultant clinical psychologist who manages specialist psychology service in mental health in an NHS trust. And I’m also director of the trust research sector. My big interest in mental health is severe mental illness and psychosis in particular, and the links between psychotic experience and various types of adversity, including social adversity.

CIARAN MULHOLLAND

My name is Ciaran Mulholland. I’m a consultant psychiatrist. A psychiatrist, just in case any of the listeners are unaware, a psychiatrist is first and foremost a medical doctor, so psychiatrists train in medicine first and then they specialise in psychiatry. So I specialised in psychiatry now three decades ago, in the early 1990s. I have an interest too, as Ciarán Shannon just mentioned, in psychosis, the causes of psychosis, in particular the role of trauma and adversity in the causation of psychosis. More recently I have an interest in trauma more broadly defined, and in particular the consequences, the long-term consequences, of The Troubles in Northern Ireland.

SARAH VICARY

Thank you, everybody. What you’ve brought is a huge range of experience, which is fantastic for this module because what we’re trying to do is understand what is meant by mental health. We use the terms mental health and mental ill-health. How would you define these concepts?

CIARAN MULHOLLAND

Yes, well, perhaps I’ll start this, Ciaran Mulholland, and these concepts are used very widely now, not just by professionals but in wider society, and every day in the news and the media we see commentary and stories about mental health and ill-health. And that’s good. There’s much less stigma than there was in the past, people talk about mental ill-health more than they did in the past. But there is a lot of confusion around terminology and that can be difficult, especially for anyone who’s starting out on a career journey in a mental health profession or any health profession. What we’ve tried to do in this book is to bring together a range of concepts – concepts that we think that complement each other mostly, though sometimes they clash, but mostly they complement each other. The first chapter that I led on the book was the chapter around biomedical perspectives and that’s the chapter that does lay out what we sometimes call the traditional medical model. Now, doctors are trained to think about health and ill-health as being dichotomous, so either you’re well or you’re not well. So, for example, with regards to blood pressure, either your blood pressure is normal or your blood pressure is pathological. But I think probably most people are aware that that’s arbitrary. So, who’s to say that a certain blood pressure is abnormal and another blood pressure is normal? An abnormal blood pressure in one country could be deemed to be normal in another country. So we’re faced with a real problem in trying to define mental ill-health. But for a doctor, for a psychiatrist, our training, it is about a person being so far away from the normal experience, in the sense of the common experience of most people, that that means that there is pathology present – it’s about the presence of pathology.

SARAH VICARY

So this next question about your book, which aims to present a critical overview of the main theoretical perspectives relevant to mental health, and in it you’ve outlined six. In doing so, you suggest that there’s no single theory or perspective that provides a comprehensive framework. Could you please say a bit more about what you mean by this?

GAVIN DAVIDSON

Yes, thanks Sarah. It’s Gavin here. I think the sort of general approach or theme throughout the book is really to acknowledge that our understanding of mental health and mental health problems is still developing. It’s part of the reason why it’s such an interesting area to work in. And that all of the different perspectives that we cover, and many others, all have something to contribute to our understanding of mental health. It also reflects, perhaps, the concern that at times debates about mental health can feel divisive. Sometimes there’s a lot of energy devoted to debating the relative importance of different perspectives, and some of that’s very healthy and helpful and sometimes maybe it’s not so helpful. We’re trying to sort of communicate that we think all of these perspectives are important and useful and we should engage with them all – an acknowledgement that we still need to be very open. Our understanding’s still developing and our understanding of the central role of trauma in mental health. Even when we were writing the book trauma-informed care wasn’t as much of a focus as it is now, so it’s great to see that’s happening.

SARAH VICARY

Thanks, Gavin. You, in the book, have a perspective you term as the ‘service user-led perspective’. Can you say what you mean by this, its contribution, strengths and limitations? And, also, could you comment about the different terminology?

JIM CAMPBELL

Thanks very much, Sarah, this is Jim. And I think it’s a really good question to be asking. The way we use language in mental health services, in the way we describe mental illness, mental health and the experience of those who have mental health problems is quite contested actually. The book reveals some of those contested ideas. From my perspective and on my understanding of these different terms, I think we need to look at how they have developed historically since the rise of the Victorian asylum, the development of professional practices in the twentieth century and, more importantly, one might say, is the increasing voice of those who have experienced these services, And I think the way professionals use the terms is quite static and fixed even though people with mental health problems would like different terminologies to be used about their identities. So, I think doctors, nurses and other professionals in the medical arena would still refer to those people as patients. Social workers, I think, still refer to the people they help as clients. And the generic term, historically, is the term service user, and I think that’s quite a problematic term because it connotes that the person who’s receiving the service is somehow a user, which can be a negative connotation. So, I do think we should embrace these new terms and identities, the lived experiences of people who have had the services or experts by experiences. But ultimately the way we use language, and this is true for the other ideas we developed in the book, the way we use language and narratives about these issues is very contingent on individual and professional identities and issues of position and power.