Dr Rhiannon Cobner, Dr Jen Daffin and Dr Sarah Brown examine the root causes of mental health issues and how their proactive work is starting to pay dividends in communities.
What coronavirus has shown us all is that the traditional story of mental health is no longer fit for purpose.
Never before has it been so clear that our mental health is linked to our circumstances and that the old narrative that ‘one in four of us will experience a mental health problem’ obscures this understanding by giving the impression that poor mental health is equally distributed randomly amongst us according to the fate of our brain chemistry or levels of personal ‘resilience’.
At any moment any of us could be unlucky enough to fall victim to our ‘genetic potluck’, and so we just need to make ourselves more personally resilient and get back on track.
But the story about the ‘one in four’ is not the full picture. It is absolutely not random. People exposed to 4 or more adverse childhood experiences (ACEs) are 6 times more likely to have received treatment for a mental ‘illness’. They are 9 times more likely to have ever felt suicidal or self-harmed.
Trauma or adversity exposed young people are twice as likely to receive a mental health diagnosis. We also know that those from the lowest 20% of household income are 3 times more likely to have a common mental health problem and 9 times as likely to receive a diagnosis of a “psychotic disorder”.
“Individual solutions that only look to medications to fix the ‘chemical imbalance’ or therapy to get us to talk about our problems are often not wholly effective.”
These issues are complex but there is overwhelming evidence of the relationship between poverty, power, inequality, and mental health difficulties. Sheer luck dictates whether children are born with more material and social wealth than others.
Without this advantage inequality can deepen over a child’s lifetime, leading to an increase in mental health problems that can take families generations to recover from.
What leads both children and adults down these dark paths is being exposed to these five things time and time again – 1) humiliation and shame; 2) fear and distrust, 3) instability and insecurity; 4) isolation and loneliness; and 5) being trapped and feeling powerless.
We often hear about the impact of poverty on our physical health but we don’t talk about our psychological health. These are the psychological costs of prolonged inequality and disadvantage and they manifest in powerful ways. The ‘life’ choices we make are limited on the choices we have.
It’s not surprising then that individual solutions that only look to medications to fix the ‘chemical imbalance’ or therapy to get us to talk about our problems are often not wholly effective. If these were the real answers surely things would be getting better?
“Having enough money to get there often meant we never saw those that needed our help the most.”
But they aren’t, and it’s not just about cuts to mental health service or an increase in awareness. It’s about the conditions in which we live our lives. These are called the social determinants of mental health and the outcomes for mental ‘illness’ can be far more severe. People with a diagnosis of severe mental ‘illness’ die on average 25 years earlier and this is not due to suicide or exposure violence.
It is becoming clear to us that traditional silo ways of working where we get people to come and sit in clinics is great for some people but a huge barrier to others and does not alleviate these social determinants.
This approach puts all the responsibility for whatever the problem is onto the person or worse so on to a child. But children are not born ‘bad eggs’ and they do not and cannot live in isolation. They rely on the adults around them to keep them safe and provide the necessary support to develop resilience and good wellbeing.
The problems many children and families face are big and often beyond their control. Children need supportive adults to help them change things. For many of these families overcoming the challenges of daily living is enough. Asking them to come and think in clinics is way too much. Having enough money to get there often meant we never saw those that needed our help the most.
So instead we began to think differently and about who is working with those people we were not seeing and how could we get alongside them. We began a partnership with Bron Afon Housing Association where we worked with frontline staff to deliver psychologically minded work together.
We worked with them to make sense of the young person’s difficulties the context of their relationships and developmental stage. Understanding the reasons behind the difficulties meant we could then create psychologically informed plans to address them.
Mostly this was enough however if the difficulties were particularly complex we also worked with the families directly in their homes with the workers they trusted alongside us so they could a part of what we were doing.
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These families don’t need more people to manage their lives and so we focused on working with the people they already had relationships with and help them ‘hold on’ rather than refer on. Feeling safe is the foundation need in trauma recover.
We can’t address the social determinants in isolation but we can do a better job of ensuring people’s physical and emotional needs are met by working alongside others and starting to bring the whole system together.
This way of working has been so successful that we have recently rapidly expanded across Gwent and are looking to work more broadly with more housing associations, Families First, the police, youth services and sports and leisure providers.
Now we are taking our psychology skills out to communities and trying to be more proactive and preventative with our approach. We are moving towards a universal whole system approach and creating a cultural shift that recognises the conditions necessary to promote children’s resilience and wellbeing.
This is an approach that will require policy that supports the right socio-economic and psychological conditions for people to thrive. We are excited to embark upon partnership working that puts relationships at the core of everything.
And we’re excited to see how the wellbeing of Future Generations act and the Social Services and Wellbeing Act will create a wellbeing, adversity and trauma informed culture across Wales.
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