Jen Daffin is a Community Clinical Psychologist with a passion for social justice. She has 15 years experiences of working across NHS mental health and learning disability services and now works for a mental health and social change charity called Platfform.
On Tuesday 24th of May Jen hosted a Conversations that Challenge event which explored the topic of relationships. These are her reflections from the conversation. Video coming soon.
Positive, healing relationships are one of the most significant ways we can help each other heal from trauma and rebuild connection. Relationships that meet our core relational needs are key.
But how can this happen within a broken, re-traumatising system? Is it possible to have spaces for healthy professional relationships when we are counting every hour, monitoring every meeting?
Mental Health is Complex
Currently not only do we work in under resourced and overwhelmed systems, systems that are traumatised themselves, but we work within them from a deficit, reductionist and for mental health services specifically a disease point of view. This is a problem because ‘mental health’ is not about disease. It is far more complex and multifaceted than that. Importantly there is ample evidence to support that our mental health is about our circumstances rather than specific genes or chemical imbalances (WHO, 2014).
In fact, the DSM (Diagnostic Statistics Manual) categorisation of human experience into psychiatric disorders was not the outcome of solid biological research. It was mostly based on vote-based judgements reached by a small select group of psychiatrists who had financial ties to the pharmaceutical industry (Davies, 2022).
Judgements that then acquired ‘scientific’ legitimacy by their inclusion but not because of it. They are based on the moral values of the time rather than scientific validity. If we accept this, then it makes no sense to organise our systems around reducing experience to disease identification or to put a societal problem on to individuals.
Burden of Responsibility
The implications for this are not limited to people to receive support from services and projects. These ideas are also applied to employees too. For example, on 19 February 2018 a university lecturer called Malcolm Anderson made his way to work at Cardiff University as usual accept this particular day he did not come home. Weeks after his death his suicide note was found in a locked drawer in his office. In it, Malcolm said that he could no longer cope with the overwhelming workload. The pressure had become too much, and he could find no other way out.
Another lecturer at the university said to Dr James Davies for his book Sedated “That the whole event illustrates some very serious problems. I mean, the tragic irony for the suicide note was that it was published just as the university was in the middle of its “wellbeing fortnight”, a programme decisioned to improve the mental health of staff and students. To safeguard against these kinds of dreadful events.”
The wellbeing fortnight did not however encourage conversation about workloads or more substantial issues, nor did it attempt to support discussion or come up with meaningful solutions.
Programmes like the one at Cardiff University have sprung up everywhere. One of them is the Mental health first aid programme which was first launched in England in 2007 by the UK Department of Health. MHFA now operates in over 24 countries with a global mission to create an international army of ‘mental health first aiders’. It popped up as a response to the growing problem of workplace distress. In 2018, 55% of Brits felt under excessive pressure, exhausted or regularly miserable at work.
What programmes like Mental Health First Aid do is what happens in the broader diagnosis lead mental health system. That is that they decontextualise and depoliticise the root causes of problems, in this instance of workplace culture, structures and policy.
In using the medical language of ‘illness’ and ‘disorder’ the program shifts the burden of responsibility of workplace mental health onto the employee. It shifts this problem on to the person. Claiming there is something wrong within you rather than in the workplace.
Obscuring Real Problems with Quick Fixes
What is more concerning about these approaches, is that research shows they do not address the needs they claim to address either. A Public Health England review found that not one of them was able to provide evidence showing that they directly improved worker productivity, lessened absenteeism or raised staff wellbeing.
These wellbeing programmes obscure the real problem and allow the false claim that organisations and governments are doing something about tackling poor mental health.
There is growing recognition that our mental health is determined by the conditions in which we are born, grow, work, live, and age, along with the wider set of forces shaping the conditions of our daily lives (WHO, 2014). This is because in its simplest form is mental health is about nervous system overwhelm and loss of connection to self, others and the world. If we take this view our system problem is not only an issue for those using the service but for everyone within it too.
The Need of Social Connection
Recognising the role that our social circumstances play in shaping our psychosocial health involves understanding our need for social connection and how it is important that we embed meeting these needs into all of our systems and practices – for everyone.
That we build psychosocially healthy circumstances and environments based on our relational needs; on ensuring the conditions for things like agency, security, connection, meaning and trust. Only then will it be possible to have good relationships – with ourselves, others, and the world around us.
More about Jen
Jen lives and works in south Wales. She is chair of Psychologists for Social Change Cymru, and a member of the BPS DCP Cymru. You can find her on twitter as @jendaffin or Instagram as @fair.play.psychology