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  • 1. mental health; mental illness: how should we respond? Lynne FriedliFair Deal for Mental Illness Debate: Socialist Health Association Coventry 16th May 2009
  • 2. This being human is a guest house. Every morning a new arrival. A joy, a depression, a meanness, Some momentary awareness comes As an unexpected visitor. Welcome and entertain them all. Even if they’re a crowd of sorrows, Who violently sweep your house Empty of its furniture. Still treat each guest honourably. He may be clearing you out for some new delight. The dark thought, the shame, the malice, Meet them at the door laughing, And invite them in. (Jelaluddin Rumi, 1207-73)Socialist Health Association lynne.friedli@btopenworld.com
  • 3. During these months something had matured in me All I’d to do was let it flourish. Just to have grown enough to accept my destiny. Every pretty blouse I put on a kind of celebration. I feel so light and radiant and cheerful. In suffering we share our loss with all creation. No admittance to Jews. The air I breathe is mine. That man cycling on Beethovenstraat, His yellow star of David a crocus in the sunshine. Such ripening strength. Gone the Bohemian waif. I want to be there at every front. I don’t ever want to be what they’ll call ‘safe’. from Etty Hillesum by Micheal O’SiadhailSocialist Health Association lynne.friedli@btopenworld.com
  • 4. Dimensions of mental health If I am not for myself, who will be for me? And if I am only for myself, what am I? If not now, when? Emotional resources Cognitive resources e.g. coping style, e.g. learning style, mood, emotional knowledge, flexibility, intelligence innovation, creativity Mental health (capital) Social skills e.g. listening, Meaning and relating, communicating, purpose e.g. vision, co operating goals, connectednessSocialist Health Association lynne.friedli@btopenworld.com
  • 5. Outcomes associated with positive mental healthA worthwhile goal in itself and leads to better outcomes: • reduces prevalence of mental illness • physical health: mortality/morbidity • health behaviour • employability, productivity, earnings • educational performance • crime / violence reduction • pro-social behaviour/social integration/relationships • quality of lifeSocialist Health Association lynne.friedli@btopenworld.com
  • 6. Promoting mental health: two routes A disembodied psychology which separates ‘what goes on inside people’s heads’ from social structure and context Critical Psychology Forum Public mental health •Self efficacy •Collective efficacy •Autonomy •Social responsibility •Individual responsibility •Wider determinants •Health behaviours •Social solutions • Money economy •Core economy •Volunteering •Timebanks •CBT •Social prescribingSocialist Health Association lynne.friedli@btopenworld.com
  • 7. Policy context and current debates.. If “being poor” once derived its meaning from being unemployed, today it draws its meaning primarily from the plight of a flawed consumer. Zygmunt Bauman • Decline of family/community/quality of life • Culture of materialism and consumerism • Plight of poor, dependent and ‘non-productive’ • Capacity of public services, lack of trust and democratic deficit environmental Economic/ instability Social fiscal policy psycho-social recession instabilitySocialist Health Association lynne.friedli@btopenworld.com
  • 8. Mental health and recessionSocialist Health Association lynne.friedli@btopenworld.com
  • 9. Untangling the determinantsI do worry about this emphasis on individual psychology;You can’t separate thoughts, feelings, self esteem, motivation from thematerial circumstances of people’s lives. Is it great to be positive?Maybe people are right to be pissed off.” Positive steps interviews • Individual skills and attributes • Material resources • Inequalities in distribution of resourcesSocialist Health Association lynne.friedli@btopenworld.com
  • 10. Mental health and deprivation Not ‘every family in the land’ Findings from 9 large scale population based studies: • Material and relative deprivation • Childhood socio-economic position • Low educational attainment • Unemployment • Environment: poor housing, poor resources, violence • Adverse life events • Poor support networks (Melzer et al 2004; Rogers & Pilgrim 2003; Stansfeld et al 2008; APMS 2007) Cycle of invisible barriers: • Poverty of hope, self-worth, aspirationsTowards a mentally flourishing Lanarkshire lynne.friedli@btopenworld.com
  • 11. Mental Health in Relation to Income InequalityDeveloped from: Pickett KE, James O, Wilkinson RG. Income inequality and the prevalence of mental illness: apreliminary international analysis. Journal of Epidemiology and Community Health 2006; 60: 646-7http://www.equalitytrust.org.uk/why/evidence/mental-health
  • 12. Health and Social Problems in Relation to Inequality Correlation: r=0.81, p < 0.0001 (excl USA: r=0.79, p < 0.0001) Index of: Life expectancy, Math & Literacy, Infant mortality, Homicides,Imprisonmentrate, Teenage births, Trust, Obesity,Mental illness, Social mobility.Socialist HealthPickett KE The Spirit Level 2009Wilkinson RG, Association lynne.friedli@btopenworld.com
  • 13. Health and Social Problems in relation to average incomes (GDP per capita US$ ppp) Index of: Correlation: r=0.81, p < 0.0001 Life (excl USA: r=0.79, p < 0.0001) expectancy, Math & Literacy, Infant mortality, Homicides,Imprisonmentrate, Teenage births, Trust, Obesity,Mental illness, Social mobility.Socialist HealthPickett KE The Spirit Level 2009Wilkinson RG, Association lynne.friedli@btopenworld.com
  • 14. “...the Greeks and Romans lived, I suppose, very comfortably though they had no linen. But in the present times, through the greater part of Europe, a creditable day labourer would be ashamed to appear in public without a linen shirt, the want of which would be supposed to denote that disgraceful degree of poverty which, it is presumed, nobody can fall into without extreme bad conduct. Custom in the same manner has rendered leather shoes a necessary of life in England. The poorest creditable person of either sex would be ashamed to appear in pubic without them” (Adam Smith Wealth of Nations 1776 cited in Zaveleta 2008)Socialist Health Association lynne.friedli@btopenworld.com
  • 15. Resilience, health assets and capabilities ‘To value the contribution of those whom the market excludes or devalues and whose genuine work is not acknowledged or rewarded’ Edgar Cahn Distribution of resources • Resilient places Quality of relationships • Resilient communities Policy responses to misfortune • Resilient individuals Valued social roleSocialist Health Association lynne.friedli@btopenworld.com
  • 16. (the ecology of)Relationships matter Tend to the social and the individual will flourish Jonathon Rutherford • Mental health is produced socially • Presence or absence of mental health is above all a social indicator • Social as well as individual solutionsSocialist Health Association lynne.friedli@btopenworld.com
  • 17. The quality of policy responses to misfortune ‘Belonging : trusting in the benefits of human solidarity and in the institutions that arise out of that solidarity Zygmunt Bauman • We are all vulnerable and dependent • We’re all in this together • Collective efficacy • ‘Other regarding’ agencySocialist Health Association lynne.friedli@btopenworld.com
  • 18. What would a fair deal look like? Resources, relationships, meaning, respect • Reduce economic inequalities i.e. Mind the gap • Include social outcomes: the quality of relationships matters • Valued roles and multiplicity of meanings • Treat people experiencing problems with respect: vulnerability and dependency are part of the human condition, not a mark of moral failureSocialist Health Association lynne.friedli@btopenworld.com
  • 19. A (wider) framework for effective action And what I shall endure, you shall endure For every atom belonging to me as good belongs to you...... Walt Whitman Reduce poverty Respectful policy and the impact of responses to misfortune poverty Mental health Opportunities and Mental Quality of social for meaningful Capital relationships activity: education, (family, schools, training, volunteering workplace, communities) Build capacity for Reduce material collective action inequalities (collective efficacy)Socialist Health Association lynne.friedli@btopenworld.com
  • 20. Figure 1 (A) Pyramid of capitalist system. Issued by Nedeljkovich, Brashick and Kuharich, for the International Workers of the World (IWW), 1913.18 Krieger, N J Epidemiol Community Health 2008;62:1098-1104 Socialist Health Association lynne.friedli@btopenworld.comCopyright ©2008 BMJ Publishing Group Ltd.
  • 21. Socialist Health Association lynne.friedli@btopenworld.com
  • 22. Socialist Health Association lynne.friedli@btopenworld.com
  • 23. Socialist Health Association lynne.friedli@btopenworld.com