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1. mental health; mental illness:
how should we respond?
Lynne Friedli
Fair 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’Siadhail
Socialist 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, connectedness
Socialist Health Association lynne.friedli@btopenworld.com
5. Outcomes associated with
positive mental health
A 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 life
Socialist 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 prescribing
Socialist 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
instability
Socialist Health Association lynne.friedli@btopenworld.com
8. Mental health and recession
Socialist Health Association lynne.friedli@btopenworld.com
9. Untangling the determinants
I do worry about this emphasis on individual psychology;
You can’t separate thoughts, feelings, self esteem, motivation from the
material 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 resources
Socialist 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, aspirations
Towards a mentally flourishing Lanarkshire lynne.friedli@btopenworld.com
11. Mental Health in Relation to Income Inequality
Developed from: Pickett KE, James O, Wilkinson RG. Income inequality and the prevalence of mental illness: a
preliminary international analysis. Journal of Epidemiology and Community Health 2006; 60: 646-7
http://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,
Imprisonment
rate, Teenage
births,
Trust,
Obesity,
Mental illness,
Social
mobility.
Socialist HealthPickett KE The Spirit Level 2009
Wilkinson 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,
Imprisonment
rate, Teenage
births,
Trust,
Obesity,
Mental illness,
Social
mobility.
Socialist HealthPickett KE The Spirit Level 2009
Wilkinson 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 role
Socialist 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 solutions
Socialist 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’ agency
Socialist 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 failure
Socialist 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
