Editorial
Article Type: Editorial From: Mental Health Review Journal, Volume 16, Issue 4
Watching demonstrations and riots in response to public sector austerity across Europe, and ourselves preparing for one of the largest UK public sector strikes in living memory (anticipated to be the largest since 1926), likely to involve or affect many frontline healthcare staff, the economics of mental health seem very much foremost in our minds. The overriding concern for many of us will always be: how much of a priority are mental health services for governments next to those for physical health, or education? How can we make clearly the case for mental health, one that many of us delivering services understand implicitly: that mental well-being is an essential for a productive,efficient and “happy” society.
In this context, it is heartening to curate an issue of the journal that directly addresses some of these important issues of the interface between mental health and social economics. In a substantial and important piece of work, Fitch, Hamilton, Bassett and Davey present a systematic review of research linking personal indebtedness to mental wellbeing. Set in the context of recent work by Wilkinson and Pickett (2009), who stipulated a causal link between inequality and – among many other social outcomes – poor mental health, their conclusions are sobering and provide a great deal of food for thought as European societies move into an economic climate where debt is higher and personal income less stable and certain.
It is interesting that, in the midst of some of the most lean economic times of the last 40 years, we are seeing an increasing emphasis on the role of service users themselves in determining the best route to their own recovery,and contributing directly to creating an evidence base for the most complex and least well understood mental health conditions. In this issue we have a number of papers that address and evaluate this welcome new movement; itself a potentially vital contributor to the movement of service users out of a traditional “sick role” and validating them as productive and capable members of society. Thus, Cowan, Banks, Crawshaw and Clifton address the issue of the involvement of service users in mental health policymaking, and rightly question whether such “partnership” arrangements can undermine the critical voice of the service user movement. Their framework for understanding“citizen power” against “tokenistic engagement” will be of great interest to anyone interested in involving service users in the development of care.
Continuing in this vein of service user involvement, Mike Rigby and Amy D’Sa provide an account of how service user consultants have been intimately involved in the evolution of the UK specialist Personality Disorder services. They explore the development of the consultant role and reflect both on the benefits of this close level of involvement between service users and providers –which takes many lessons from the therapeutic community movement – and also ask whether the loss of some traditional boundaries in these new relationships may demand more attention and reflection for services that work in such a close “partnership”.
Two more articles take a more provider-focused perspective: Abdur-Razzaq’s paper evaluates the mental health triage process in a busy hospital in New Jersey, USA and highlights inconsistencies between local practice, state guidance and international consensus about best practice. Within the context of highly variable levels of service provision and differential “sensitivities”amongst caring staff to distress and acting out by patients, which may result in chemical or physical restraint how can a “fair” and curative process be implemented in a consistent way across services?
Also in this issue, Phillips, Leighton and Sargeant give the perspectives of the UK psychiatrists on the mandatory inclusion of psychotherapy experience in their training. The psychodynamic model experienced by these authors and their contemporaries is often at odds with traditional medical ways of thinking about patient care and can require some “framing” to be integrated fully into the expected role definition of new psychiatrists. On the other hand, the authors make an interesting point that many services would benefit from this more thoughtful perspective on mental health and may contribute to managing some of the most acute forms of distress experienced by staff.
This issue has been especially interesting to edit, and I hope that it proves stimulating to our readers and perhaps encourages them to take up the gauntlet(or gauntlets) offered by many of the featured papers, and consider writing about their own experiences or local innovations.
Mark Freestone
