Clarity needed over what constitutes as a ‘mental health problem’

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A systematic review uncovered several models used to understand mental health problems with implications for how people are assessed and supported.

A new review by researchers at the University of Bath looked at the theoretical models used globally to assess, diagnose, investigate and treat mental health problems and highlighted the wide range of approaches being undertaken. Theoretical models refer to a theory, or set of theories, that seek to explain how a problem should be understood and responded to. A model for mental health problems refers to the causes and characteristics of the condition.

The findings were published in the Journal of Mental Health.

Understanding the nature of a ‘mental health problem’

Researchers of the bath university Y Bern University of Applied Sciences examined more than 100 publications that referred to ‘mental health’ or ‘mental illness’ and identified 34 different theoretical models used by professionals, researchers and users of mental health services.

One of the most important findings highlighted was that they did not find criteria that could be used to prioritize why one model might be used over another. The researchers noted that these issues are responsible for how mental health problems are understood and have lasting ramifications for how people with mental health problems are assessed and supported.

Theoretical models ranged from being based on biology (body or brain), psychology (mind and conduct), sociology (social circumstances affect people), and cultural and consumer considerations (the experiences of people treated by mental health services and the adaptation of treatments to different cultures).

Previously, policymakers and practitioners have tried to reach a consensus on the use of so-called “biopsychosocial models,” an umbrella term that draws on elements of all the different models. This consensus appears to be fractured, the researchers said.

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The team of researchers said their findings have important implications given the growing rise in diagnosed mental health problems. Figures from the Mental Health Foundation have found that one in six people will experience a common mental health problem. However, these figures depend on how the problem is understood and measured.

Co-investigator Dr Jeremy Dixon, from the Department of Political and Social Sciences at the University of Bath and the Center for Social Policy Analysis, explained: “Uncertainties about what constitutes a mental health problem have become more pronounced in decades due to the increase in the number of mental health conditions that are identified in the manuals used by general practitioners and psychiatrists.

Professor Dirk Richter, from the Bern University of Applied Sciences, added: “Mental health problems are often presented as something that medicine and psychiatry understand. However, there is still debate about what exactly mental health problems are and how they should be treated. These are not just academics. Questions like, ‘what are mental health problems?’ or ‘what counts as a mental illness?’ have impacts within health systems. They can affect decisions about who can receive a mental health service and how behaviors such as aggression can be interpreted.

“One way out of this problem could be to ask service users which model they think is most appropriate for them and their treatment. However, the consequence would be that non-medical models could become more important than doctors would be willing to accept.

More clarity is required

The researchers call for greater clarity on how contrasting models of mental health can be used in practice. The wide range of theoretical models used by professionals should require a greater contribution from non-medical professionals and service users.

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“Mental health professionals tend to say that they use a biopsychosocial model in their daily work, but our research shows that this model is breaking down. While this field has been dominated by psychiatry and psychology, the perspectives of service users and other professionals, such as nurses and social workers, are now beginning to be heard,” said Dr. Dixon.

“Mental health services must recognize the wide range of perspectives now held by those who use services. Rather than insist that service users accept biological or psychological perspectives, mental health professionals need to understand and work with people’s preferences,” Professor Richter concluded.

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