This essay will review the article ‘Policy implications of a psychological model of mental disorder’ (Kinderman, P., Sellwood, W. and Tai, S., 2007), and discuss how this article is relevant to my future career, by comparing the ideas that it espouses with those in other articles within the same field. The broad idea that underpins this article is that existing mental health service policy is predicated on the medical model of mental disorder, and that a psychological model of mental disorder could help to inform or even replace the medical model in terms of shaping policy.
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Kinderman et al’s (2007) article presents the view that mental disorders are “implicitly assumed to be biological disorders requiring treatment with variants on the traditional medical care systems”. The article presents evidence from a number of different sources, including the National Office of Statistics, and the charity Mind, in support of the view that people suffering from mental disorders often receive inappropriate care, and that the underlying reason is the assumption of medical rather than psychological models of therapy. The mediating psychological processes model of mental disorder (Kinderman, 2005, as cited by Kinderman et al 2007) is the psychological model proposed to enhance or replace the existing medical model. This model sees social and cultural influences, as well as biological factors as causing disturbances in the psychological processes of people suffering from mental disorders, as the diagram from Kinderman et al (2007) below illustrates;
The benefits of using this model are that interventions would be designed to benefit the underlying psychological processes rather than to treat a diagnosed ‘illness’ as part of a generic medical response. The model suggests causation is external to the individual, and that mental disorder is a response to external factors. The difference with this model in relation to the medical model is that the medical model only considers biological factors, and ignores social and cultural factors. Interventions, from this perspective, would therefore be much broader, and would include in large part mental health workers, with less emphasis on the more medically inclined psychiatric approach, and more emphasis on a multi-disciplinary approach.
Kinderman et al’s (2007) article goes on to look at how services could be structured around a social rather than medical framework and how existing organisational and operational structures would be altered across management and front-line departments. How users would engage with a service restructured around psychological concerns is looked at, particularly with respect to the stigma felt by patients that is currently associated with the medical model of mental ‘illness’, and the implications for patient recovery models. The more community-based, ‘quality of life’ approach to caring for people suffering from mental disorders is emphasised across all of these sections of the article. A breakdown of how the roles of specific mental health workers would be affected by adoption of Kinderman et al’s (2007) psychological model is also provided. The role of the mental health worker in this brave new world would be very much as part of a multi-disciplinary team. The role of psychiatrist focuses solely on biological interventions in terms of impact on psychological processes, and the traditional emphasis on psychiatry over other disciplines would be replaced by a more collaborative approach within a team of professionals across a number of disciples. Kinderman et al (2007) propose that nurses take on a broader role that encompasses psychological interventions, may carry more responsibility for clinical decisions, but still based on personal therapeutic relationships in both community and residential care settings. Psychologists are seen mainly as supervisors and trainers, and as formulating appropriate interventions as part of a multi-disciplinary team, rather than carrying them out. Social workers supply the social perspective to the team, and would be involved in socially based interventions, as opposed to psychological or biological interventions. Finally, occupational therapists also focus on the social aspects of care, specifically social inclusion, and the article suggests that a closer relationship between occupational therapy and return to work advice may come about.
I have attempted to place Kinderman et al’s (2007) article into context by reviewing literature related to this topic, so as to understand the issue of the medical model within the mental health services from different perspectives. Petrie, K., Broadbent, E., and Kydd, R. (2008) look at the affect of the patient’s own perception of their illness in terms of how the patient engages with mental health services and rehabilitative efforts. The self-regulation theory proposes that individuals form common-sense beliefs about their illness so that they can “understand and cope with health threats” (Leventhal et al., 1997; Leventhal, Nerenz, and Steele, 1984, as cited by Petrie et al 2008). Individuals actively try to understand their symptoms and their illness, which “…drives the patient’s coping and emotional responses to the health threat.” Petrie et al (2008) are arguing that the perceptions of the patient influence how they seek help, cope with interventions, rehabilitate, and respond emotionally to mental disorder. This view aligns to Kinderman et al’s (2007) view that social and cultural factors are as important as biological factors in how the mental health services engage with people suffering from mental disorders, and how well people respond to interventions. People’s perceptions of themselves are heavily contingent upon how they think other people see them, which is a social and cultural influence on an individual psychological construct. As an example of this Kondo, D. (1990), in reflecting as a researcher on her own experiences as a Japanese American describes how people “seemed to be constituted in and through social relations” and how the self is a dynamic construction. From this point of view, it is likely that an individuals’ perception of themselves, because it is a social construct, will change over time, and particularly with respect to how they perceive the state of mental disorder they suffer from, and how any intervention progresses (or not). This fits with Kinderman et al’s (2007) recognition that individuals are stigmatised through the application of the medical model to them, in the hands of the mental health service. Rose, Thornicroft, Pinfold, & Kassam, (2007, as cited by Petrie et al 2008) point out that “the diagnoses used for mental health problems are more often associated with negative connotations.”
Müller DJ, Mandelli L, Serretti A, DeYoung CG, De Luca V, Sicard T, Tharmalingam S, Gallinat J, Muglia P, De Ronchi D, Jain U, Kennedy JL. (2008) carried out research into the influences of genetic and non-genetic factors on adult Attention Deficit Hyperactivity Disorder (ADHD). According to Muller et al (2008), there is “strong evidence that ADHD is highly heritable and has a neurobiological underpinning” (Faraone and Biederman, 1999, as cited by Muller et al 2008), and that “low socioeconomic status, parental psychopathology, and family conflict” (Scahill et al., 1999 and Biederman et al., 2002, as cited by Muller et al 2008) are all strong contributors to the risk of ADHD. This view aligns to Kinderman et al’s (2007) view that social and cultural factors as well as biological factors need to be incorporated into the model that underpins mental health services policy. Muller et al (2007) concludes that the inclusion of “environmental factors in genetic studies, [would help] to resolve…” inconsistencies in studies of ADHD and of “…other psychiatric disorders.” Again, the importance of social and cultural factors as well as biological factors in understanding mental disorder is emphasised.
Much research has linked suicide, and having suicidal thoughts, to depressive disorders. For example, “most adolescents with depressive disorders report significant suicidal ideation, and a significant minority report having made a suicide attempt during the course of their depression (Myers, McCauley, Calderon, & Treder, 1991, as cited by Brown, R., Antonuccio, D., DuPaul, G., Fristad, M., King, C., Leslie, L., McCormick, G., Pelham, W., Piacentini, J., Vitiello, B., and Brown, R. 2008). It can be argued that suicide is a profoundly individual act. According to Durkheim, the motives of an individual could be explained by psychology, but psychology did not provide a general explanation of suicide as a ‘social fact’ (Smith, M., 1998). In Suicide (1897/1952, as cited by Smith, M. 1998), Durkheim studied suicide rates across time and place, and found patterns between suicide rates and amongst other factors, the geographic location of people that committed suicide, and membership of religious groups. It would seem that social and cultural factors had a very real impact upon the state of mind of individuals, and that there may also be psychological factors at play.
In relation to the article under review here, it would therefore seem that not only do social and cultural processes need to be taken into account when caring for people with mental disorders, but psychological factors also influence, or perhaps mediate how social and cultural factors influence, the individual. This is broadly in line with Kinderman et al’s (2007) model, although the relationship between biological and psychological factors is not clear, and could stand further research, notwithstanding the limitations of this particular essay. It would also seem that professionals and researchers across several disciplines and schools of thought relating to mental disorders agree with Kinderman et al’s (2007) article, in terms of the need to include social and cultural factors in understanding and caring for people with mental disorders.
In terms of my own career, Kinderman et al’s (2007) article illustrates the inadequacies within the existing structure and approach of mental health services, and how the mental health services could be improved by broadening the focus of the underlying model to include social and cultural causation of disruptions to individual psychological processes. I am unsure of how biological processes and psychological processes interrelate in terms of Kinderman et al’s (2007) model, but I would assume that in line with the deterministic causation of social and cultural factors, that psychological factors were are derived from biological factors. As a student considering a career in the mental health services, I see Kinderman et al’s (2007) article as very relevant. I chose the Kinderman et al (2007) article for review as it was of personal interest to me, and relevant to issues I may have to confront both in my future studies, and in my chosen career. I am specifically interested in how people are engaged with by the mental health services, and how effective that engagement is, in terms of promoting individual agency, and respecting individual differences. My own feelings and thoughts around how people shape themselves, how people are shaped by external factors, and how people should be treated by society and by the mental health services, tend toward equality and non-judgemental institutions, processes and workers. Kinderman et al’s (2007) article and the thinking it embodies is provocative and very interesting, as it challenges the status quo, and the accepted medical model; a model that sees people as merely organisms rather than people with their own feelings, thoughts, histories and needs. As someone planning to work in the mental health arena, I would prefer to work within a structure that aligned with my own ideals and values, rather than being constrained by the ideas and values of the institution, and not being able to work in a way that I thought was effective and valuable.
In writing this essay, the academic skills I have used include summarising, picking out key points, selecting relevant materials relating to the article under review, and constructing a logical flow of argument. I read the article itself through several times, first just to get a broad idea of the thrust of the article, and then again more carefully, paying attention to the points raised, and any thoughts I had related to the points raised. I noted down all of the ideas I had about the article at each reading, and used them to formulate a list of subjects for searching under on-line. These subjects included the main ideas underpinning the article, which included terms like medical, biological, illness, sickness, treatments, diagnosis, social / cultural influences (family, environment, socio-economic) psychological disorders, and related ideas like mental health, mental illness, intervention, child development, genetics, and psychiatry. I accessed the Open University library and carried out key word searches using different combinations of the terms themselves until I found articles that I could relate to the Kinderman et al (2007) article under review, and read, summarised and picked out key points. I then wrote up a rough essay plan that threaded all of the articles together, incorporating the key points of each, and led to the conclusion I had in mind, that is, the article was relevant to me, and was more or less supported by the additional reading I had done.
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I find studying academic skills as a subject useful, in that I feel as if I am developing a technique for better comprehending information and better expressing myself, by utilising evidence to support my views. This helps me to feel confident in approaching tasks that I may have felt previously were challenging because I was not comfortable that I knew how to achieve the objectives. I think I understand more about the process of working through information and evidence, with a view to applying that evidence to what I need to achieve. I feel as if I can see a logical path, which will help me to understand something and apply it in the way that I need to. In reflection, I think that one of the skills I have learnt is to break down things into smaller chunks that are more manageable. Taking a more methodical approach allows me to make sure I understand something fully before I move on to the next thing. This makes me feel as if I am achieving something at each step, rather than just grinding through a long task with no clear end in sight. It helps me to feel as if I am in control, and as if I know what I am doing, which I think is what makes me feel more confident. In conclusion then, studying academic skills makes me feel more confident about tackling difficult tasks for which I would not previously have had the skills or confidence to tackle, and I demonstrated this to myself in carrying out this assignment. Bibliography
References
Kinderman, Peter, Sellwood, William and Tai, Sara (2007)‘Policy implications of a psychological model of mental disorder‘, Journal of Mental Health,17:1,93 — 103
Kinderman, Peter, and Tai, Sara (2008)‘Psychological models of mental disorder, human rights, and compulsory mental health care in the community’, International Journal of Law and Psychiatry, Volume 31, Issue 6, December 2008, Pages 479-486
Petrie, Keith J. ; Broadbent, Elizabeth ; Kydd, Robert , (2008), Illness perceptions in mental health: Issues and potential applications, Journal of Mental Health, Volume 17, Issue 6 December 2008 , pages 559 – 564
Müller DJ, Mandelli L, Serretti A, DeYoung CG, De Luca V, Sicard T, Tharmalingam S, Gallinat J, Muglia P, De Ronchi D, Jain U, Kennedy JL. (2008). Serotonin Transporter Gene and Adverse Life Events in Adult ADHD. American Journal of Medical Genetics Part B 147B:1461-1469.
Kondo, D. (1990), Crafting Selves: Power, Gender and Discourses of Identity in a Japanese Workplace, Chicago, University of Chicago Press, pp. 9, 11-24
Brown, R.T.; Antonuccio, D.O.; DuPaul, G.J.; Fristad, M.A.; King, C.A.; Leslie, L.K.; McCormick, G.S.; Pelham, W.E. Jr.; Piacentini, J.C.; Vitiello, B. (2008), Depressive disorders and suicidality, in Childhood mental health disorders: Evidence base and contextual factors for psychosocial, psychopharmacological, and combined interventions.; pp. 69-85. Washington, DC, US: American Psychological Association. xii, 207 pp.
Smith, M., (1998), Social Science in Question, London, Sage Publications in association with the Open University Press, p84
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