Can We Embrace a More Complex Discussion of Mental Illness

“The aim for me, in getting people well, is for them to develop insight – understanding that you have a mental illness. And that you require medication, and that you will comply and adhere to a treatment plan.”

These are the words of Dr Mark Cross during the opening scenes of ABC’s 2014 edition of Changing Minds. To many they might affirm a simple fact about the treatment of mentally ill people. To me, it demonstrates the need for us to cultivate a more critical – but constructive – dialogue about how we understand and respond to mental illness.

My views are not original or radical within the sector. Professor Allan Fels, Chairman of the National Mental Health Commission recently spoke about the Commission’s new review:

The first barrier [sic] would be to lose sight of the fact that this is about people with lived experiences of mental illness and their families and carers. Yes, it is about ‘the system’, but it is about a system being reoriented to focus on the need of individuals, families and communities, rather than supply as determined by funders and providers.’

In other words, it’s about a person-centered approach, which relates to the concept of “Recovery”. Recovery refers to, among other things, mental health practice that respects:

  1. The Uniqueness of the individual;
  2. Real Choices and Autonomy;
  3. Attitudes and rights;
  4. Dignity and respect;
  5. Partnership and communication.

To be clear, these are the principles that the national commission says must be part of an effective mental health system. These are not anti-medicine or anti-psychiatry stances, they have been supported by the commission’s lengthy consultation period and enormous research base.

However I’m left with a very different picture of recovery from Changing Minds. I’m aware that Dr Cross’ views should not be limited to this quote, and that his engagement with consumers seemed informed, empathetic and respectful. Nevertheless, the focus on (1) insight, (2) medication, and (3) compliance is very concerning.

It creates a picture of people with mental illness as being without capacity. It overlooks the complex interaction between social, psychological and biological factors that contribute to mental distress.* Recovery from mental illness may be resolved by insight, medication and compliance, but for many others who have recovered from mental illness, or survived psychiatry, it requires much more.

It requires services that respond and adapt to the needs of consumers. In a space where collaboration and innovation is vital, compliance and behaviour management strategies are often resorted to. Therefore rather than meeting individuals at a place where all parties can address someone’s distress, they cut off social spaces and institutional factors by saying the problem is you. Working as an advocate in the sector, I’m more saddened every time I see someone’s behaviour being used as a reason not to listen to them, integrate their experience, and work creatively with their trauma.

While I believe the show has privileged certain perspectives and silenced others, I welcome how the ABC has put mental health on the map. Now that it is there, we can start to unearth and tease out some of the finer details.

This blog is about this and other issues. It aims to create a space to talk about mental illness critically. It’s a journey I take as a person who works in the sector, and as someone who lives with mental illness.

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* The biopsychosocial framework is mentioned within the documentary, however psychological and social factors appear to be unexplored.

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