Nikki Aitchison, one of Mayday’s PTS Coaches, blogs on how frontline workers can challenge diagnosis and the ‘let’s fix it culture’ prevalent in mental health and homelessness services.
Last month, I attended an exciting conference called ‘A Disorder for Everyone’ in Bristol. The day explored how strength-based and personalised interventions could offer an alternative to the current biomedical framework and the ‘let’s fix it culture’ prevalent in our public services.
More people are being diagnosed with mental health problems every year, this is partly due to the success of public campaigns aiming to destigmatise mental health problems. But as Carl Rogers says “the shoe that fits one person pinches another”, simply speaking out about mental health problems and relying on more diagnosis, and more professional support is not a recipe that will appetise everyone.
‘A Disorder for Everyone’ challenges the current system within mental health and looks at every single individual case. Instead of saying ‘what’s wrong with you? They ask ‘what happened to you?’ – A language shift surely makes less severe subconscious stamps and makes recovery an option. Clinical Psychologist Lucy Johnstone explained that if each individual case is to be looked at uniquely using a method called “formulation” there would be far less diagnosis and less prescribing. It is a person-centred process that creates a unique intervention.
In other words, ‘diagnosis’ is a generic identity – for example, hearing someone has been diagnosed with depression, tells very little about the influencing factors that brought to person to feel and behave in a certain way. The diagnosis of depression tells nothing about our interaction with the environment, culture, media, parents and social networks around us. So the question we should be asking at the frontline is not ‘what diagnosis should this person receive (or should they have received)’ but ‘how can I include the person in their recovery and encourage them to recognise their strength so that they can bounce back from tough times’.
Alongside this, I recognise that the reliability and validity of ‘mental disorder’ remains contested by people who survive the psychiatric system – but for the purposes of this blog, I will not go into a debate about how well the diagnostic manuals measures what they purport to measure – it is not a field I am trained in – but I will reflect on my experience of coaching people who received a mental health diagnosis, and how, if at all, this should have an impact on how we work in the frontline.
In my experience of working with people who are going through tough times like homelessness, leaving prison, care or psychiatric hospitals, I find three key principles ensure a quicker and more positive transition:
1- Challenging identities based on diagnosis, as any label, including those given by medical profession attempts to neatly categorise individual experience. The language and labeling that comes as a result of the diagnosis can give someone a false generic identity that can leave them feeling hopeless and discourage their drive forward
2- Challenging our ‘let’s fix’ culture of the overly diagnosed and prescribed generation, and instead of offering a new psycho-active drug, or even a psychological framework, sitting down with the individual and having a honest conversation about who they are, what matters to them, and ask what, if any, support they want from us, rather than assume what is best for them.
3- Recognising “what happened” that led to someone experiencing tough times, but focusing on “what is next”, what their dreams and aspirations are, and what strengths they already have and can build on to get there.
Let me illustrate this with my experience of working with Peter:
Peter made it very clear from the beginning that he does not want any support with his mental health diagnosis. For years and years, he was pressured to engage with mental health services and was feeling sick and tired of people nagging him about the same issues. We agreed we would focus on his aspiration – developing his knowledge and skills in Street Art. We spent much time walking across East of London, looking at street art, talking to artists, building positive networks and finding exciting projects for Peter to get involved in. Focusing on what Peter wants to do became a positive motivation to tackle and overcome challenges, including those caused by previous mental health problems, and Peter continues to learn to work through what life throws at him and build the resilience to overcome challenges in the future. In other words, Peter has better mental health, because he has not focused on it!
Starting the conversation with dreams and aspirations, focusing on strengths, and slowly building on what is already good (and important for) people is far more empowering and useful. This strength-based and personalised approach gives people hope, whereas a support to fix problems based on a diagnosis leaves people hopeless. Labeled as mad, bad, sad, client, service user doesn’t motivate anyone to take a positive step and move forward – instead, labels reinforce people’s insecurities, ‘places in hierarchy’ and makes them dependent on services. We all go through a rough patch – some rougher than others – but these difficulties should never define us!
I hope this blog encourages other frontline workers like me to consider strength-based and personalised practice, and together we start a front-line revolution by putting people (not the labels) at the centre of every decision and action.