‘Crisis’ a failure of definition

Not all emotions need to be taken to a psychologist, says Helen Rook.

We keep talking about the mental health crisis as if it were about a generation of fragile minds. It’s time to refocus this conversation: the mental health crisis is about fragile systems, not fragile people, but also about how we define our relationship with emotions.

It’s very important to get mental health problems out of the closet: admit that depression exists, talk about anxiety disorders, discuss mania.

But that doesn’t mean all our emotions – even strong and unpleasant ones – need to be taken to the psychologists.

We might call this way of talking the ‘‘psychological turn’’. So focused are we on transforming our approach to previously stigmatised mental illnesses that we’ve lost sight of the other ways we have of hefting our emotional baggage.

We’re supposed to be sad when we lose loved ones. It triggers normal support reactions and we reach out to friends and family. But if the only words we know to describe these emotions are psychopathological – that is, they relate to mental illness – then the only consequent action is professional help. And, if everyone needs psychological help with their mental health, we over-stretch slender resources.

The psychological turn is closely linked to the ‘‘medicalisation’’ of society. Even while psychologists would argue – and they’d be right – that their clinical work is completely different from the work of medicine, the phenomenon is the same: over-reliance on the professional.

Medicalisation, and, indeed, psychologisation, is when we take something which is arguably normal, albeit possibly very unpleasant, and place it in the purview of the professional fields.

If we think this way, we’ll find we have another problem. If everyone needs a clinical psychologist, then we need more clinical psychologists. If we need more clinical psychologists, we need to reduce the constraints on their training.

There’s been a call for a tripling of the workforce, but there is not a university in this country that has increased enrolments sufficiently to deliver this number. And the training requirements are excessively arduous.

Unlike any other healthcare professional registration pathway (medicine, nursing, dentistry, social work . . .), the Psychologists Board requires an advanced research degree in addition to clinical training. This extends the duration of training and restricts entry to the research-minded.

It’s an elite programme which privileges a select group and which, some say, dilutes clinical skills, as clinicians focus on research at the expense of practice.

Both the privileged nature of entry and the research-intensive pathway make clinical psychology training a problematic solution to the mental health crisis.

We also must extend the range of solutions beyond psychology alone. This is to free up the (understrength) clinical psychology workforce to work with the seriously ill and also to recognise the mind is more than a psychological arena.

Emotions, spirituality and relationships are among the range of phenomenons handed over to psychology without blinking.

Yet peer support, coaching, spiritual leaders, families, teachers and friends all can contribute to the understanding of human emotions and the support they require. This is more difficult when these emotions are psychopathologised.

All sadness is not depression; all worry is not stress; all shyness is not social anxiety. Having said that, with our new-found emphasis on destigmatising mental health problems, we seem to have lost the vocabulary of emotions.

What’s more, we’ve started using the term ‘‘mental health’’ politically. Every time we want political action, we emphasise the consequences of a particular situation on the mental health of the people involved.

Instead of saying understaffing and unsafe work conditions are unacceptable for nursing units, nurses and patients, we focus on psychological distress. There’s a lot more than that to focus on.

We do have a problem. We can’t properly look after those community members with mental health problems. But the problem is not as simple as it looks on the surface. The ‘‘mental health crisis’’ on everyone’s mind is a failure of definition and of systems as much as it is of minds.