In an excerpt of their article from theJanuary/February edition of Mental Health Today, AlisonClare and Sharon Lee Cuthbert discuss the importance of thewellbeing approach to mental health services and how it isinfluencing training programmes. To read the full article,subscribe to the magazine here.
Since mental health services began moving from isolatedinstitutions to local communities in the 1980s there has been aslow but steady shift in health and social care practice from an’illness approach’ to a ‘wellbeing approach’. We no longer focussimply on people’s problems and what they can’t do – a deficitapproach – but on people’s potential and aspirations in all areasof their lives – a strengths approach.
Over the years, many different initiatives have driven thisshift in focus. Although packaged in different ways, recoverymodels, person-centred planning, self-management and, mostrecently, personalisation all make the same point: we need to moveaway from seeing people just in terms of their diagnosis and workwith them in defining their own goals.
The concept of ‘wellbeing’ has permeated all areas of society.For example, The Office for National Statistics is currentlydeveloping new measures of national wellbeing, which will cover notjust the economic performance of the UK but the quality of life ofpeople as well. Schools are introducing activities such asmeditation to promote the wellbeing of children and even leadingsupermarkets now have ‘wellbeing’ aisles. The concept of ‘promotingwellbeing’ is here to stay and is changing what mental healthpractitioners do.
Benefits for people with mental health needs
Here are two scenarios that many practitioners will be familiarwith. One involves a person already in contact with mental healthservices and the other is someone who may need mental healthsupport in the future.
Scenario A:
Adrian is 50 and lives at home with his wife. He tried to killhimself three years ago following bankruptcy and the closure of hisbusiness. After a compulsory hospital admission he is stilldepressed and being monitored by a community mental health nurse.His wife is frustrated because while she’s at work Adrian spendshis days in bed chain-smoking. The main goal in his care plan -apart from his medication and what should happen in a crisis – isto attend a local job club for people with mental health problems,which he occasionally attends, more regularly.
Scenario B:
Phillip is 69 and has recently moved into an older people’shousing scheme. The scheme manager, Joan, has encouraged Philip tojoin the weekly coffee morning but he is very shy and finds itdifficult to make conversation with the other residents. Philliphas told Joan he is used to being busy but now spends a lot of timesitting on a bench outside. Joan has noticed he has become quiteconfused and forgetful and she is very concerned about him.
- There are several features common to both these scenarios, andto many other real life situations, which illustrate thelimitations of the illness/deficit approach:
- Those closest to the service user are trying very hard to givesupport but are frustrated by the lack of help and don’t know whatelse to do.
- The service users have the potential to do more with theirlives but the response to their needs is limited to what servicesare currently available and to their immediate problems.
- There is an unspoken assumption that probably not much else canbe done until there is some sort of crisis.
A worker taking a wellbeing approach could bring a newperspective to both these scenarios and to many other people inapparently hopeless situations. They could work creatively withthose involved to come up with new ideas and interventions andfoster a sense of hopefulness. This doesn’t mean abandoninginterventions that are intended to help people with their problems,but it does mean giving equal value to other initiatives that maytake longer to have an impact, but which have the potential to makea big difference to how people feel and to the quality of theirday-to-day lives.
How can learning help workers change their perception?
The difference between an ‘illness/deficit’ and a’wellbeing/strengths’ view of people can be described as a’threshold concept’ (Meyer & Land, 2003) because it opens up anew way of thinking about people and, consequently, new approachesto mental health practice. Without this transformed way ofunderstanding a worker cannot progress and begin to see how tochange what they do in their day-to-day work.
Wellbeing as a threshold concept therefore presents a challengeto tutors to teach. The Pavilion learning programmes deal with thisby using person-centred teaching and learning strategies that:
- Start from where the learners are, rather than from wheremanagers or trainers would like them to be
- Break the concept down into small parts, building up slowly tothe whole picture
- Link the approach to everyday experiences and to how we thinkand feel as individuals.
For example, in Unit 1 of Working in Community Mental HealthCare the first session includes an activity in which learnersidentify what the term ‘wellbeing’ means to them. Later, they thinkabout the campaign to get us to eat five portions of fruit andvegetables a day as an example of promoting physical wellbeing; andrelative effectiveness of self-directed change versus being toldwhat to do.
About the learning programmes
Both learning programmes have been designed to support learnersto achieve a full City & Guilds Award or Certificate in Workingin Community Mental Health Care (Level 3) or Promoting the MentalHealth and Well-being of Older People (Level 2 or 3). Units 1 and 2of Working in Community Mental Health Care are also option units inthe Diploma in Health and Social Care.
In the current economic climate many organisations are unable tofund qualifications for their staff but the learning programmes canalso be used on their own to deliver in-house and work-basedtraining programmes, including cultural change programmes.
To find out more about these learning programmes search thePavilion website at www.pavpub.com. For moreinformation about the qualifications search the City & Guildswebsite at www.city-and-guilds.com using the following codes: 3561for Working in Community Mental Health Care and 3062 for Promotingthe Mental Health and Well-being of Older People.
For a list of references and to read the article in full pick upyour copy of Mental Health Today Jan/Feb 2012 here.
