Clarity needed over what constitutes as a ‘mental health problem’

Clarity needed over what constitutes as a ‘mental health problem’
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A systematic review uncovered various models used to understand mental health problems with implications for how people are assessed and supported.

A new review by researchers at the University of Bath looked at theoretical models used globally to assess, diagnose, research, and treat mental health problems and highlighted the vast range of approaches undertaken. Theoretical models refer to a theory, or a set of theories, which seek to explain how an issue should be understood and responded to. A model for mental health problems refers to the causes and characteristics of the condition.

The findings were published in the Journal of Mental Health.

Understanding the nature of a ‘mental health problem’

Researchers from the University of Bath and Bern University of Applied Sciences examined over 100 publications that referenced ‘mental health’ or ‘mental illness’ and they identified 34 different theoretical models used by practitioners, researchers, and users of mental health services.

One of the most important findings highlighted was that they found no criteria which could be used to prioritise why one model might be used over another. The researchers noted that these matters are responsible for how mental health problems are understood and have lasting ramifications for how people with mental health problems are assessed and supported.

The theoretical models ranged from being based on biology (body or brain), psychology (mind and behaviour), sociology (social circumstances affect people), and consumer and cultural considerations (the experiences of people treated by mental health services and adapting treatments to different cultures).

Previously, policymakers and practitioners tried to form a consensus about using so-called ‘bio-psycho-social models’ — a catch-all term, which draws on elements of all different models – this consensus seems to be fracturing, said the researchers.

The team of researchers said their findings have important implications given the growing increase in mental health problems diagnosed. Figures from the Mental Health Foundation have found that one in six people will experience a common mental health problem. Yet, these such figures are dependent on how the problem is understood and measured.

Co-researcher, Dr Jeremy Dixon from the University of Bath’s Department of Social & Policy Sciences and Centre for the Analysis of Social Policy explained: “Uncertainties about what constitutes a mental health problem have become more pronounced in recent decades due to the increase in the number of mental health conditions being identified in the manuals which are used by general practitioners and psychiatrists.”

Professor Dirk Richter, from the Bern University of Applied Sciences, added: “Mental health problems are often presented as something which is understood by medicine and psychiatry. Yet, debate remains about what exactly mental health problems are and how they should be treated. These are not just academic. Questions such as, ‘what are mental health problems?’ or ‘what counts as a mental illness?’ have impacts within health care systems. They can affect decisions around who might receive a mental health service and how behaviours such as aggression might be interpreted.

“One way out of this issue could be to ask service users which model they feel to be most appropriate for them and their treatment. The consequence, however, would be that non-medical models might become more important than clinicians would be willing to accept.”

Greater clarity is required

The researchers are calling for greater clarity over how contrasting mental health models can be used in practice. The extensive range of theoretical models being used by practitioners should require greater input from non-medical professionals and service users.

“Mental health practitioners tend to say that they use a bio-psycho-social model in their everyday work, but our research shows that this model is fracturing. Whilst this field has been dominated by psychiatry and psychology, the perspectives of users of services and other professionals such as nurses and social workers are now beginning to be heard,” commented Dr Dixon.

“Mental health services need to recognise the wide range of perspectives which are now held by those who use services. Rather than insisting users of services accept biological or psychological perspectives, mental health professionals need to understand and work to people’s preferences,” concluded Professor Richter.


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