1

Chapter # Social Models of Mental Illness

 This chapter provides a brief history of the rise and fall of the asylum in the
UK
 It discusses a range of social theories which help explain the ideas of mental
health and illness are constructed
 The chapter selects four important ‘identities’ – gender, race/ethnicity, social
class and age – to illustrate the interface with ideas on mental health
 A number of explanatory models and case studies are used to help the reader
understand the application of theory to practice.
 The chapter concludes by arguing for a more critical, reflexive approach to
these relationships, one that is important for practice in mental health services

Introduction
This chapter will describe and analyse a range of social perspectives and models
which inform the way that mental illness and health can be understood. It begins with
an account of the varies histories of madness, from the mid century on, explaining
how social theories became increasingly influential in the way mental health services
were perceived, designed and delivered. It then draws upon the tripartite division of
perspectives described by Rogers and Pilgrim (2010) in their text: A Sociology of
Mental Health and Illness, and then summaries the critical realist position on mental
health and illness. The second part of the chapter then focuses on the evidence
base which indicates how specific social groups (in terms of gender, race/ethnicity,
class and age) become more likely to be diagnosed and labelled as mentally ill.
Throughout the chapter exercises and case studies are used to illustrate how theory
can be applied to practice. The chapter concludes with an appeal for professionals to
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think more critically about the knowledge base and how relationships of power need
to be questioned in the context of the delivery of mental health services.

Historical perspectives on the rise and fall of the asylum

When we study the ideas that inform practices in mental health services it is
tempting to assume that the concepts we use and apply are reasonably fixed; the
culmination of advances in scientific and social scientific knowledge. The discourses
that underpin such confidence in concepts of mental health and illness have been
very influental in the design and delivery of services in Europe, north America and
Australasia over the last century. It is possible to trace this sense of progress, from
the use of physical treatments that were routinely used in late 19 th and early to mid
20th century asylums (straightjackets, insulin therapy and leucotomies), latterly
replaced by more humane, scientifically tested interventions based on talking
therapies (see chapter # on Psychological Approaches) and increasingly refined
forms of medication (see chapter # on the Medical Model). This notion of a
positive trajectory in care and treatment is perhaps best represented in the writings
of Jones (1960). Here it is argued that, despite the harshness and coercion of the
asylum there were constant attempts to improve the lives of in patients through
examples of innovative policy and practice, typified in the methods of moral
treatment introduced by Tuke and others. In the transition from madhouses, to the
lunatic asylum, and eventually the mental health hospital, Jones gathers evidence of
change and progression in mental health policies in the UK, partly reflected and
underpinned by the growth in professional knowledge and expertise in psychiatry,
nursing and later clinical psychology, social work and occupational therapy.
This is an attractive, although not altogether uncontested view of the history of a
relatively even development of mental health systems and services. Sociological
approaches can help us critically to analyse, not just taken for granted, common-
sense assumptions about the everyday lives of service users and professionals here
in the early twenty first century, they enable us to deconstruct ideologies and
discourses about the past, and in doing so reveal important relationships about the
power of professionals and hegemony of the state and other institutions. Scull’s
(1975) critique of the Enlightenment account of the rise and development of the
asylum adapts Marxist theory to expose the interface between mental health
3

policies, professionals practices, and the capitalist system. In an argument echoing

contemporary debates, his view was that the process of decarceration (the large
scale emptying of psychiatric hospitals and policy shifts towards care in the
community) was carried out for ideological or fiscal reasons as much as concern for
better, more humane care and treatment regimes. An important contribution to this
critical way of thinking about the past is represented in the work of Michel Foucault,
in particular the way in which he sought to construct an archaeology of mental illness
in his seminal text Madness and Civilisation (1965). His ideas were particularly
influential as a precursor to post-modern theories which were developed later in the
twentieth century and which are discussed below.
As a result of these and other ideas, it is no longer possible fully to analyse past and
present policy and professional practices without interrogating systems of individual
and institutional power, especially in the way ‘experts’ construct the language of
mental health and illness, and its impact on the everyday lives of clients whose
thoughts, behaviours and feelings are described in such discourses. Thus Sartorious
(2002) is critical of the way that some psychiatrists use diagnostic labels carelessly.
This is exacerbated, he argues by a tendency for public and health professionals to
have negative attitudes to people with mental illnesses. He argues for a more rights-
based approach to mental health practice in which skills of advocacy, alongside
clinical practice, can change attitudes to mental ill-health:
“It would be useful if all of us were to examine our own behaviour and actions and
change them where necessary to reduce stigma. Stigma remains the main obstacle
to a better life for the many hundreds of millions of people suffering from mental
disorders and their consequences. We must make our contribution to eliminate
stigma and fight it in every way possible.” (2002: 1470)
In viewing the past histories of mental health systems we can also make sense of
our current realities. Although successive waves of decarceration in the UK and
elsewhere in the world has, at one level, attempted to transform systems of care and
treatment (Finnane, 2009) new types of community care have not necessarily
resolved the problems of the past (Bartlett et al, 2008). Service users continue to
received services that are less well-funded than other parts of the health care sytem
and sometimes these services are just as stigmatising as those from the past. It is
also an unfortunate reflection that access to care and treatment is often uneven. The
4

chapter now explores how social theories can assist us in understanding why these
inequalities persist and how this affects and limits opportunities for mentally healthy
lives.

Using social theory to understand mental health and illness

Just as we can examine the history of mental health services through a critical
sociological lense, so too can we considering the way that contemporary ideas,
discourses and practices are constructed. The tripartite division of perspectives
described by Rogers and Pilgrim (2009) are helpful in this respect. These
perspectives are: Social Causation – in which arguments are made for viable causal
relationships between social problems and mental health distress. An example of
this is the original study by Brown and Harris (1978) which sought to establish an
empricial link between the multiple deprivations experienced by single mothers living
in poor housing conditions and an increased likelihood of being diagnosed with
depression. The Societal Response perspective builds on the early work of of
Goffman (1961) and (Scheff, 1966) to explain how stigma, secondary deviance
contribute to wider systems of discrimination. Thus Goffman’s study of the asylum
described how both patients and professionals performed expected roles which
became normative, embedded in everyday practices. Usually the identities ascribed
to patients were, and continue to be negative and depersonalising, reinforced by
forms of institutionalised stigma which proves difficult to challenge and erase.
Scheff’s analysis of labelling sought to highlight the way in which the processes
leading to secondary deviance (where further, negative characteristics were
attributed to the person who received the lable). We are also now more conscious of
the fact that, not just patients, but their families can also suffer from the negative
effects of stigma (Corrigan et al (2011). Only by concerted efforts at the level of
policy and radical changes to professional and public attitudes can we hope effect
change in this crucial area of mental health needs and services
The third perspective, Social Constructionism, challenges the assumption that an
objective existence can automatically be attributed to a notion of mental illness
without first considering the meanings ascribed by professionals, policy makers and
the wider public. We can begin to understand how social construction by asking two
questions: have our ideas about mental illness changed over time? And are there
5

variations in contemporary ideas across cultures and identities. There are many
possible examples of such social construction, for instance in the way systems of
psychiatric classification (DMS II) included homosexuality as mental disorder in the
1950s and 1960s, a decision which would be viewed to be discriminatory today. In
the second case we know that different ethnic communities perceive mental illness in
diverse ways depending on cultural norms and interpretations of behaviour. For this
reason it is imperative that mental health professionals should avoid making
Eurocentric assumptions when intervening in the lives of clients from Black and
Ethnic Minority (BEM) communities (Robinson, 2013, in Walker (ed)., an issue we
will discuss later this chapter. These three perspectives are useful in helping us think
more critically about how we describe and operationalize ideas of mental illness, but
this is a rapidly developing area of knowledge which is in constant flux and
interpretation, caught between traditional, modern views of the social world and late
and post-modern theories which continue to challenge discourses and practices
(Bhaskar, 1990). This fourth, social realist, position is summarised by Pilgrim and
Bentall (1999):
“In a critical realist account it is not reality which is deemed to be socially constructed
(the axiomatic radical constructionist position), rather it is our theories of reality , and
the methodological priorities we deploy to investigate it. Our theories and methods
are shaped by social forces and informed by interests. These include interests of
race, class and gender as well as economic invest ment and linguistic, cultural and
professional constraints in time and space. These forces and interests invite forms
of sceptical or critical analysis when we are asked to accept or reject empirical
knowledge claims about reality. Thus deconstruction has a part to play in this
exercise, but human science should not be reduced methodologically to this position
alone. We can, and should, make attempts at investigating reality in itself, but do so
cautiously and critically.” (262)
What this perspective offers is a sort of middle ground in which the ‘reality’ of mental
illness and distress is recognised as a significant lived experience, but moves us
away from static, realist assumptions about mental illnesess as ‘facts’. In
deconstructing the language and descriptions of mental illness used by professionals
(and service users), we can begin to uncover relationships of power and the wider
social contexts that creates such usage.
6

Exercise 1

Now that you have read about these different ways of

viewing mental health and illness, take some time to
consider your own practice. Chose a situation where a
diagnosis has been made and apply two of the
theoretical positions described above to this diagnosis.
In comparing and contrasting these two perspectives,
how does this alter the way in which you would
We expect intervene in the person(s) lives? that this exercise
will have been challenging
for you, especially if you have been practising using conventional psychiatric
approaches to assessment, diagnosis and treatment. Yet, as we argue in this book,
such critical approaches can sit alongside others in practice environments where the
knowledge base is in constant, often creative change (see Chapter # on Post-
Psychiatry).

Applying Theory to Practice

We have argued so far that social models can enable us to critically analyse the
social and political processes that inform decision making in mental health services.
This is not just a theoretical proposition, there is a considerable body of empirical
evidence to support this perspective:
“Sociological research on the antecedents of disorders rests on a foundation of
empirical research demonstrating repeatedly and convincingly that mental disorders
are not randomly distributed throughout society but tend to cluster more densely with
some social strata than others.” (Aneshensel et al (eds), 2013: 10)
A convenient way of demonstrating the importance of considering social
perspectives on mental health is to apply theories to a range of identities and
subjectivities; in this section we will discuss how professional and public discourses
affect particular populations in terms of the interface between mental health systems
and four social identities: gender, race, class and age. In doing so we need to
acknowledge the complexities of how these identities overlap and the manner in
which structural discrimination may adversely affect the mental health of some social
groups rather than others. An example of this is Beayboeuf-Lafontant’s (2007)
7

discussion about the interface between race, gender and mental health issues. At
the same time we need to be mindful to avoid an approach that overdetermines
structure at the expense of more subtle causal factors. For example, Rosenfield
(2012) discusses the intersections between of gender, race and class and mental
health and argues that theories of structural causation, alone, cannot explain
‘schemas of self-salience’ and subjective hierarchies which are created in everyday
social interactions.
The section will also describe how professionals can intervene in ways that enhance
the mental well-being of clients. This sense of complexity makes the application of
theory to practice nuanced and tricky but not without its rewards in finding
meaningful, reflexive approaches to working with individuals, families and
communities. Tew (2011: 4) has tried to capture this complexity in his model that
describes The Components of a Social Approach:

Insert Tew’s diagramme about here

As you can see from the diagramme, a recognition of social models of mental
distress is one of a number of knowledge claims, alongside core skills and values
which, if considered holistically, he argues, will contribute to socially orientated
practice. It would be useful at this point for you to consider whether you see your
practice in terms of interventions at these domains (this will vary according to which
mental health professional you are). Let us now consider this notion of socially
orientated mental health practice when working with a range of individuals, families
and communities.

Gender
Much has been written about the intersection between gender and mental health and
the often unspoken assumptions that are made about how women and men are
differentially treated and cared for by mental health professionals. Sociologists and
social theorists are keen to interrogate the processes which often create inequalities
and consequent social problems. Sometimes gendered differences are starkly
represented in ‘facts’ of mental health care. For example, women are much more
likely to be diagnosed and treated for depression, eating disorders, anxieties and
8

phobias, and men for addictions problems as reflected in the following UK

government statistics (Mental Health Foundation
(http://www.mentalhealth.org.uk/help-information/mental-health-statistics/men-
women/)

Table 1
 Women are more likely to have been treated for a mental health problem than
men (29% compared to 17%).This could be because, when asked, women
are more likely to report symptoms of common mental health problems.
(Better Or Worse: A Longitudinal Study Of The Mental Health Of Adults In
Great Britain, National Statistics, 2003)
 Depression is more common in women than men. 1 in 4 women will require
treatment for depression at some time, compared to 1 in 10 men. The reasons
for this are unclear, but are thought to be due to both social and biological
factors. It has also been suggested that depression in men may have been
under diagnosed because they present to their GP with different symptoms. 
(National Institute For Clinical Excellence, 2003)
 Women are twice as likely to experience anxiety as men. Of people with
phobias or OCD, about 60% are female.  (The Office for National Statistics
Psychiatric Morbidity report, 2001)
 Men are more likely than women to have an alcohol or drug problem. 67% of
British people who consume alcohol at ‘hazardous’ levels, and 80% of those
dependent on alcohol are male. Almost three quarters of people dependent
on cannabis and 69% of those dependent on other illegal drugs are male.
(The Office for National Statistics Psychiatric Morbidity report, 2001)

There are indeed a range of possible biological and psychological explanations for
these relationships between gender and mental health, as we have discussed in
other chapters in the book. In the case of post-natal depression, for instance, it has
been argued that biochemical changes during pregnancy may be a contributory
factor, and psychological and stressors and issues of coping also can explain the
aetiology of the mental health problem. Alongside and intersecting with these are the
many social processes which adversely affect the lives of women in terms of their
9

mental health. Role expectations about caring and the dual labour market (when
many women work outside the home and carry out disproportionate domestic duties)
sometimes create adversity and stress (Williams, 2005). Other social problems
contribute to gendered patterns of mental ill-health. For example women and
children are particularly vulnerable in situations of familial violence and abuse. In a
study of 520 children by Olaya et al (2010) the researchers found that mothers
exposed to intimate partner violence were more likely to protect sons and punish
daughters whereas fathers were more likely to display great emotional distress and
punish and reject children.These gendered behaviours tended to increase the risk of
posttraumatic stress disorder, dysthymia (depression or mood disorder), self-
harming behaviour and functional impairments for children.
Normative assumptions about the womens’ roles create help-seeking behaviours
which may problematize the interface with mental health systems. They are then
captured in the sorts of statistics described in Table 1, above. Women are more
likely than men to talk about emotions and concerns, visit primary care services and
be diagnosed and treated for anxiety disorders and depression. When we consider
other parts of the psychiatric system we can discern patterns of gendered decision-
making by professionals, underpinned by legal and policy processes. For example,
aspects of admissions to psychiatric hospital have been, and continue to be, marked
in terms of gender. Prior (1999) notes changes in trends, the growth of older women
with dementia and younger men with severe personality disorders being more likely
to be hospitalised in psychiatric institutions. Shifts in psychiatric admission rates can
be partly explained by demographic trends associated with an aging population, but
just as importantly, assumptions that professionals make about risk and
dangerousness. In their study, Warner and Gabe (2006) found that decisions about
risk and mental health by social workers could be explained by their capacity, or
otherwise, to decode gendered identities, both social worker and client.
Nuanced perceptions of risk are increasingly applied to groups of men with mental
health problems, in particular those with severe personality disorders or who have
been ‘dually diagnosed’ with psychosis and drug and/or alchol misuse. It has been
argued (Rogers and Pilgrim, 2010) that gendered assumptions about how and why
women behave differently is reflected in professional making in forensic services and
sentencing; some men are much more likely to be subject to informal and formal
10

powers of coercion than women. In exceptional circumstances these discourse on

risk are played out in populist accounts following public inquiries into homocides
(although rarely when people with mental health problems take their own lives).

Race, ethnicity and mental health

As alluded to above, there are considerable variations in the way different cultures
and ethnic groups understand and experience mental ill-health; it is often the case
that predominant cultural discourses inform policy-making, as well as the practices of
mental health professionals which negatively impact upon on the lives of clients,
particularly those from BME communities (Sashidharan, 2001) . It is sometimes
difficult to unpack the processes which lead to the situation when institutional policies
and choices made by practitioners practices lead to racism, deliberate or
unintentional. Any analysis of this phenomenon must take into account legal, policy,
societal factors, as well as the way professionals internalise ideas about ethnicity
and race. Lets start with a discussion of how the application of mental health laws
appear to disadvantage member so BEM communities across the developed world.
There is compelling evidence that these populations are much more likely to be
compulsorily admitted to psychiatric hospitals than those from white communities. In
a recent survey found that rates of admission continue to be higher in Black African,
Black Caribbean and Black Other groups compared to White British, Indian and
Chinese groups. The Black Caribbean group by 100 per cent, the Black African
group by 27 per cent the Black Other group by 52 per cent. In addition Black African,
Black Caribbean and mixed race groups had a significantly higher referral rate from
the criminal justice system, ranging between 30–83 per cent (Community mental
health survey, 2010). Black people are also overrepresented in forensic services in
the Britain (Browne, 2007). Research has also established that indigenous peoples
in other parts of the world are more likely to be subject to community treatment
orders (Campbell et al 2006).
A number of arguments have been used to explain what might be happening in
these circumstances in these circumstances. One is that people from BEM
communities tend to be marginalised and alienated in societies where white cultures
predominate. Spatial factors may be at play which explain the ‘ethnic density’ effect.
It would appear that psychiatric morbidity amongst BEM communities is more likely
11

when they are living in lower proportions alongside other white communities.
Conversely greater proportions of BEM communities seem to offer cohesion,
solidarity and less vulnerability (Boydell et al, 2001 ). In addition, experiences of
overlapping discrimination tend accumulate, leading to stress, vulnerability and
increased contact with mental health services – and the added possibility of
compulsory legal powers being used. Perhaps the most concerning aspect of this
interface with mental health services is the possibility that professionals can be racist
(intentionally or otherwise) in the manner in which they make judgements about
diagnosis and risk (Fernando and Keating, 2009). This is part related to the
perception that Eurocentric professional discourses fail to adjust to culturally
‘atypical’ thoughts, beliefs and behaviours which may, or may not, indicated mental
ill-health (Fernando, 2010). Eshun and Regan (eds) (2009) present a frame of
reference for policy makers and practitioners, one that argues for a more assured,
culturally literate awareness of the interface beween professionals and marginalised
populations whom we know are much more likely to become mentally unwell, given
these social circumstances.
Let us now examine the particular, contemporary issue of the mental health needs of
those who to seek refugee and/or asylum status, often when fleeing from political
conflict. Chantler (2012) discusses the iatrogenic impact of government policies in
the UK that adversely affect the lives of individuals, families and communities She is
critical of how policy exacerbates poverty and creates social problems in the way
that refugees are dispersed and detained. In her analysis she is critical of simplistic
uses of the Post Traumatic Stress Disorder classification in the mental health care
and is particularly concerned about the effects of policy for women. Chantler appeals
for practitioners to adopt more holistic approaches to this issue which embraces a
human rights perspective, as well as a more developed skilled base. Masocha and
Simpson (2011) also critique the way in which mental health social workers tend to
to overuse medical models of mental health to address the needs of asylum seekers
and argue for alternative social perspectives that can assist practitioners understand
pre-, post- and migratory stress factors. Similarly Kirmayer et al (2011) describe how
how each stage of the migration process can be associated with risks and
exposures, and vulnerability to specific mental health problems. A mixture of factors,
often complex in nature have to be understood and disentangled by mental health
12

professional through holistic approaches, including the use of trained interpreters

and thoughtful communication with families and community organisations.
Kirmayer et al (2011) summarise these factors in Table 2, for both adults and
children, taking into account the phases in the migration process.
Table 2:
Factors related to migration that affect mental health

Exercise 2
Now consider the these factors in the context of the following case study.

Case study 1
Boutros Abdella, his wife Ishtar and three children have suffered the consequences
of the civil war in Syria and have arrived at a detention centre in southern England
for assessment. They fled their village with very few belongings and have never
travelled in Europe before, nor do they have any family or community connections.
The family have experienced different levels of violence and witnessed a number of
deaths and injuries. It is clear from an initial observation that that some form of
trauma is event because both parents are confused and tearful, their children are
silent.
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Based on their summary of evidence based practice in this area, Kirmayer et al

(2011: ??) recommend that professionals should consider use the following
knowledge, values and skills in such situations:
 Among immigrants, the prevalence of common mental health problems is
initially lower than in the general population, but over time, it increases to
become similar to that in the general population.
 Refugees who have had severe exposure to violence often have higher rates
of trauma-related disorders, including post-traumatic stress disorder and
chronic pain or other somatic syndromes.
 Assessment of risk for mental health problems includes consideration of
premigration exposures, stresses and uncertainty during migration, and
postmigration resettlement experiences that influence adaptation and health
outcomes.
 Clinical assessment and treatment effectiveness can be improved with the
use of trained interpreters and culture brokers when linguistic and cultural
differences impede communication and mutual understanding.

If you have experience of working in this area see if you can read these principles
into your own practice. What impediments would prevent you from employing these?

Social class, social capital and mental health

As with other social concepts, our notions of social class are contested and shifting
but the variables that are often associated with the concept – poverty, social
exclusion, deprivation, unemployment– not only affect life chances but in crease
vulnerability to mental ill-health. There is compelling evidence of links between
occupation, standard of living and health and mental health morbidity (Wilson and
Pickett, 2009). Murali and Oyebodet (2004) have highlighted the way in which a
constellation of social problems affect the mental health of populations, drawn from
the literature. The prevalence of many psychiatric disorders, including neuroses,
functional psychoses and addictions were found to be more common in people from
lower classes in an important US survey (Meltzer et al, 1995). Employment, in
particular was a factor understanding prevalence rates of all psychiatric disorders in
14

adults. Prevalence rates for psychosis have been found to be higher rates amongst
lower social classes; explanations range from causation to drift theories. Similarly
mood disorders appear to be more frequent in populations that experience financial
and other deprivations; in these circumstances people are more likely to be suicidal
or parasuicidal. Drug and alcohol dependence is also much higher amongst people
who are unemployed or in unskilled manual classes. Where poverty is concentrated,
often in areas of high urban density, it has been argued that there is higher risk of of
depression and other experiences of mental distress. Fitch et al’s (2007) review of
the international literature on relationships between debt and mental ill-health
summarise the following associations. Mortgage debt tended to lead to stress,
anxiety and depression and debt generally being a strong socio-economic predictor
of depression. Some studies found that people in debt were more likely to self-harm
and have suicidal ideation. Wider, negative social consquences tended to be
associated with debt, including social isolation, stigma, social exclusion and strains
on relationships.
A number of interventions are available to mental health professionals when dealing
with the mental health needs of disadvantaged individuals and communities.
Employment can be both protect against mental health but create stressors which
lead to mental ill-health. Mental health problem occurring in the workplace account
for high turnover in staff). High proportions of people with mental health problems are
often excluded from the labour market (it has been estimated that only between 10
and 20 per cent of people with severe mental health problems are in paid
employment). Gomm (2009: 98) summarises the complex interplay between
inequalities and mental ill-health:“…for nearly every kind of ‘mental’ illness, disease
or disability, poorer people are affected more than richer people, more often, more
seriously and for longer.” One more recent way of thinking about the causes of, and
solution to, such inequalities has been the development of social capital as an
explanatory theory. These ideas have gained creedance in recent years, so let us
consider this approach and then apply it to the case study below. In an early paper
on the subject, McKenzie et al (2002) examined the key components of the theory
and summarise findings from the literature on the subject:
 Putnam’s (1986) generic ideas have been formative in the development of
theories of social capital (the processes that lead to the building of social
15

relationships that enable participants to work more effectively together

towards common objectives
 Social networks are envisaged as ecological, community and groups based,
rather than being the property of individuals
 There are four overlapping theoretical strands: collective efficacy, social
trust/reciprocity, participation in voluntary organisations and social integration
for mutual benefit
 Bonding of groups and individuals can be viewed as structural (rules, roles,
networks and institutions, and cognitive (the attitudes and valued that
encourage cooperation between participants). These domains relate in
complex ways, depending on a range of circumstances.
A more recent review of literature (Bassett and Moore, 2013) has further clarified
ways in which the theory base has developed and is used to understand social
networks, capital and the mental health needs of individuals and communities. Two,
sometimes competing perspectives are identified, one viewing social capital in terms
of communitarian and the other network approaches. They found that most studies
of social capital and mental health investigate aspects of depression in populations,
investigating, for example, notions of trust and participation which may protect
against levels of morbidity. There are fewer studies using a formal network analyis of
these relationships where individuals who say they are socially isolated are more
likely to experience depression than those with more extensive social relationships
with others. Although some studies have examined the relationships between social
capital and anxiety disorders, the authors suggest that more detailed and
comprehensive research is needed to explore wider experiences of other mental
disorders.

Case study 2
You are a member of a Community Mental Health Team and have realised that most
of the clients in your team are unemployed and socially isolated. On reviewing the
literature on the relationship between unemployment, social exclusion and mental
health you feel you need to find alternatives to the conventional, individualised case
work approach.
16

Now consider the following principles in building community networks (Mind, 2013)
for people with mental health problems:
1. Provide a comprehensive information tool covering all wellbeing and
resilience activities, resources and services.
2. Ensure this resource is accessible to people with visual impairments and
other disabilities, as well as people without access to the internet.
3. Actively promote this information resource to groups most likely to benefit and
to frontline professionals who can signpost people to further support.
4. Use local community groups and networks to disseminate this information
Explore how this could be done with your colleagues and local communities.

Age and mental health

Mental ill-health has adverse effects on many populations across the lifecycle (see
Chapter # on Psychological Models) . This varies according to positioning in the
life cycle, traumatic events and levels of resilience (Miller (ed) 2010). In this section
we will consider the needs of one specific group, young people who experience
mental ill-health. As a way of introducing this topic, consider the UK statistics
represented in Table 2 below.

Table 3
 One in ten children between the ages of one and 15 has a mental health
disorder. (The Office for National Statistics Mental health in children and
young people in Great Britain, 2005)
 Estimates vary, but research suggests that 20% of children have a mental
health problem in any given year, and about 10% at any one time.  (Lifetime
Impacts: Childhood and Adolescent Mental Health, Understanding The
Lifetime Impacts, Mental Health Foundation, 2005)
 Rates of mental health problems among children increase as they reach
adolescence. Disorders affect 10.4% of boys aged 5-10, rising to 12.8% of
boys aged 11-15, and 5.9% of girls aged 5-10, rising to 9.65% of girls aged
11-15. (Mental Disorder More Common In Boys, National Statistics Online,
2004)
17

(http://www.mentalhealth.org.uk/help-information/mental-health-statistics/children-
young-people/?view=Standard)
As we have discussed throughout this chapter, prevalence rates for mental health
disorders are often associated with other social variables. A recent report (WHO,
2010) on the social determinants of health and well-being amongst young people in
Europe found important factors associated with mental ill-health in these populations.
Whilst young men tended to act out and engage in a range of risky behavours,
young women were more likely to internalize worried or express psychosomatic
symptoms and health problems. Young people living in poorer households were
more likely to be exposed to psychsocial stress, but where they could more easily
communicate with parents and were supported through peer or school based
relationships they were less likely to have physical and psychological complaints.
Of particular concern to policy makers in many parts of the world is a reluctance on
he part of young people to seek help. In their review of the literature, Gulliver et al
(2010) found that only between one third and a fifth of young people diagnosed with
mental health problems sought help and summarise key findings about reasons for
not seeking help, including negative attitudes to professionals and preference to look
to peers and family members for help. For example, Anakwenze and Zuberi (2013)
argue that, in order to improve the mental health outcomes for young people in urban
areas there has to a concerted attempt by policy makers and practitioners to
implement a coherent, comprehensive system of care which traverses professional
boundares and engages directly with communities and groups.  Where such
disadvantages can be mediated, or example by enhanced social relationships, it is is
possible to reduce the incidence of these mental health problems (Joongbaeck,
2010). Children and young people are particularly vulnerable to stress at moments of
change and transition in family and social life. Rothon et al (2011) found that
appropriate forms of social support can ameliorate the effects of school bullying of
youg people. Notably young men who were bullied were more likely to exhibit
depressive symptomology than young women. Although the support of family and
friends were protective factors, the authors argue that a more active approach for
educational professionals was necessary.
Using the case study of Australia (McGorry, 2002) argues that this multi-level
approach should involve a concerted public policy agenda because (i) of the
18

disjointed nature of mental health services for young people, spread across multiple
levels of government; (ii) the paediatric-adult split in services creates a disjuncture at
a moment in the lives of young people when they are vulnerable to mental ill-health;
(iii) young people need friendly, culturally appropriate services with is responsive; (iv)
a specialist mental health service should be created for young people in the broader
age range of 12-25 years, one that is integrated with wider health and social care
services.

Exercise 3
Consider the value of these different approaches to the care and treatment of young
people with mental health problems. What changes would you need to make in the
service that you work in to ensure that young peoples’ needs are being met at
individual, familial and community levels? How would policy makers create the
opportunity for such changes?

Conclusion
This chapter has reviewed a number of perspectives on social models of mental
health and illness. A key to understanding the debates in this area, and their
implications for your understanding of their application to theory and practice is
consider the contested nature of the knowledge base and the influences of structural
determination and the complex interplay of subjectivities. Crucially there is a need to
recognised the power that mental health professionals acquire and apply in everyday
practices, reinforced by discourses that often restrict clients’ understanding of their
lives and opportunities for change. Social models should not necessarily be viewed
in opposition or conflict with the other models we have discussed in this book; our
approach has been to encourage you to think critically about the knowledge base
you are using when intervening in the lives of people with mental health problems.
Whilst we cannot ignore important biological and psychological processes that affect
our understanding of some mental disorders, similarly to neglect the social
processes that cause or construct mental illnesses is to miss an opportunity to view
the clients world holisitically and thus consider a more ecological approaches to
helping.
19

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