Peter Kinderman on the British Psychological Society
On the future of mental health
Posted March 2, 2016
The following interview is part of a “future of mental health” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress. I’ve aimed to be ecumenical and included many points of view different from my own. I hope you enjoy it. As with every service and resource in the mental health field, please do your due diligence. If you’d like to learn more about these philosophies, services, and organizations mentioned, follow the links provided.
Interview with Peter Kinderman
EM: You are the president-elect of the British Psychological Society. How can an individual in emotional or mental distress make use of what the British Psychological Society has to offer?
PK: The British Psychological Society is the professional body for psychologists in the United Kingdom, so it represents clinical and other applied psychologists, but also helps to promote the work of academic psychologists, spread the word about psychological science, and help members of the public learn more about this fascinating subject.
I think, in all honesty, the first place that someone in emotional distress should turn is their loved ones, and then to use professionals … at least here in the UK, where our rather wonderful National Health Service offers pretty good access to health and social care professionals. So in part, the role of the British Psychological Society is to maintain all those standards - to lobby government and healthcare organizations about the use and the quality of psychologists, to ensure that the teaching and training is world-leading in terms of quality, and to make sure that people are using top-quality science. But the British Psychological Society can help people find a psychologist (there’s a search facility on our website), has a lot of information about psychology and mental health, and especially, we’re producing some really high-quality information booklets, written for the general public.
EM: Specifically, can you describe some of the free reports (really book-length documents) that the British Psychological Society has commissioned and produced?
PK: So we’ve produced a range of reports on a whole range of issues. I should mention some of my personal favorites. We’ve got position papers on the use of torture in interrogations (we made a stand on this issue many years ago), we’ve made some robust comments about diagnosis and specifically the publication of DSM-5. We’ve also got some useful documents on formulation, a key skill for psychologists. The longer documents - books, really - on distressing mood swings (‘bipolar disorder’) and psychosis are particularly important, though.
These documents are written for the general public (not for academics or professionals). So, while they review the most recent research in each topic, they also put this research in an understandable context. We think they’re positive documents - while they make it crystal clear that these problems can be very serious for some people (and we argue that much more money should go to researching and caring for people with mental health problems), we also point out that these kinds of problems - often seen as merely inexplicable symptoms of illness - can be understood from a psychological perspective. People deserve to have their experiences understood in a genuine bio-psycho-social approach. All too often, this is ignored in favor of what is a very reductionist, bio-medical, model, and our reports are written to give a more rounded, more scientific, more empathic and more optimistic picture.
EM: How would you like to see our current dominant model of the “diagnosis and treatment of mental disorders” improve or change?
PK: I believe that mental health services should be based on the premise that the origins of distress are largely social. The guiding idea underpinning mental health services needs to change from an assumption that our role is to treat ‘disease’ to an appreciation that our role is to help and support people who are distressed as a result of their life circumstances, and how they have made sense of and reacted to them.
This also means we should replace ‘diagnoses’ with straightforward descriptions of problems. We must stop regarding people’s very real emotional distress as merely the symptom of diagnosable ‘illnesses’. This does not mean rejecting rigor or the scientific method – quite the reverse. We can straightforwardly define people’s problems – it’s what scientists do – and this would have greater scientific validity and would be more than sufficient as a basis for individual care planning and for the design and planning of services.
Our health services should sharply reduce our reliance on medication to address emotional distress. We should not look to medication to ‘cure’ or even ‘manage’ non-existent underlying ‘illnesses’. We must offer services that help people to help themselves and each other rather than disempowering them: services that facilitate personal ‘agency’ in psychological jargon. That means involving a wide range of community workers and psychologists in multidisciplinary teams, and promoting psychosocial rather than medical solutions. Where individual therapy is needed, effective, formulation-based (and therefore individually tailored) psychological therapies should be available to all. When people are in acute crisis, residential care may be needed, but this should not be seen as a medical issue.
Adopting this approach would result in a fundamental shift from a medical to a psychosocial focus. And because experiences of neglect, rejection and abuse are hugely important in the genesis of many problems, we need to redouble our efforts to address the underlying issues of abuse, discrimination and social inequity.
EM: Can you tell us a little bit about the recent books that you’ve authored?
PK: Well, I’ve written two books. The first ‘The New Laws of Psychology’ discussed the role of ‘nature' and ‘nurture.’ I expanded on an argument I made in a journal paper, where I argued that (of course) biological factors, social factors, circumstantial factors – our learning as human beings – affect us as those external factors impact on the key psychological processes that help us build up our sense of who we are and the way the world works. This is important, for me, because it explains how nature and nurture are locked in what I’ve called a ‘complex, interactive, dance’ . It also means that there are things that we can do about it.
My most recent book, ‘a prescription for psychiatry’ builds from a psychosocial approach to mental health and well-being to recommend a wholesale revision of our mental health services. Arguing that the origins of distress are largely social, and that therefore we need a change from a ‘disease model’ to a ‘psychosocial model’, the book argues that we should reject traditional psychiatric diagnosis, significantly reduce our use of psychiatric medication, tailor help to each person’s unique needs, invest in greater psychological and social therapies, and place mental health and well-being services within a social rather than a medical framework. I end ‘a prescription’ with a manifesto for change … the basic ideas of my answer to question 3.
EM: If you had a loved one in emotional or mental distress, what would you suggest that he or she do or try?
PK: I’m very reluctant to offer advice. It's a big subject matter … and if I were able to offer wise "self-help" advice that actually worked for everybody, I'd be a millionaire. Nearly every simple piece of advice is going to be glib, obvious, or wrong. So I'm probably not going to be much help. But here goes:
1. Get the basics right
Eat well, nutritiously, get the saturated fat content down and the salt content low. Eat five portions of fresh fruit or vegetables a day, drink plenty of water, and make sure you’ve got your vitamins. Aim to get your BMI in the healthy zone. I don’t want to sound prudish, but don't smoke, drink moderately and be generally quite cautious with recreational drugs. Get at least 7 hours sleep a night. Sleep is really important … and there’s even evidence the brain needs sleep to remain physically healthy.
Although straightforward, this is all difficult. There’s a lot of advice and specific help that the NHS can offer here, from quit-smoking and other similar services to sleep clinics, etc. But the message is the same … get the basic, physical, fundamentals right.
2. Five ways to well-being
There's a great approach called "the five ways to well-being." This is an approach that really works, and is being taken up by more and more people. It's recommended by MIND and the NHS and there are plenty of tips to help you take do-able steps towards better mental well-being.
The five ways are:
a) Keep active – do something physical each day. Could be as simple as taking the dog out for a walk (if you’ve got a dog!), but could be going for a swim, or going to the gym every day.
b) Maintain your relationships – for all kinds of reasons, friends are vital. Good friends, supportive friends, friends who won't judge you or try to take advantage of you. And we can all take steps to maintain our friendships. We can make sure we ‘phone, write, text, etc. You might even consider a kind of semi-professional approach - self-help groups for people in a similar position to yourself.
c) Learn – keep your brain active. Engage your brain. Your brain is the most fantastic machine ever created, and it needs to be exercised (I would say this, I’m an academic, but honestly … it’s good for you!).
d) Give – this isn’t political brainwashing, there’s real evidence that getting involved in charitable activity (and it’s probably better to give your time and effort, rather than money) makes people happier.
e) Stay open-minded – this is perhaps the trickiest thing, but it relates directly to rumination … so it deserves its own section.
Rumination tends to be eased if we learn to be mindful; if we are able to be aware of, and understand how our own thoughts work. This does NOT mean taking up any kind of religious practice, but some of the practical techniques of clearing the mind of 'clutter' can be helpful. Again, it's recommended by the NHS as well as being part of the five ways to well being. In part, it means becoming able to decide where we focus our attention, because if we are good at this, it makes it less likely that our thoughts will always be dragged back to our ruminations.
4. “Catch it, check it, change it”
And if we’re aware of what’s happening in our own minds, we can start to change things. My colleague, Sara Tai, has neatly summarized the popular ‘cognitive behavioral therapy’ or CBT as; "Catch it, check it, change it."
a) First ‘catch it”; identify what you are thinking. It’s often really useful to use a change in your emotions as a cue to examine your own thinking. So, when you notice an unhelpful emotion or a shift in mood, or when you notice that you’re doing something you know can cause problems (being snappy, for example, or drinking too much), that could act as a cue to examine your own thoughts - “what am I thinking?”.
b) And then “check it.” Are you (after engaging your fantastic brain in a mindful manner) thinking sensibly, wisely, proportionately, about the situation? Is your mood affecting the way you are thinking?
c) And then “change it.” Generate an alternative point of view; question the evidence for your negative thoughts, and find possible alternatives.
Finally … if you’ve tried all that … try therapy.
I wouldn’t recommend it for everybody – many people are probably better off avoiding therapists and using the resources and support available to us in everyday life. But therapy can be a chance to think things through with a professional in a calm, supportive and nonjudgmental atmosphere, and that can be helpful. I personally prefer the straightforward approach of CBT, but there are many different approaches, all of which seem helpful, so it’s a question of finding an approach that suits you.
Peter Kinderman writes: I am professor of Clinical Psychology at the University of Liverpool and President-Elect of the British Psychological Society. I recently launched a free, online, open-access course exploring our understanding of mental health and wellbeing and published ‘A Prescription for Psychiatry’, which presents my vision for the future of mental health services. You can follow me on Twitter as @peterkinderman.
Eric Maisel, Ph.D., is the author of 40+ books, among them The Future of Mental Health, Rethinking Depression, Mastering Creative Anxiety, Life Purpose Boot Camp and The Van Gogh Blues. Write Dr. Maisel at firstname.lastname@example.org, visit him at http://www.ericmaisel.com, and learn more about the future of mental health movement at http://www.thefutureofmentalhealth.com
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