An evolution: towards a holistic and social justice understanding of mental health
Our understanding of mental health has evolved as research and evidence has advanced, leading to an urgent need for a paradigm shift in approach. By this, we mean we must move away from seeking to cure individuals by targeting disorders and move towards prioritising policy innovation at the population level (WHO, 2014; Shim & Compton, 2018). The World Health Organisation now sees mental health as existing on a complex continuum, with experiences ranging from an optimal state of well-being to debilitating states of great suffering and emotional pain (WHO, 2022).
Well-meaning statements like ‘one in four people will experience a mental health problem’ imply that poor mental health occurs equally and randomly across the population according to the fate of our levels of ‘personal resilience’ or biology. But this is not true. Our mental health is largely determined by the conditions in which we are born, grow, work, live, age along with the wider set of forces shaping the conditions of our daily lives (WHO, 2014). It’s therefore not about what’s wrong with us. It’s about what’s happened to us, what relational needs we didn’t or aren’t getting met, what did we do to survive this and what impact it then has on our mind, body, and soul (Perry & Oprah, 2021; Johnstone & Boyle, 2018).
Mental health in its simplest form is about nervous system regulation and connection to self, others, and the world.
This means it is not just a problem for the ‘one in four’ of us, it is an issue for everyone. Every single one of us experiences distress, pain and suffering. This is part of our human condition. Therefore, mental health is relevant to all of us. The intergenerational nature of trauma and distress means this is a problem for our future generations too.
But our current system is broken. A complex, inflexible and fragmented system organised largely around healthcare means we have a crisis. There is widespread public concern about the levels of distress and suicide across Wales. Growing outrage too at how we treat people who our services serve with increasing rates of coercion, traumatising interventions and no follow up support.
More of the same will not fix the problem.
We have outgrown the story that people having a tough time with their mental health are just experiencing the fate of biology, genetic potluck and lacking ‘personal resilience’. If we understand that distress and mental health is not rooted in disease and pathology then it makes no sense to construct our understanding from this starting point.
Instead, we need a holistic and social justice approach starting with an understanding of wellness and of the impact adversity, toxic stress, and trauma have on us and our development (Mate, 2022). As individuals but as a society too. One that can accommodate the complexity involved, a holistic, wellness and human rights focused approach. Nothing short of a total stepped change and paradigm shift (UN, 2017). This requires a focus on our physical needs as well as our relational ones.
Our Relational Needs
Relational health refers to the capacity to develop and sustain safe, stable and nurturing relationships (SSNR’s), which in turn prevent the extreme or prolonged activation of the body’s stress response systems (Garner, 2021). Not only do SSNRs buffer adversity and turn potentially toxic stress responses into tolerable or positive responses, but they are also the primary vehicle for building the foundational resilience skills that allow children to cope with future adversity in an adaptive, healthy manner.
Relational health is about having safe and supportive relationships with our families, our friends, our communities, and ourselves. It's about having our core needs of agency, security, connection, love, belonging, meaning, and trust met (PSC, 2015).
We also need predictability, consistency, acceptance, empathic responses, and opportunity for repair when there are ruptures or breakdowns in our relationships.
We are not born with the ability to meet these needs ourselves. We first learn how to make sense of our emotions through our primary attachment figure tending to our needs. Through them tending to our cries and voicing back to us or ‘organising our feelings’ we learn to make sense of our emotional world and develop a sense of trust in others, ourselves and the world. What we are also learning here is how to feel safe and secure. A core need for happy healthy children and parents too. We call this developing a ‘secure base’ and it is how we learn to regulate our emotions as well as how we learn to do relationships. It gives us the blueprint for how we will respond in relationships with other people, as well as how we relate to ourselves, throughout the rest of our life. This is called our relational patterns.
Emotional regulation is a term generally used to describe a person’s ability to effectively manage and respond to an emotional experience. We unconsciously use emotion regulation strategies to cope with stressful situations many times over throughout our day. But we are not islands and we can only ever be as regulated as the people around us (Porges, 2011). This is why our circumstances are so important but also deterministic of our mental health.
It is normal for all of us to feel overwhelmed and dysregulated throughout the day and periods of our lives. This does not make us broken or weak. But when we are persistently overwhelmed there are costs to our physical and mental health. You may know this as toxic stress or adverse childhood experiences. Too much stress in our daily lives, particularly our early years compromises our health and can lead to diabetes, heart disease, mental health issues including addiction as well as autoimmune issues, cancer and arthritis.
We know that we are more likely to experience emotional overwhelm if we're living in poverty, faced with injustice, forced to rely on fear and shame-based systems, and don't feel connected to our communities, ourselves, or the people around us.
We also know that the first two months of our lives have a disproportionate impact on our later life mental health outcomes than any other period in our development (Perry & Oprah, 2021). We therefore need to go back and ensure we create the right circumstances, right from birth for everyone. This means ensuring that we are meeting parents and caregivers needs too.
A mental health evolution: a holistic and social justice approach
At Platfform, we see the current understanding and approach to mental health as no longer fit for purpose. We acknowledge the role that experiences of injustice, adversity and trauma play in our mental health. Often called the social determinants of mental health (WHO, 2014) and we see the necessity in addressing these as a core public mental health intervention.
It is clear to us that they are behind almost every present day policy challenge. From educational outcomes, children’s health, substance use, offending and criminal behaviour, to improving health services, all are affected and impacted by trauma and relational health. Therefore, it is our belief at Platfform that governments and public services must seek to create the core conditions for relational health as a foundation for any strategy and service improvement if we are going to improve the collective mental health of our society and future generations too.
Playing our Part: Becoming a Trauma and Relationally Informed Organisation
We recognise that the prevalence, and multi-layered impact of this happens at an individual, family, societal, policy and organisational level. We therefore need to ensure all these layers are culturally, adversity, trauma, and relationally informed, infused, and responsive for all of us to have a chance at good mental health.
As an organisation we recognise we have a part too. We need to focus on humanising our systems and making them healthier, more relational, more integrated, more reflective, and more connected. These changes can feel overwhelming and some are beyond our control. But we believe that change starts with self. It starts with understanding and becoming aware of our own relational health needs, learning to tune into these. It is about being aware of what are we doing and what are we not doing yet. This way we can become active agents in the systemic change required.
Only then too can we approach change with the compassion the task ahead of us will require.