What is system change?
Our public systems, intended to help people when they are facing the toughest times, are no longer fit for purpose. To change them, we first need to change how we understand mental health, and the things that are really at the root of distress.
“Systems change is a journey” – Esther Foreman, The Social Change Agency
Why the mental health system needs to change
At the moment, our mental health systems work like this: we look at a person, and we decide what we think is ‘wrong’ with them. We do this by analysing their behaviour, and then deciding that they have some sort of mental ‘disorder’. We then try and ‘fix’ them.
Basically, our approach says that the ‘problem’ is within the person. But the truth is that our mental health is largely determined by our circumstances, and the conditions in which we are born, grow up, live, work and play. Once we understand this, it makes no sense to see mental health difficulties as individual problems faced by individual people.
Our mental health challenges are often social problems. We are responding to the circumstances and systems around us.
The bottom line is that mental health is complex because humans are complex. But our current mental health system isn’t set up to deal with that complexity. Instead, our system treats mental health a bit like we’re trying to repair a clock – there will be an obvious problem that an expert can fix, and no-one really needs to know much about the clock itself.
That’s not how people work. Problems are unique to each person, and to each complex set of circumstances, relationships, and past traumas. To understand each person, and the challenges each person faces, our systems need to involve people in finding their own way forward. There are no one-size-fits-all answers, and no instruction manuals.
Systems are all about relationships – they are ‘relational’. They are a web of connected people and interactions that is greater than just the sum of its parts. What this means is that system change will depend on how we work together, and how well we understand how relationships work.
The first step: changing how we understand mental health
In order to change our public systems, we first need a new conversation about mental health. We need to look at the root causes of distress, and how we can create systems and communities that allow us all to thrive.
Our current public service systems and policies were designed in the post-war days. The world has changed since then; this means we can, and must, redesign our public systems to better support us today. We need systems that prioritise relationships and connection, and that work better as a whole ecosystem, for everyone.
As human beings we all need practical things like a sustainable income, decent housing, good nutrition, a healthy environment, equality, fulfilling work, thriving culture, local amenities, and transport that allows us to connect with our communities and each other. But we also need less practical things, like good relationships and feeling that we belong.
You can sum all these up as safety, purpose, and connection. These are things that all of us need. They’re the foundations for good mental health.
If we understand that distress and mental health are rooted in our circumstances, and not in disease and disorders, then we can see how our mental health systems need to evolve. We need a big-picture social justice approach, built on an understanding of the impact of poverty, adversity, injustice, and trauma.
This is why Platfform wants to be part of the movement for change – so we can try new things, change the system, and build a better future for all of us.
What are the next steps?
In 2023, Platfform launched our manifesto for mental health. In it, we cover the case for change, the evidence that backs up a new approach, and the practical steps that the Welsh Government can take to drive this change forward.
The building blocks of a better system in Wales are already being laid. What’s needed now is co-operation, long term commitment, and a willingness to listen the stories of millions who have found that our current mental health system isn’t providing the support they need.