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22nd December 2015

Mental Distress

Theater MasksChristmas is a time for soap opera specials, and whilst I’m not a regular watcher of Emmerdale, I’ve watched enough to see the character Eric Pollard failing to come to terms with the death of his wife Val following a helicopter crash onto a hall of mirrors. I don’t how the story is going to develop over the festive period but his family are worried he may end his own life.

The story reminds me of a training exercise I’ve run, posing a number of scenarios whereby someone is displaying certain thoughts and behaviours that can be seen by others as a problem – and invite students to think whether the problem is a  mental health  problem. The scenario here would be, Eric erects a shrine in his house including various items of his wife including her last packet of cigarettes. Has Eric got a mental health problem?

Now the answer to that at the moment is not a definite yes or no, but hopefully provokes a debate as to what mental illness is. That’s really the theme of this article – how do we decide whether someone has got a mental health problem, and is there something about your own beliefs and values and how you view things, that helps you decide what it is that turns a problem into a mental health problem.

Helpful storylines

At the time of writing this, Eric’s son has asked his GP to visit. The GP talked to Eric and said Eric is grieving in his own way, and didn’t think there was evidence of a serious mental health problem, but has asked his son to contact the surgery if he thinks his father’s mental state is worsening. So I’m going to try and use the storyline to explore these concerns. Incidentally I’ve often found soap operas provide useful storylines to get a discussion going in a training session about mental health. Students and trainees may not have read the course textbooks, but will probably follow one TV soap or another! In recent years we’ve had lots of material to go at with portrayals of Steve McDonald in Coronation Street, Zak Dingle in Emmerdale, and Ian Beale in East Enders all suffering from depression.

What makes a problem a mental health problem?

So back to deciding what a mental health problem is. I’ve been reading a book called Critical Thinking and reflection for mental health nursing students(Marc Roberts Sage 2015) where it looks at how we decide on health problems by looking for signs and symptoms – symptoms are behaviours, signs are more scientific. The author points out that in the field of physical health identifying signs and symptoms is easier than in the field of mental health. So a physical symptom might be fever or confusion that indicates an infection. The doctor can do tests to show signs of an infection, and then prescribe treatment. In the field of mental health the symptoms will be there to see, but the signs will be more difficult to identify.  In Eric Pollard’s case, becoming angry, being verbally and physically abusive, being tearful and distressed, and erecting a shrine on his coffee table of paraphernalia associated with his wife may indicate something is happening but these are not necessarily symptoms of a mental health problem – we need more evidence.  So this is where we try and identify to signs, but tests to establish signs are hard to come by in mental health. The clinician’s tools are really about talking to people, and observing them, and trying to formulate an assessment. In addition, the formulation that a worker comes up with will depend not just on their observation of behaviours and thoughts, but the worker’s own values and beliefs.

Our view of the world

So you see, Eric’s behaviour and responses are there for everyone in Emmerdale to see, the difference will be how people react to it – and that will depend on different views. Here’s two possible contrasting views:

  • Some people, particularly his son will be naturally worried, they feel something is very wrong with Eric and the only way to deal with it will be for him to get professional help. He has seen that Eric’s behaviour has changed, and he’s not seen him or indeed anyone like this before, he thinks he must have a mental health problem and if we don’t do something he will deteriorate and then he might harm himself.
  • Others may through experience have seen other people reacting similarly to bereavement and think this is a normal human response. They may very much believe in Eric’s right to independence – the right to be left alone.

Finding a way forward

So how are these views resolved? Well you’d hope that family and professionals can get together and agree a way forward. Hopefully Eric can start to trust them. On the other hand, it may be that the situation will deteriorate so that intervention becomes necessary. Our mental health laws do allow us intervene against someone’s will where circumstances are such that the person is suffering from a mental disorder and the risk factors are high. That brings us back to the debate – is Eric suffering from a mental disorder?  Who decides? If you look at the Mental Health Act where we find a legal definition of mental disorder you will see how difficult this is, and how potentially all-encompassing this term is. Richard Jones who has recently published the eighteenth edition of his Mental Health Act Manual includes a commentary on this definition. He talks of the fine line between mental distress and recognisance psychiatric illness. There’s no doubt Eric is showing signs of distress, even he would agree with that. The question is whether that makes it a mental disorder that could come under the powers of the Mental Health Act.

So what can we learn so far from this storyline? I think it is important to be aware of how your own beliefs and values affect your view of mental health. Your views of someone’s mental distress may be different from your colleagues. Self-awareness is crucial to being an effective mental health worker.

David Beckingham – QCS Expert Mental Health Contributor

Topics: Mental Health

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