Mental health: Time to evolve our understanding

CIH Futures
Nov 4, 2019 · 5 min read

We’re delighted to welcome Joe Frampton, Community Investment Team Leader from United Welsh to the #Futures50 series this week. Joe’s blog focuses on the impact of new thinking on mental health and wellbeing.

I should start this blog by saying that I’m not a mental health professional — most of my understanding has come from my own personal experiences, loved ones’, things I’ve seen and read, and conversations with my wife, who is a psychologist.

So these musings are my own with what little sense I’ve made of the world, and I’m sure they’re flawed and incomplete and other people could teach me a thing or two. But I thought I would share my views even if it’s just to kick off a conversation!

Lately, I’ve been reflecting quite a lot about mental health and how far we’ve come, in my lifetime alone, in terms of public understanding and empathy. Thanks to the constant chipping away at the brick wall that is stigma, more and more of us feel comfortable about talking about mental health. One in four of us experiencing mental health problems each year, so the more we can do to normalise the conversations, the better. It’s really encouraging to see the journey we’ve taken as a society, but I can’t help but think that we’ve got so much further to go.

To many, chats about mental health often circulate around sets of “symptoms” or the labels that these symptoms fit nicely into, such as depression, anxiety, OCD, PTSD etc. Even Mind’s FAQs here is heavily focussed on the different types of disorders. I think this understanding can be useful, but it does frame someone with diagnosis as having something wrong with them, which I think is the basis for stigma and shame.

I know that for some people, receiving a diagnosis is often key to accessing the support or services that can help them. Some people find it validating, that they’re not alone in how they’re feeling. That said, I’m increasingly hearing that people find diagnoses unhelpful, stereotyping and ‘othering’. People feel like their humanity is stripped down to a label and a set of symptoms.

Be honest, have you ever heard a friend or colleague describe a behaviour of someone as ‘typical’ of their diagnosis? I know I have.

‘Classic PTSD that.’

‘You’ll get that with someone with bipolar.’

I know that the people who have said these things are caring, empathic people. I just think they’re limited by their understanding of mental health which is all framed around labels and disorders.

There are interesting discussions taking part in the clinical world too. There is a growing recognition that the medical approach used within physical health settings (in the diagram below) doesn’t necessarily translate to mental health settings.

Trying to cure or fix mental health problems in a time limited manner isn’t realistic or reflective of how mental health impacts people. One of the areas I work in is the South Wales Valleys, which has one of the highest rates of anti-depressant prescriptions in the UK.

I’m not disparaging of anti-depressant use — they’re vital for many people to manage their mental well-being. However, trying to ‘symptom manage’ isn’t effective in the long term; at some point we need to think about the underlying reason for these symptoms in order to help people better cope with mental health.

It’s not surprising that a consultant clinical psychologist, Lucy Johnston, who works in the same area, has been at the forefront of developing a new model of mental health which aims to take a new approach: the Power Threat Meaning Framework.

I’m definitely stepping into territory that’s outside my reach, but my broad understanding of the PTM framework is to reframe the approach from: ‘What’s wrong you? What symptoms do you have?’ to ‘What’s happened to you in your life? How has that affected you? What sense did you make of it? What response did you have to that?’

The PTM moves away from people being given labels or diagnoses, and towards understanding why a person may be experiencing difficulties at this time. Someone much more eloquent than me summed up the approach by this quote:

‘It’s not abnormal behaviour, it’s normal behaviour in an abnormal situation.’

It’s the recognition that the behaviours people display are a combination of coping mechanisms and learned responses to things that have happened to them in their lives. It’s not wrong, it’s normal. Given the same experiences and put in the same circumstances, I’d probably expect us all to have a similar response. We’re starting to think through this lens in housing.

In Wales, there has been a lot of work on understanding ACEs (Adverse Childhood Experiences), and how people with multiple ACEs are at higher risk of developing both physical and mental ill-health in adult life. There has been a concerted effort, particularly in the supported housing world, of developing Psychologically Informed Environments (PIE) and Trauma Informed Practices.

It’s a recognition that each person is different, and the behaviour that we all display is due to a product of our experiences and the environment that we’re in. If we are to get the most out of people, we can’t change their history, but we can make the environment that they’re in as safe as possible.

This way of thinking shouldn’t be confined to supported housing. I think it should resonate into all of our services and across all tenures and to everyone involved. One in four of us experience mental health problems each year. That’s one in four tenants, one in four licensees, one in four leaseholders, one in four staff members, one in four board members, one in four friends, one in four loved ones.

Joe Frampton, Community Investment Team Leader, United Welsh


The housing sector needs professionals. Whoever they are, wherever they are and we’ll drive to create, develop and support them.

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