Moral narratives and mental health: rethinking understandings of distress and healthcare support in contexts of austerity and welfare reform

Abstract

Associations between mental health and poverty are increasingly well established. Yet in neoliberally oriented contexts in which distress engendered through the everyday hardships of poverty is increasingly pathologised and medicalised, important questions are raised over the assumptions inherent within mental health policy and its implementation. Using the UK as a focus, this paper reviews and maps out key questions that require investigation in order to better understand the complex interrelations between poverty and distress; explores how current paradigms might influence notions of individual responsibility and agency as well as health seeking behaviours; and examines the role of, and cultural and systemic expectations and constraints placed upon GPs as they respond to distress amongst patients from low-income communities. In so doing, we argue for recognition of the moral narratives that underpin both mental health care and processes of welfare reform, and call for an expansion of conventional notions of evidence-based healthcare to incorporate the understandings, experiences and priorities of people from low-income groups. We call for more detailed questioning and analysis of the interactions that lead to mental health diagnosis and treatment and better understanding of the relevance and effectiveness of current treatment options. As a central tenet of this, we argue for more flexible and nuanced healthcare responses that better reflect the dynamic and multi-faceted nature of poverty-related distress.

Understanding and improving the experience of claiming social security for mental health problems in the west of Scotland: A participatory social welfare study

“…Social stigma is, by its nature, externally imposed. Therefore, the findings of this study support concern expressed in other work that the distress experienced by claimants has been overly medicalised, which obscures social antecedents (Thomas et al, ). Claimants in these focus groups described having a stigmatised identity, which is externally imposed on them.…”

Health and Social Care Diversity Among Individuals with Longstanding Physical and Psychological Health Problems: Pooled Repeated Cross Sectional Analyses

“…These investments in mental health care did expand service provision, but it still needs to be evaluated if further equalisation of resources is needed (Baxter et al 2018). Furthermore, mental health service utilisation is not only based on expressed need by the patient, but partially controlled by professionally defined need (Thomas et al 2018;Levesque et al 2013;Pilgrim 2012) as well as the political climate. It needs to be evaluated whether the current balance between patient's expressed need, professionally defined need, and political climate is promoting a resource provision to mental health care that is equal to the resource provision to physical health care.…”

Autism in the Twentieth Century: An Evolution of a Controversial Condition

“…This was eloquently expressed in a recent text by Thomas et al: This is not to deny the reality of mental health issues within people's lives, but rather to acknowledge that if we are to comprehend the ubiquity and impact of mental distress within a contemporary UK context, then we need to recognise the ways that particular types of scientific knowledge and particular narratives of distress have been invested with meaning and authority, and as such, have the potential to become tools for use in the pursuit of broader political agendas. 150 The twentieth century saw many changes in the scientific and medical community understanding of autism. What we understand about autism is 'constantly in flux'.…”