Simon Newitt | 30th July 2016

OTR in 2016: How We Do Mental Health

This is a blog about the OTR model and the conceptual ideas that underpin it.

But please read on, I promise it won’t be as boring as that reads back! I’ve written it to help explain the OTR mission more clearly and because it’s important we make our assumptions about what we do explicit. One of the most enduring ways mental health services have historically served to recycle societal inequalities is by not being transparent (with themselves; let alone the people that might come to need them) about what it is they believe about what it is they do.

Personally, I was attracted to work in the field because of my politics. I’ve always considered ‘mental health’ to be shorthand for the ways human beings experience the world and each other in it. To that end it’s a really important lens through which to peer at and understand society – not just the individual and their distress – but the world around us; how it’s arranged and how and why that shapes us as individuals and as a people.

Mental health practitioners, researchers and government make a number of important assumptions about all this that have real consequences for people’s lives. In the way they evaluate, design and deliver public services, they express fundamental ideas about the world and what it means to be human This includes powerful ethno-centric beliefs about the role of the individual and society, happiness, the emotions, the nature and meaning of knowledge and time, and of course the relationship between our mind and body. They are underwritten by a medical language and status that invests these assumptions with an aura of objectivity and scientific validity. But really, they are little else than human constructs that mirror the prevailing socio-economic conditions of our time.

Assumptions like this matter because they frame (without ever being said out loud) what we mean by healthy/unhealthy and normal/abnormal. They draw a line between ‘us’ (healthy and normal) and ‘them’ (sick and abnormal) that serves to Other and stigmatise the latter. And they persist because of the enduring belief that it is the individual (and their pursuit of happiness) that is the most meaningful unit of enquiry in mental health. This perspective actively strips our emotional landscape of context, locating the problem and solution in the individual or perhaps their family or some other nearby external trauma.

I’m talking in generalised terms, for which I make no apology, and I certainly don’t mean to imply that biological perspectives are irrelevant or that individuals don’t suffer and have no need of support. But historically and today such perspectives are dominant, and that’s a problem because taken together the powerful assumptions they make about mental health define our systems and responses toward a very particular end – maintenance of the status quo. Why? Because if we actually followed the symptoms beyond the individual to the surrounding context, the remedies we’d promote would look very different. They would be social and cultural, economic and structural – in a word, they’d be political.

Working in the field for any length of time you soon realise that the suffering of individuals is usually driven and shaped by wider forces. For instance, are the near epidemic levels of anxiety we work with little more than several thousand variations of unrelated personal distress? Or do they also tell us something important about what it is to be young these days? To exclude the bigger picture from our organisational analysis of human suffering is to be complicit in its continued existence. To include this context at the very least changes the role of mental health professionals – from neutral ‘experts’ to activists and advocates for social change.

So here’s our first OTR assumption; mental health is social (and therefore political) as well as personal. And here’s the second; our work in this field is therefore a social and political vocation. We are actively on the side of young people as a diverse social group.

Youth is a biological fact, but it’s meaning is a construct that evolves as social conditions change. If you look through the annual reports and evaluations of OTR across the last half-century, you can’t help but notice that the issues distressing young people in any given year reflect the social landscape of the time. This is as true in 2016 as it ever has been, so what does the current landscape look like?

Well it’s fair to say that young people face a multitude of new and emerging developmental pathways and transitions to adulthood. Some of that is about migration and economics, but digital technologies are also transforming the way young people communicate, relate, and learn about their bodies, about sex and relationships, and about what’s valued and normal in relation to each. Identities are fragmenting and multiple as the grand organising principles of gender, sexuality, nation and race (particularly) are deconstructed and re-invented by the young in increasingly fluid forms of self-determination. At the level of cultural politics at least, diversity is the new normal.

Given this cultural landscape, what theoretical perspective offers us the best analysis on which to base our services and support? The answer is our third assumption – none of them. In the face of this diversity all theoretical models are wrong, but all of them are useful. As a result we actively embrace a theoretical position that is open-minded, critical of certainty and dogma, and pluralistic in outlook, with our emphasis placed firmly on the utility of theory as young people encounter it. A fourth assumption must then follow to help ground our belief in a world of unstable theories and concepts; it is relationships that make the difference and that matter most.

Diverse as Bristol may be, the structure of our society and city remains fundamentally racist, homophobic, transphobic, disablist, ageist, classist and sexist. Social mobility is stagnated and the class structure for those at the bottom has all but collapsed. The neoliberal myth that if you work hard enough you can achieve anything (meritocracy) is undermined by the life chances of today’s indebted young people, most of whom will do worse than their parents by those material measures capitalism sets for itself. Nonetheless, despite the absence of a level playing field and the continued upward re-distribution of wealth, individual happiness is increasingly sold as ‘a thing’; a destination in a good, normal life determined by the possession and consumption of things and experiences, hedonism and status.

What does being well adjusted and mentally healthy even mean in this context? And what then is the role of an independent mental health charity like OTR?

Our final two assumptions are based on the political position that the increasing incidence of mental health issues among the young (or more accurately, the increasing demand for services like ours) says something important about our society – that it is organised in such a way as to make distress as likely than not for many young people. That those experiencing distress are displaying a normal, healthy and humane response to social conditions that are toxic to our wellbeing. Improving our mental health then becomes an exercise in re-organising society as much as supporting young people to find individual solutions and accommodations to their circumstances. In which scenario our fifth assumption must be that social networks are more powerful than individual solutions in effecting that change.

Demand for transactional mental health services (where young people consume support from ‘an expert’) has a place, but even if I believed such a design was the most progressive and fit for purpose we could imagine – which I personally don’t – it is not and cannot ever be the future in a system so impoverished as ours, where demand for ‘help’ far outstrips supply, and where funding and support services are shrinking not growing.

But if we move beyond a fixation on money and approach our material challenges more creatively, then it should be obvious the biggest resource available in our work is young people themselves. This final assumption – that participatory services are more effective than transactional ones – is grounded in the belief that all young people, whatever their circumstances, have capacities and capabilities as well as needs and vulnerabilities.

Our charitable mission is very simply to defend and unlock these potential capabilities and resources; to promote a consciousness of the wider world through the lens of mental health, and to encourage a capacity for resilience and intellectual self-defence by creating spaces for young people to recognise where their distress has its origins outside them, in unjust social arrangements that are not inevitable but man-made.

These assumptions take us to a place where good mental health is about providing opportunities for young people to come together and connect, to learn and to mobilise in a spirit of collectivism that believes the answer to all our problems is each other. More than this, and in our own small local way, if we want to support young people to act and re-organise the world into a fairer, healthier place, then we must give OTR to them as a brand and vehicle for change.

In these challenging social and economic times we must evolve beyond a ‘provider of services’ to become something more radical and transformative: a social movement.

Simon | CEO

To read more about what we do, why and how; check out the OTR Strategic Plan 2016-21.