Why Labels Matter

The media storm over Robin Williams sad death this week has had David Smith thinking yet again about labels and how we use them so frequently and sometimes damagingly in both society and particularly within mental health services.


Whilst being quite pleasantly surprised by the way this story has been portrayed the thing that has been common to most stories has been the long list of diagnoses trotted out – depression, schizophrenia, bipolar, psychosis etc – often used in such a way as to indicate that these labels can be used to differentiate mental illness in the same way as cancer, fracture, virus and infection are used in physical health.

It’s a sad fact that within our mainstream health services will still rely far too heavily on a medical model of mental illness. A model in which mental illness is considered to be like a disease and that by following a prescribed set of actions that disease can be treated and if not cured, then mitigated.

In my experience this is a flawed way of thinking. For the lucky few who fit the model it works but for many others what is needed is a different approach, one that avoids medicalisation altogether for those at the lower end of the mental health spectrum and blends psychological, social and medical support at the more acute. Our current system in the UK is far, far too likely to bring somebody with low level mental health problems into a clinical setting when in fact what they often need is social and educational support to help them overcome the root cause of the difficulties they are facing not drug, IAPT or a referral to the community mental health teams.

I’m in a fortunate position of being able to work at The Retreat and see first-hand the impact this blended approach can have. We try wherever possible to avoid talking about diagnoses – for us the people we work with are people who need our help, people who are in distress and often people whose difficulties are cause by trauma from many years ago. In many ways the diagnosis is irrelevant – what those individuals need is hope that they can recover a better way of life, that we are there to help them on that journey and the inspiration of others who have already trodden that path.

Mental illness is frightening. We know it tears apart lives and can destroy families but until we start to genuinely treat it as just one facet of an individual we will continue to struggle to help people recover and sustain their recovery in the longer term. We need to treat the whole person not just those aspects of an individual that are listed within payment by results clusters, diagnostic manuals or funding criteria.

Having worked with people living with and recovering from mental ill-health for almost twenty years now it’s reassuring to see the progress we have made. The danger is that we sit back and think the jobs done. It’s not. There’s a long way to go and need to use our collective voices and whatever influence we have to make sure the individual, the whole individual, is at the forefront of our minds and it’s their voices we listen to when looking how best we can help them.


Comments (3)

  1. Kim Pennock:
    Aug 13, 2014 at 04:34 PM

    David thank you for this blog as it speaks so much to me personally.
    When society starts to look at the person first and foremost and starts to actually listen to them as individuals, then and only then, can a process of correct care begin.

  2. Mike Wash:
    Aug 13, 2014 at 08:07 PM

    30 yrs ago I co authored a psychiatric nursing text book - it majored on person centred care rather than the medical model - although the nursing curriculum at that time was changing it still relied on definitions and diagnoses - symptom description and related treatment regimes. Never the less it was a start and caused a bit of a storm at the time - although now out of print I still get a few royalties from library and photocopying rights! The sentiment David speaks of is vital not only for dynamic person centred care but also for our society to reduce stigmatise and become more open about the mental health struggles for many today - from the famous and wealthy (RIP RW ) to the lonely, desperate and homeless.

  3. carol:
    Aug 17, 2014 at 08:37 AM

    I echo David's thoughts which are - right on the money. The impact of depression and anxiety based conditions is ever presebt. During the wee hours I read with sadness posts from people who were suicidal. Un updare shared thatvone had been hospitalised for their safety and was very angry abour this. Medicalising a petson in this situation is not always the answer. Far better to connect on some level and gently lead that person to fibd tgeir own solution. There will be times where swift intervention is needed to prevent a tragedy ...far better for this to be a community cridis team that can support the individual inrensively in their own community until the desire for the ultimate maladaptive solution abates.


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