Peter Kinderman, University of Liverpool

Nobody really believes that our mental health system is fit for purpose, but too many people persist in reinforcing this failed system. It is no longer good enough to call for better funding; we need genuinely radical change.

My new book, A Manifesto for Mental Health, presents a new and distinctive perspective. One that challenges traditional approaches and vested interests of professionals, but one with surprisingly well-placed support.

I argue that we need to change our ideas about what mental health actually is.

Before setting out practically how our mental health system should change, the book critically examines the dominant “disease-model” of mental health care. Using research in both biological neuroscience and the social determinants of psychological problems, the book offers a contemporary, genuinely biopsychosocial, alternative to the idea that our psychological distress is best thought of as symptoms of illnesses, and treated as such. The way we care for people with mental health problems at present is not only unscientific and ineffective, but it is also creating a hidden human rights emergency. We need a new approach. 

It is clear that our mental health and wellbeing depend largely on the society in which we live, on the things happen to us, and on how we learn to make sense of and respond to those events. To move forward, we need to recognize that distress is usually an understandable human response to life’s challenges, especially experiences of abuse, neglect, and inequity, and offer practical help rather than medication. We could start by rejecting invalid diagnostic labels, and instead, pay attention to the circumstances of our lives (something understood by public health physicians) and record the emotional consequences in simple, straightforward, non-medical language.

We need a revolution in mental health care; a shift from seeing our mental health primarily in terms of biological illness, to a social and psychological approach. That means we should replace the pathologizing and invalid diagnoses with effective, scientific, understandable, alternatives—straightforward descriptions of people’s problems, using their own words. Hospitals could be replaced with residential units designed and managed from a psychosocial perspective, and instead of treating so-called disorders we should be helping people solve the problems in their lives that lead to their distress. The law needs to respect our right to make decisions for ourselves; unless, of course, we are unable to do that, in which case there needs to be much greater judicial oversight. And because our psychological health and wellbeing are largely dependent on our social circumstances, we need to work collectively to create a more humane society: to protect people (especially children) from abuse, to reduce or eliminate poverty and inequality, and build healthier communities.

Our mental health cannot simply be reduced to genetic vulnerability, and distress merely passed off as the symptom of an illness—it depends heavily on the society in which we live, on the major life events we face, and the ways in which we interpret and face them. It’s about collectively creating a more humane society and establishing healthier communities. It’s about recognizing the human and psychological cost of failed societies, ensuring that people get the practical and emotional support they need… and it’s about reminding ourselves that social problems ultimately require social solutions.

Offering a serious critique of establishment thinking, A Manifesto for Mental Health explains how, with scientific rigor and empathy, a revolution in mental health care is not only highly desirable, it is also entirely achievable.