Reconstructing a social model of distress


See article Going Social: Championing a holistic model of mental distress within professional education


There is nothing new about social perspectives – in different ways, understanding the interrelation of ‘mental distress’ and ‘problems of living’ is something that has, for many years, been on the agenda of, among others:

Social psychiatry

Psychology and psychotherapy


Systems theory

Social work

Transcultural psychiatry

Race Equality Unit

User movements

Recovery movement

Women’s movement; lesbian and gay perspectives

Disability movement

Research based on longitudinal surveys shows that advances in pharmacology and other medical treatments have resulted in little consistent improvement in recovery rates – so we cannot say that the medical model, on its own, is a sufficient basis to underpin policy and practice in mental health. Instead, variables such as cultural setting and unemployment rates appear to have a much greater impact – and there is some evidence that socially oriented services achieve higher recovery rates. As Pat Bracken and Phil Thomas have argued in OpenMind,

"For 150 years, psychiatry has fanned the flames of public hope and expectation, holding out promises of ‘cure’ and treatment for an ever-wider range of complex human and social problems. But these promises have failed to materialise… We believe that psychiatry should start a ‘decolonisation’, a phased withdrawal from the domains that it has laid claim to, including psychosis, depression and PTSD, by admitting the limited nature of its knowledge"

It may be that medical technologies have a particular contribution to managing the acute phases of people’s distress, but both mental health promotion, and longer term action and support, may more effectively be guided by social perspectives.

What has not so far happened is for the various strands of alternative ‘social’ thinking, all of which have been to some extent in the shadow of the medical model, to be brought together as a coherent model (or set of models) in its own right – one that can, in its own way, be as influential on policy and practice as is the medical model.

The need for a more holistic approach is reflected in the National Service Framework for Mental Health, in which concepts such as social inclusion and recovery play an important role. This also recognises that a broader evidence base is required than that provided by evaluations of medical treatments.

February 2002 saw the launch of the Social Perspectives Network for Modern Mental Health whose aims are to:

It is hoped that such thinking also becomes reflected in the work of the new National Institute for Mental Health, the Social Care Institute for Excellence and other bodies with a brief over research, policy, education and practice agendas.

However, although there may be a groundswell of interest in social perspectives, there is currently a lack of clarity as to what exactly is meant by a social model of mental health (if indeed it is a model that is required at all), and how such approaches could be more effectively implemented in practice.

I would argue that at the core of a social model are two parallel perspectives that link ‘mental distress’ with ‘problems of living’:

Thus, at one and the same time, it may constitute both an awesome story of survival in relation to an oppressive or ‘unliveable’ situation, and a desperate cry for help and understanding. Whether viewed as a coping strategy or as an expression of extreme disquiet, it may represent a way of being that is lived out at some considerable cost to the person, and may potentially pose difficulties or risks both to them and to those around.

Workshop discussion

There was a strong consensus that this was just the start of a process of discussion.


Contacts for follow up discussion:

Social Perspectives Network

Jerry Tew


Tew, J. (2002) Going Social: Championing a holistic model of mental distress within professional education. Social Work Education 21:2