Psychosocial approaches and rights-based mental health care

Between 2014 and 2020, the UN special rapporteur on the right to health was psychiatrist Professor Dainius Puras, who became a visiting Professor at the University of Essex in 2015. His work investigating human rights in mental health care across the world was supported by a Senior Advisor, Julie Hannah, Lecturer in the School of Law.  In collaboration with Julie, who provided research support, Dr Puras published a number of groundbreaking reports to the UN Human Rights Council calling for a radical change in the practice and organisation of mental health care across the world.

The reports called for a challenge to the dominance of biomedicine in mental health care; for power asymmetries to be addressed; and for systematic bias in the mental health evidence base (including conflicts of interest) to be acknowledged and addressed. Above all, the work highlighted the need for a much broader application of psychosocial approaches across the world in order to better support people experiencing mental distress. Subsequently, Julie co-founded the Centre for Mental Health, Human Rights, and Social Justice, a “multi-disciplinary global community of scholars and activists dedicated to the study of right-based approaches to mental health law, policy and practices”.

Puras’ work stimulated considerable activism in the field with many professional and survivor organisations joining the call for a greater emphasis on the psychosocial environment and the need to transform mental health systems worldwide to ensure they comply with human rights legislation.

The work also triggered responses from psychiatric organisations defending their role in mental health care and evidence generation. These responses were analysed by Prof Susan McPherson, along with Dr Jeppe Oute, honorary Lecturer in the School of Health and Social Care. McPherson and Oute’s analysis illustrates how psychiatric organisations attempted to undermine the special rapporteur and his detailed country-based inspections which led to his call for a radical change towards rights-based care in mental health. Their work was featured by Mad in America, a widely read blogsite which serves as a “catalyst for rethinking psychiatric care in the United States and abroad”. In spite of the resistance, the push for radical change has gained momentum with the World Health Organisation joining the call in 2023 for a rethink of mental health systems.

Philosopher Prof Wayne Martin has conducted pioneering research on mental capacity, which determines a person’s legal right to refuse unwanted treatments. University of Essex research in this field has played a significant role in informing and shaping public policy and practice including influencing the 2018 Independent Review of the Mental Health Act. This research continues to inform the ongoing global reform of mental health and mental capacity legislation and the effort to embed respect for patient autonomy and human rights within care practices including a recent analysis of compulsory treatment orders in Scotland.

As well as University of Essex being at the heart of this call for radical changes to global mental healthcare towards human rights-based psychosocial approaches, we also have leading experts in psychosocial theory, psychotherapy practice and outcomes research as well as experts researching the psychosocial correlates of mental distress including family systems and social contexts. Our research challenges the current psychiatric evidence base, questioning the methods and assumptions including the underlying problems with the way mental distress is typically measured.

Challenging assumptions about the efficacy of biomedical treatments, Prof Susan McPherson has examined patient experiences of a wide range of psychological treatments for depression, showing that patients need to be more involved in discussions and decisions about therapy and that therapy needs to be more tailored to individual needs, taking into account social and cultural contexts. She has also shown how in couples, relationship difficulties can be intertwined with experiences of depression, meaning that couples therapy can be a helpful approach.

Furthermore, for people with persistent depression, psychological therapies like mindfulness-based cognitive therapy, interpersonal therapy and psychoanalytic psychotherapy can have important benefits for quality-of life, which is often more important to patients than improvements on the symptom checklists typically used in biomedical research to decide if a treatment is beneficial or not.

Our research shows that mental distress needs to be seen in a wider context of families, schools and society rather than being seen as an individual issue. Dr Ebenezer Cudjoe has shown how children whose parent has mental distress worry about their parent when at school while also needing the space school provides to be away from the pressure of caring for their parent. Prof McPherson’s research shows that depression can complicate family life; that the NHS requirement for ‘carer involvement’ in mental health care is naïve to this complexity and that psychosocial family or couple interventions may often be more appropriate in these instances.

Research using representative UK household survey data, Understanding Society, also shows the importance of families. For example, Dr Edith Aguirre and Prof Michael Benzeval found that children have fewer emotional and peer relationship problems when their mothers have more egalitarian gender role attitudes. They are now working with psychologist Dr Ayten Bilgin using the same dataset to establish whether parental mental distress before pregnancy might be causing infant difficulties such as excessive crying, sleeping or feeding difficulties. Analysis of Understanding Society by Prof Emily Grundy has also shown that when young people struggle financially when living independently from their parents, moving back in with their parents can boost their mental health.

Alongside our training programme in clinical psychology, our Department of Psychosocial and Psychoanalytic Studies is leading the way in training psychosocial practitioners who can deliver this much needed shift in approaches to evidence based mental health care.

Training in psychological therapies and psychosocial practice is informed by our world leading research in psychosocial theory. For example, Prof Renos Papadopoulous, a systemic psychotherapist, has pioneered psychosocial interventions for refugee populations and developed a unique evidence based model of trauma-informed care to promote “adversity activated development”.

Prof Sue Kegerris, a psychoanalytic psychotherapist whose research on remote psychotherapy has shown how practicing psychotherapists were able to adapt their practices to remote working, triggered by necessity during the pandemic.