Real talk about mental health

Dr Lucy Foulkes beautifully articulated several concerns I have felt over the years, particularly those around mental health related content on social media.

Depending on your use of social media, you may have seen a rise of short videos explaining symptoms of diagnoses, such as 'Things I didn't realise were ADHD' or '5 signs your partner/parent is a narcissist'. Social media platforms do offer opportunities for online communities to grow, with people sharing information about their diagnoses and experiences, bringing solidarity in what feels like an increasingly isolated world. But while I am sure most individuals whose content centres on their professional/lived experience of mental illness/neurodevelopmental conditions are well intentioned, and do bring a lot of good to reduce stigma, it is important to recognise that the platforms that facilitate such content have different aims – namely, profit through the provision of advertising.

I was recently left with an uneasy feeling after seeing an 'influencer' partnering with a private psychological service to advertise $99 ADHD screening-assessments, and have seen numerous similar creators with a variety of paid partnerships. I don't blame those accepting such partnerships, but it's important we open a discussion about the companies potentially profiting off people looking for acceptance and understanding.

There's also a commodification of complex psychological concepts. To go 'viral' on social media, it helps to share information through a video format that lasts 30-60 seconds. If you can adapt your content to fit a current 'trend' (e.g. using a certain song or dance) this will also put it in favour of being viewed more widely. Sweeping statements are incentivised, and so is relatability. It seems of the videos highlighting symptoms of a clinical diagnoses, those most likely to go viral are not those showing the most life-limiting but those most relatable to the human-condition. I worry there is a lack of nuance to how psychological concepts are displayed, a lack of context to the wider debates in which they may sit. What we are presented with is determined by algorithms with palatable and simplified content taking priority for most of us.

I do not have the answers… these are complex topics and I have only scratched the surface. The far broader issue is how as a society we manage a constant stream of unregulated information, controlled by corporate companies that do not function to serve our best interests but to drive profit. However, social media is unlikely to go anywhere, and I hope these thoughts can help stimulate some wider debate about how we engage with it as professionals and how/if we can inspire nuance and understanding on platforms that seem to preference reductionism and relatability.

Ruth Roberts, Assistant Research Psychologist
Dorset

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I read with interest and enthusiasm the September 2022 issue of The Psychologist, with articles from many people whom I admire and whose views I share. It was great to read Lucy Foulkes' article about the problems with mental health awareness and I commend her for taking a critical position in relation to something that most of society would view as so obviously positive (as she notes). Many of the points made resonate strongly with my own experience. I remember, for example, being asked to speak on local radio in mental health awareness week and being told to make sure I didn't encourage any more referrals to local mental health services! In my work with young people, I also shared her concern about the tendency to locate problems within individuals, in the process ignoring the environment and circumstances of their lives.

Taking the issue further, I think the problem is that mental health awareness campaigns are not raising awareness of mental health, they are raising awareness of mental illness. As other pieces in the issue note (e.g. interviews with Lucy Johnstone, James Davies, Rufus May), the medical model of mental illness dominates our discourse around mental health and this is evident in almost all awareness-raising campaigns. As a society, we have taken a model of illness that has its roots in asylums and psychiatric hospitals and we are presenting it to the entire population as if it were a model of health. We tell people that to understand their mental health, they need to understand the symptoms of things like anxiety disorders and the impact of things like depression. As a result, we have all started to understand our emotional experience through the language of illness and disorder. As Rufus May highlights, language is powerful, and the expression of distress in medical terms – 'I'm depressed' or 'I feel suicidal' for example – is likely to lead to friends, family and colleagues feeling unable to help and recommending medical intervention. In comparison, the expression of emotional distress in alternative language 'I'm miserable', 'I feel overwhelmed' would likely lead to a very different response.

So I would second Lucy Foulkes' call to adjust our campaigns, but ask that we really do talk about mental health. For me, this will involve putting a greater emphasis on alternative ways of understanding our human experience, which will have the added benefit of reducing the weight given to the medical model that, as James Davies notes in his interview, 'has presided over four decades of flat-lining outcomes'. There are a variety of different models we can use, most of which are represented in the issue: adverse childhood experiences, the Power Threat Meaning Framework or my own work (see my book, Understanding Your 7 Emotions).

Dr Lawrence Howells, University of East Anglia

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Lucy Foulkes' initial concerns relate to a general message of Mental Health Awareness initiatives she perceives as 'Just Seek Help'. As a Mental Health Awareness facilitator, I refute this perception – the message I and many others convey, is 'Seek help'. The 'Just' to me infers a simplistic solution and myself and my colleagues go to great pains to avoid this.

A significant message in our work relates to the complexities around mental health and the contributing factors. Within this context Lucy also expresses concern that the brevity of this message encourages people to believe the cause and solution to mental health issues lie within the individual. Again, we go to great lengths to avoid this and, personally, in the main, I advocate a Psychosocial perspective highlighting the importance of social support.

Another criticism within the article focuses on banner messages like 'It's good to talk' expressing the concern that if you talk to a friend or family member, they won't know what to say. This may indeed be accurate, but the banner messages don't stand alone. The campaigns work hard to promote contacts for further information particularly related to suicide, with details of staffed 24/7 help line numbers (CALM, Papyrus, Samaritans) foregrounded. Similarly, there are a range of Mental Health Awareness training programmes available – Mental Health First Aid and I- Act for example. Mental Health First Aid England reported that by June 2020 1 in 70 of the adult population of England had undertaken one of its training programmes. These awareness initiatives do not exist in isolation.

Bernie Graham, Plymouth

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Lucy Foulkes responds:

My article was about public campaigns and their brief soundbites, not about in-depth training led by facilitators, which can be very helpful. I agree that in-depth training is much more useful and solves a lot of the problems that I describe about brief media advertising campaigns.

Ruth Roberts raises interesting points, particularly regarding how relatability will be more popular in social media videos and therefore MH videos will only focus on the milder, more palatable symptoms.