Coaching for Mental Health: Ethical Dilemma or Ethical Development?

Definitions and Diagnosis in current context

Even with the progress of time and medical advances there is an increasing rather than decreasing burden of caring for people with mental health disorders. Dr Raj Persaud , (a doctor of medicine, psychology and psychiatry) is disturbed that medical progress and media message is leading to a “medicalization of distress”, (as in the use of antidepressants for grief). “It is clear… we are in danger of reflecting the belief that the experience of life should never include distress, and that such experiences require professional or medical assistance”. Staying sane. (p.102).

Others working in the mental health field also believe that only through experiencing distress can people further develop their ‘sense of self’ and that far from being a negative experience it is a beneficial one, breakdown leading to breakthrough. The experience of distress provides the impetus to change, to break outdated patterns of behaviour and to offer an opportunity to create new appropriate responses. “I believe that most of what we call mental and physical illness is evidence that the way in which the person had been living up to the point of his collapse has truly been outgrown and that way of life and need to invent a new way which is more compatible with wellness. But members of our healing and helping professions construe the signals that a way of life has been outlived as an illness to be cured, rather than a call to stop, reflect and meditate, dream and invent a new self. The helping professions do not so much help a person to live as they help him to perpetuate a way of living that has been outgrown” Jourard 1971 p.98. Appendix 1: Breakthrough.

Unfortunately thirty years later the helping professions are still not attending to the cause of the distress, this need for change, but is still focusing on symptoms, as observed by an addiction specialist. “Change is at the heart of any treatment enterprise and particularly so in the treatment of addiction. But very few approaches attempt to understand the process or consider the ramifications.” Phil Harris, 2001.

Currently diagnosis of mental health is carried out through the NHS. The first consultation is with the GP. “Anyone with experience of the mental health industry will know how varied practices are and how little control people have over what happens to them”. How to survive without Psychotherapy. (pg 249). The diagnosis will have an impact on specialist referrals – psychiatry, clinical psychology or counselling, and possibly involve social services and other agencies – but is still based on the GPs subjective judgement. The follow up Mental Health services “are still in need of urgent reform. Too often, services are fractured and people fall between the cracks. I am keen to hear directly from patients, families and professionals about their experiences and the changes they would like to see”. The National Director of Mental Health, Prof Appleby. June 2000. Appendix 2:The NSF. A pioneering project addressing these issues, training GPs, and coordinating appropriate support has been undertaken in London and now Yorkshire. 08.05.02.

Perhaps of even greater importance is the effect of the diagnosis on the patient’s mental state, they already doubt their ability to cope, a diagnosis confirming this self belief further intensifies and perpetuates the condition. Additionally they may have arrived, anxious and confused, but still functioning by using their own coping strategies. Now, possibly misinterpreted and misdiagnosed, they may be labelled psychotic with all the associated personal fears, social stigma and intervention measures that increase dependency on specialists, artificial systems and the State. 08.05.02

A scathing indictment of the mental health system and its effectiveness comes from David Smail based on his 30 years work. In “How to survive without Psychotherapy” 1996, he considers that domestic and societal issues are the main culprits in causing distress and that the established mental medical practice “to incarcerate people, drug them, patronise them… Was just to add insult to injury” (pg.237) “In fact none of the approaches to ‘curing’ people’s emotional and psychological distress, whether derived from medical psychiatry, clinical psychology or the established approaches of psychoanalysis and psychotherapy, could make out a convincing case for its effectiveness” (pg.239). Fortunately, “there is a shift in view among some psychologists that the key issue is not the symptom itself, but your ability to retain control over it”. Staying Sane (p.96)

Many mental health conditions result from unacceptable life experiences and much aberrant behaviour is in fact an intelligent coping and survival strategy, therefore reversing the accepted definition of mental ill-health as abnormal behaviour, “In my view, the better measure of mental health is your ability to bring yourself back from the brink”. Staying Sane (p. 96).

The NSF and many specialists consider that to bring about a new public attitude to mental illness, it “must be recognised as a part of everyday life and not something that happens to other people. It can happen to any of us”. Henderson 2001(p.17).

“People have long been aware of the connection between stress, mental and emotional attitudes, psychological health and overall wellbeing. However, in recent years a growing body of compelling research along with increasing healthcare costs are bringing these crucial relationships to the forefront of the scientific arena. Scientific research now tells us plainly that anger, anxiety and worry significantly increase the risk of heart disease and sudden cardiac death.”

Statistics show a rapid rise in the incidence of mental ill-health, arguably in relation to increasing “environmental, social, economic and cultural” local and global pressures. (Agenda 21). Appendix 4: Statistics.

Social and economic pressures manifest as reduced health and life expectancy and an increase in the financial burden on society and the state. “Around 85% of people with long term mental illness have no job and 3 in 10 employees will have a mental health problem every year” Guardian April 2nd 2002. Existing strategies that keep people passive and dependent on drugs and carers are becoming less cost effective, and insurance companies are actively exploring new models of effective intervention.

In fact there is currently a radical reassessment of diagnosis “The BMJ is suggesting that depression, for example, should be reclassified as a ‘non-disease’. … It is certainly an interesting move – and one that does reflect much of our research into the ways that people manage their own mental health, particularly focusing, for example, on social support, creativity, alternative and complementary therapies and talking treatments”. 10.04.02 Ruth Lesirge. ( Appendix 5: Letter.

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