Equality is the best therapy

If someone asks “how are things?”, and you knew they really wanted to know, what would you say? You might tell them about how you felt physically; what’s happening for you emotionally; or at work; or whether or not your new apartment is working out. You might talk about the important people in your life and how they’re doing; you might even talk about the state of the nation and your feelings on the latest election.

They might be getting more than they bargained for but any less would be only half of the story. Because knowing ‘how we’re doing’ isn’t a one stop shop. Our well-being is more complex than can be captured in a sound bite.

The same applies when we try to decide how ‘well’ we are as a country? The progress of most countries tends to be measured in terms of Gross Domestic Product (GDP). However, since 1971, Bhutan has rejected GDP as the only way to measure progress. In its place, it has championed a new approach to development, which measures prosperity through the formal principles of gross national happiness (GNH). This measure takes into account the spiritual, physical, social and environmental health of its citizens and natural environment.

Bhutan’s measurement of its prosperity fits much more comfortably with the words of Robert Kennedy, who three years earlier on the 18th March 1968, just three months before he was assassinated, said:

.. gross national product does not allow for the health of our children, the quality of their education, or the joy of their play.
It does not include the beauty of our poetry or the strength of our marriages; the intelligence of our public debate or the integrity of our public officials.
It measures neither our wit nor our courage; neither our wisdom nor our learning; neither our compassion nor our devotion to our country; it measures everything, in short, except that which makes life worthwhile…

We seem to disregard the things that make life worthwhile – the beauty of poetry, the strength of our relationships and the intelligence of our public debate. We seem to forget the central role that compassion and wisdom play in shaping a society where individuals can live good lives. We seem to forget that the health of our children, the quality of their education and the joy of their play lay the very foundations for later well-being and mental health. As long as we continue to do this I am afraid that nothing is going to change when it comes to the mental health of our nation.

Over the last three decades there is growing evidence that we need to work with whole systems if we are to improve health and well-being. We are faced with a very serious systemic problem when it comes to well-being and mental health in this country. This problem requires a very serious systemic response. I firmly believe that if we continue to think in siloed terms about mental-health and well-being we are going nowhere quickly.

We know intuitively that the alarming increase in self-harm and the consistently high rate of suicide in this country is a whole society issue. It is tragic that the annual figures for the number of people who end their lives by suicide in this country is unchanged over the last decade or more. In 2001 for example there were 519 suicides and in 2012 there were 507 suicides.

This national tragedy, made up of the life shattering loss for those left behind and the beautiful lives lost to suicide, needs a whole society response. As long as we continue to seek a solution in one particular department or in one particular service the HSE provide, such as the mental health services, we are destined to continue repeating annual national tragedy of more than 500 lives lost to suicide.

We cannot continue to abdicate the entire responsibility for well-being and mental health to specialist mental health services or to the Minister with responsibility for Mental Health. Well-being and mental health are whole-government responsibilities and we have to stop thinking in segments, artificial departmental divides.

The government’s recent Suicide Prevention Strategy, Connecting for Life (2015), is a good example of a whole-government approach. But, we need to start much earlier than at the point of suicide prevention. We need to adopt a proactive whole-government approach to the well-being as the actual foundations of mental health. If we fail to adopt a whole system approach to well-being and positive mental health – to put it simply – we are at the wrong end of the pitch.

To do this we have to recognise the well established determinants of health – the social, economic, political, cultural and environmental factors that determine health including mental health. The World Health Organization (2005) states that “some of the major determinants of mental health are located within social and economic domains and include: social inclusion, access to supportive social networks; stable and supportive family, social and community environments; having a valued social position; physical and psychological security; opportunity for self-determination and control of one’s life; and access to meaningful employment, education, income and housing.” (p.92)

Too often decisions taken by our government are made without consideration for these social determinants of mental health, or as Kennedy said – things that makes life worthwhile – such as; health of our children, the quality of their education, or the joy of their play, the beauty of our poetry or the strength of our relationships. Decisions and debate that happen in the absence of compassion and wisdom, in the absence of knowing what really makes life worthwhile, will never be effective in achieving well-being for our citizens and the collective mental health of our nation.

The well-being of our citizens will never be advanced if we simply see ourselves as an economy and continue to measure our success only by growth in GDP and loose sight of ourselves as a society, as an interdependent collective. We are a collective and an interdependent species who from the first moments of our lives are dependent on the kindness and love of others.

We need to move away from the understanding that well-being is simply the result of some magical internal psychological process.

We need to be very cautious of the insidious mentality that places excessive responsibility for well-being and mental health in the hands of the individual alone. We need to fully credit the power of deprivation and inequality to erode the capacity of the individual at an emotional, spiritual, psychological and intellectual level. There are of course other factors at play but social injustice and inequality play a pivotal role – we know this from decades of research in the field. As a psychologist and educator for almost 20 years I remain convinced, in fact more convinced than ever, of on one thing – equality is the best therapy.

It is abundantly clear that the chronic stress inherent in disadvantaged communities has significant impact on their mental health. An extensive body of research confirms the relationship between social inequalities, general health and poor mental health. The well-being that we seek as a nation will not be achieved until our policy makers and leaders address these inequalities. We need to radically reorient our approach in the evidenced based knowledge that social and economic development are two sides of the same coin and a sustainable flourishing economy is only built on a flourishing population.

There isn’t a citizen in the country who doesn’t want radical change to the well-being and mental health of the people of this country. There isn’t a citizen in this country who doesn’t want to stem the national tragedy of suicide we endure year after year. But if we keep doing what we are doing, we will keep getting what we’re getting. We need to start at the foundations of mental health – we need to adopt a whole-government approach to promote well-being and positive mental health.

How do we do this? We have to determine prospectively the potential implications of government actions upon the social determinants of mental health. Just as we are now accustomed to conducting an environmental impact assessment of proposed projects we need to adopt a mental health and well-being impact assessment of all future government actions.

There are a number of well-recognised tools available some used in other jurisdictions such as Mental Wellbeing Impact Assessment (MWIA) tool for example. This tool assesses the impact that policies, programmes and services have on mental well-being at individual, community and structural levels.

It is only then that we can ensure our citizens enjoy mental health as defined by the WHO. The WHO define mental health as: ‘a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community’ (WHO 2013, p.3).

It is only then that we will measure what matters most, what GDP misses and what mental health is built on – health of our children, the quality of their education, or the joy of their play, the beauty of our poetry or the strength of our relationships and communities, the intelligence of our public debate, our wisdom and compassion.