Ally Rooney is an academic psychiatrist with an interest in the psychiatric consequences of having a brain tumour. In May he will be speaking at our Nurse and AHP Study Day, joined by other leading experts from the brain tumour community.
Mental health is so hot right now. The Royal Family are spearheading a new campaign to end stigma around mental health. In England and Wales, mental and physical health now have equal ‘parity of esteem’, meaning equal prioritisation by NHS commissioning services. In Scotland too, improving mental health is a priority area.
This is great news. But what is mental health? You might think it strange but I struggled to come up with a good answer. Every definition that came to mind involved, in some way, the presence or consequences of illness – in other words, defining mental health by its very absence. A small voice inside reminded me of the risk – ever present in clinical practice of seeing what people can’t do, rather than what they can.
Thank goodness then for the World Health Organisation (WHO), which defines mental health as, “a state of well-being in which every individual realises 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.”
This is a wonderfully positive definition. And yet once the Star Trek music had died away, I still struggled.
We all know the obstacles facing those living with a brain tumour. People living with a brain tumour often can’t drive and often can’t work. Depression, personality change, cognitive difficulties, and fatigue are rife, to say nothing of the stress of waiting for scan results. Carers can feel exhausted.
For many, it seemed, the WHO’s lofty ideal of mental health is an impossible goal. Surely they can’t have it.
But the small (and by now, I confess, irritating) voice said: “Why? Who says they can’t?” And for the life of me, I couldn’t answer that at all.
Maybe it was just a bad day for philosophical introspection. Or maybe it wasn’t. Maybe we all struggle with this. Maybe it’s time to follow the lead of Wills, Harry, and the rest: time to re-frame.
What if we framed the problem not as being about the obstacles, but how to find ways to help patients realise their potential after treatment? To cope adaptively with the daily stress of having cancer, to work (or function) productively, and – yes – to make a contribution to their community?
In other words to focus relentlessly not on what our patients can’t do, but on what they can? Many of us, of course, already do precisely that. But even then…
– What are we doing to develop local rehabilitation services?
– What are we doing to routinely seek and treat mental distress?
– What are we doing to actively help patients adapt?
– To help them contribute?
– To support their carers?
– To secure funding to study new and better mental health initiatives?
… and so on.
Mental health matters because we believe in the importance of quality of life. We go to work committed to positively restoring our patients to physical health. Let’s do it for mental health too.