Hannah Frith, Lead of the Social Justice and Inequalities (SJI) Research Group, describes the work of the group
What is the SJI group about?
Inequalities in mental health are stark. Understanding that inequalities in mental distress and wellbeing are not random, but are shaped by social and historical conditions, leads inevitably to a concern with social justice. As an example, the link between poverty and mental distress is well-established. Working with individuals living in poverty to ‘feel better’ may tackle the symptoms of distress for that individual, but it does little to address the underlying cause. For this, structural change and community level interventions are needed. Of course, both/and approaches can be helpful. We need to ensure that everyone who wants or needs psychological therapies can access them, and that interventions are effective for all sectors of our community. At the same time, we need to advocate for social conditions which will promote good mental health for everyone – but perhaps especially those people in our society who lack material and other resources often because they are marginalised, traumatised, and oppressed. Members of the SJI work to expose inequalities, to understand processes and practices which create and perpetuate inequality, and to explore mechanisms for alleviating the conditions which produce distress.
Understanding of mental distress
The working assumption of most Western mental health systems, professional training, and academic research is that mental distress is a pathological condition, a mental illness, that can be best understood and treated through the use of diagnostic categories and the development of specific treatments to alleviate ‘symptoms’. In this way, mental distress is pathologized – seen as an abnormal, different, or problematic state of being in the world. It is also individualized – seen as a problem located within the individual who is sick or unwell. This reflects the dominance of a medical approach to understanding mental distress. An alternative way of conceptualising mental distress is as a normal and understandable reaction to what Szasz (1960) called ‘problems of living’. In other words, that mental distress is an understandable response to poverty, abuse, discrimination, violence, marginalization, stigma. In a recent article in The Guardian, clinical psychologist Sanah Ahsan also talked about mental distress as arising out of living in a ‘traumatising and uncertain world’ (2022) – as examples we might think about living in a global pandemic, the cost-of-living crisis, an overwhelmed health and social care system, a justice system which often fails to protect the vulnerable. Of course, the sharp end of these features of contemporary living are felt more acutely by some sections of society than others.
Working within a system that adopts a medical model of mental distress, whilst contesting diagnostic classifications, market driven models of care, and individualised models of therapy can be challenging. For example, whilst acknowledging that ‘personality disorder’ as a way of describing mental distress is hugely problematic, we have a number of ongoing projects exploring how a diagnosis of ‘Borderline Personality Disorder’ (BPD) intersects with gender, sexuality, and youth in ways which pathologize and marginalise people in distress. Our work seeks to challenge the stigma associated with mental distress, and particular forms of mental distress (such as personality disorder) and the intersection of this with other forms of stigma. For example, Hannah Frith and Laura Simonds’ review of literature examining BPD in Lesbian, Gay and Bisexual people explores bias in diagnosis and exposes some of the problematic assumptions which underpin the (rather weak) research evidence. Other projects explore how men experience masculinity in relation to a ‘feminized’ BPD diagnosis (Georgina Jones, Laura Simonds, Hannah Frith), and the meaning a diagnosis of BPD has for young women specifically in relation to their identity and future (Jessica Phipps, Mary John, Hannah Frith). As well as understanding the experience of receiving a particular diagnosis, our research aims to foreground the perspectives of those who live with mental distress. This includes examining the masking of distress in young black men (Chamagne Martin, Laura Simonds, Mary John), the experience of suicide among Gypsy, Roma, and Travellers (Shannon Mcdonagh, Lydia Poole, Hannah Frith), resilience in young people that have experienced parental bereavement (Tim Callan, Mary John, Paul Hanna), and intergenerational narratives of resilience in marginalised families (Taneesha Jones-Seale, Laura Simonds, Mary John). As these last two examples demonstrate, we often adopt a strengths-based approach which acknowledges and respects the ways that individuals, groups, and communities are resourceful, knowledgeable, and creative in responding to adversities.
Relationships, relationality, and mental health
A core feature of our work is understanding that individuals experience and make sense of mental health and distress in relationships with others – friends, partners, carers, family as well as mental health professionals and other care workers. The stigma associated with experiencing mental distress or being diagnosed with a mental disorder can often result in isolation, loneliness, and the breakdown of social relationships which may be exacerbated by aspects of the mental health difficulty itself (such as paranoia or fear of rejection). Our projects aim to explore how people with mental health difficulties experience, manage, and retain relationships with others. Examples include projects investigating the experiences of romantic relationships for people with learning disabilities who identify at LGBTQ+ (Rachel Powell, Hannah Frith, Jen Mance) and care leavers’ experiences of friendships (Orla Kelly, Mary John, Paul Hanna). We also seek to understand how mental distress is experienced and given meaning systemically – within the family, institutional, and cultural systems in which people live. Some of our work examines how family and friends manage relationships, identities, and roles in the context of being impacted by mental distress. This includes exploring how intimate partners accommodate to appearance anxiety (Gemma Lumsdale, Hannah Frith, Lucy Hale), how experiencing a stroke or TIA impacts the identity of those who typically provide care to others (Catherine McGoldrick, Hannah Frith, Mariette Henning-Pugh), how siblings of young people with eating disorders experience changing identities over time (Bryony Routledge, Mary John, Hannah Frith), identity change in families living with an acquired brain injury (Siobhan Culley, Lucy Olafson, Freddie Byrne, Sara de Silva Ramos, Hannah Frith), how family members relate to minimally conscious disorders (Cathy Clifton, Hannah Frith, Mariette Henning-Pugh), and how parents of children with learning disabilities experience support, and the effect this has on their own well-being (Gemma Driver, Lydia Poole, Sarah Glew).
Inequalities in, and experiences of, accessing mental health services?
Recognising systemic inequalities in mental health services, and the interpersonal perpetuation of racism, sexism, homophobia, and others forms of prejudice and discrimination in interactions between providers and users of mental health services, research within the group seeks to explore the experience of psychological therapies for marginalised groups including: disclosure of racial trauma (Nicole Samuel, Laura Simonds) or experiences of being a refugee (Alice Storey, Laura Simonds, Goran Lukic) to therapists; care leavers’ experiences of transition from CAMHS to adult services (Ella Butterfield, Hannah Frith, Mary John), and older trans* people’s lifetime experiences of mental health and mental health services (Nicola Rogers, Hannah Frith). We also examine how therapists work across cultural and other differences to build the therapeutic relationships which are at the heart of therapeutic practice – such as exploring how therapists experience establishing trust in work with refugees (Alex Chamberlain, Laura Simonds, Goran Lukic).
You can find out more about the work of the group on the webpage: Social Justice and Inequalities (SJI) Research Group
Ahsan, Sara (2022). I’m a psychologist – and I believe that we have been told devastating lies about mental health. The Guardian, 6 September 2022. https://www.theguardian.com/commentisfree/2022/sep/06/psychologist-devastating-lies-mental-health-problems-politics