Moving Social Policy From Mental Illness to Public Wellbeing

This blog is based on an article in the Journal of Social Policy by Matt Fisher. Click here to access the article.

The ultimate purpose of social policy, and public policy at large, is surely to promote human welfare or wellbeing. An essential element of wellbeing is psychological wellbeing, understood in terms of coping with life, avoiding chronic stress, having a sense of satisfaction and purpose and maintaining positive relationships with other people and the natural world.

Although human societies have done quite well in improving physical health and longevity by providing medical care and preventing disease, we are doing far less well on psychological wellbeing. In fact, in many societies around the globe, common forms of mental health problem such as anxiety, depression and addictive use of drugs and alcohol are at epidemic levels.  Provision of mental health services is not working as a strategy to reduce the prevalence of these mental health problems because, in large part, they are caused by chronic stress brought on by the demands of living in modern societies.

While, for some, material conditions of living and access to medical care have improved, the psychological demands and stressors of life and work have only expanded. For those struggling to get by due to insecure work, poor housing, discrimination or a low income the stress-demands of life are typically even greater.

This is reflected in the higher rates of mental health problems amongst socioeconomically disadvantaged population groups. Constant exposure to digital media adds to the load. Mental health services are needed for people with severe mental illness, but there is little to be gained is spending ever more on psychiatrists and psychologists while many of us continue to live in social, economic and environmental conditions that cause chronic stress. It is little wonder that, in the face of these stressors, many turn to addictive behaviours such as alcohol use, over-eating or gambling to try to self-medicate their distress.

There is a way out of these seemingly intractable problems and is not as complex or difficult as one might think, but it does require a fundamental shift in social policy: away from a remedial, biomedical approach to ‘treating’ mental ill-health and toward a focus on the social and environmental conditions required to promote human wellbeing. This article is based on a recently published theory of public wellbeing; one that is grounded in an understanding of the role of stress arousal in human social intelligence and behaviour. The publication is freely available here. This previous work asked what psychological wellbeing is and how it is shaped by social conditions; this article moves on to ask, how can social policy cultivate the basic conditions required to promote wellbeing?

Nine areas of social policy action are proposed and with each of these I explain how effective action in that area will contribute to wellbeing. The nine action areas proposed include, for example, meaningful work, child development and parenting, social relatedness, connection with and care for nature, and comprehensive primary health care.  The article proposes that social policy should aim for universal access to supportive conditions in each of these areas.

While these areas of work are already recognised widely, what is important – I think – is to link them together in a coherent theoretical understanding of human wellbeing. Social policy in many places is taken up overwhelmingly with trying to remedially address health and social problems after they have already occurred. The challenge to shift this dynamic more toward health promotion has long been identified as a desirable goal, but to do so in the real world of public policy making requires theoretical clarity and what it is one is aiming to achieve and how to go about it. The final part of the article examines some of the possible challenges involved in advancing a social policy agenda based on a principle of wellbeing. One such challenge is that existing social policy is shaped by many ideas about what the aim is and the steps required to get there. In policy theory this is described as a theory of change. The article concludes with a basic theory of change model, for social policy to use to shift focus from mental illness to public wellbeing. 

About the author

Matt Fisher is Senior Research Fellow at the University of Adelaide.


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