With reference to the biomedical, psychological and social needs perspectives on mental health, critically discuss how mainstream mental health practices can be empowering and/or oppressive for someone in Mandys circumstances.

With reference to the biomedical, psychological and social needs perspectives on mental health, critically discuss how mainstream mental health practices can be empowering and/or oppressive for someone in Mandys circumstances. 

Oliver et al. (2005) help-seeking behaviour in men and women with common mental health problems: cross-sectional study

Goldberg and Huxley’s (1980) Filter Model

Mandy is a 25-year-old woman who lives alone in a small, privately rented flat. Mandy’s birth mother had problems with drug addiction and led a rather chaotic lifestyle which meant that her contact with support services was intermittent. She never revealed who Mandy’s father was and started living with another man some months after Mandy’s birth. After social services were called in to investigate suspected physical and sexual abuse within her mother’s home, Mandy was taken into care at the age of two. She was fostered by a couple in a nearby town, and they went on to adopt her. The couple wanted her to do well, but rarely displayed warm or loving feelings either to her or to each other. She found it difficult to settle at school, but at the age of 15 she began to take a keen interest in art which motivated her to work harder and she left school with A Levels in Art, English and Geography. She went on to university to study Art and Design in a city more than 100 miles away from her family home and only kept up minimal contact with her adopted parents. She enjoyed the course and the student lifestyle, throwing herself into the social scene associated with the Art Department and its students. Mandy began a relationship with a fellow student while at university. After graduating they stayed in the same city and moved in together but neither of them was able to find a job that used their degrees and this regularly made them both despondent and they rowed frequently over money. Mandy tried being a waitress for a few months but found it too stressful and tiring, so she went to work in a department store instead. Her boyfriend decided to move to another city in the hope of finding better work there; the distance drove them apart and they split up. Meanwhile, Mandy tried to distract herself by using her spare time to work on producing abstract paintings and socialised with some other graduates from her course who had also stayed on in the city. But she couldn’t help comparing herself to the other graduates, who all seemed to be much more successful in their careers than she was. Over the next few years her contact with these other people gradually declined and she spent most of her free time in her flat, either painting or watching television. She often found that she was consumed with a deep sense of dissatisfaction with how her life had turned out and wondered at times if this was all life had to offer, because she felt miserable. In the last year Mandy has started to hear a voice commenting on what she is doing. At first she thought it was someone outside the flat talking through the door, but each time she opened it there was nobody there. Sometimes the comments are negative, at other times they merely describe what she is doing at the present moment. She recently found out her ex-boyfriend is getting married and she has been particularly depressed. The voice has become increasingly distracting and during a recent shift at work, when she encountered a difficult customer who accused her of short-changing him, she found herself unable to stop herself from shouting at him the things which the voice had uttered. She woke up the next morning with a bad cold; she uses this as an excuse to take time off work and has not been in for the last two weeks, only leaving the flat briefly to fetch her shopping. She has not told anybody about hearing the voice and has told her work manager that she was off with ‘the flu’. She is vaguely aware that she feels out of sorts but hopes it will pass. A few months after returning to work as a result of ‘the flu’, Mandy wakes one night from a dream and feels a new sense of connection with the universe. She feels she has been reborn as one of a small number of disciples of the cosmos. She is delighted with this development and feels at last she has some meaning in her life. During her weekly phone call with her mother Mandy mentions the rebirth. Her mother doesn’t challenge this notion as she thinks it is another one of Mandy’s ‘hippy phases’. As she hangs up the phone she says to herself, ‘Mandy has always been an overly sensitive girl’. A few years ago, Mandy had the following experience just after her relationship with her boyfriend had broken down. Mandy had not been sleeping well since he had moved out and she felt agitated constantly, with a sense of dread like something bad was going to happen. One morning she got on a bus travelling towards the town centre. She was just about to hand over the fare to the bus driver when she suddenly became panicked about whether she had locked her front door. She usually left the house with her boyfriend, but as he was not there any more she was alone when she left the house, and now the internal narrator in her head was exasperated, telling her she probably had not locked it properly. She lived in a socioeconomically deprived area and was worried that someone would take advantage of an unlocked door, and she would be robbed. As the negative thoughts rushed through her consciousness, her heart began to race, her knees began knocking together and her palms became sweaty. The bus driver asked her if she was okay, but her mouth was dry and she could not get the words out. She ran off the bus, suddenly terrified that the house was being ransacked by strangers. She got home to find there was no problem, the door was safely locked: There will be no shopping today, you’re a crumbling mess and a big mistake. Losing control of yourself like that, what must the bus driver have thought? You can’t even get on a bus, you’re losing your marbles, the internal narrator shouted. Mandy collapsed onto the sofa and sobbed. She was aware that her moods had been up and down since her boyfriend left, but she thought she had been coping with the relationship breakdown reasonably well. She had mentioned her struggles to her friends, and they had told her it was normal to feel this way after a stressful event, but she now questioned if the stress was too much for her, and wondered if she should take time off work to visit her GP. We join Mandy two months after she had the dream about the cosmos. She has stopped going to work, and has stopped leaving her flat. Initially she finds she is coping well with the changes in her life, as long as she does not have to leave the flat, but increasingly she finds the feeling of the security offered by her flat to be slipping away. She finds that she is getting distressed by the voices and will do anything to keep them quiet. She has not smoked since she was a teenager but she thinks that smoking might help calm her down. Mandy leaves her flat to go to the local shop. ‘Can I have ten cigarettes?’ snaps Mandy. The shop assistant smiles and says, ‘Of course. How are you today?’ Mandy thinks the shop assistant is looking at her strangely. She doesn’t reply. She has started to feel sweaty and panicky, and feels her face go red. Why is he taking so long snaps the voice in her head? ‘Shushh’ she instinctively utters out loud. The shop assistant looks confused, but he is used to people acting oddly so just says, ‘Anything else for you?’ Mandy is sure he knows about the voice. She has not told anyone about it because she suspects people will think she is mad. But now sweat is accumulating on her forehead, she feels sick, she feels detached from where she is physically standing, and wonders if she has been transported to another planet. Her body feels weirdly separate from her mind. You need to get out of here before they come for us, demands one of the voices.They are always looking for sacrificial lambs, it can’t be us. Mandy is scared. She doesn’t know what is happening to her anymore. The world has suddenly become a frightening place. She is losing control over her thoughts, feelings and behaviour. She leaves the shop without the cigarettes and heads home clearly flustered. In the stairwell to her flat she bumps into her friend and neighbour, Tom. He tries to stop her to say hello but she brushes past him. Although Tom cannot hear her inner voices scream, he recognises that she looks dishevelled and stressed. As she progresses up the stairs he senses that she is talking to someone, but there is no one there. Tom feels concerned something is very wrong and Mandy probably needs help. Tom persuades Mandy to let him into her flat. While they sit down over a cup of tea, Mandy recounts the episode in the shop and Tom is initially frightened when she tells him about the voices. He wants to help Mandy but does not know how.

Relevent things to add:

• Activity 1.2 Case study of Mandy
• Activity 1.4 Does Mandy seek help?
• Activity 1.5 Oliver et al. (2005) help-seeking behaviour in men and women with common mental health problems: cross-sectional study
• Activity 3.2 The balanced care model
• Activity 3.4 Improving mainstream health services