Medical Humanities and Mental Health Policy: Lessons from the AHRC’s ‘Engaging with Government’ Course (Institute for Government, March 5-7) by Åsa Jansson
In 1765, twenty-year-old Johann Gottfried von Herder wrote in a letter to a friend that he wanted to bring his ‘many favourite ideas’ together under one theme: ‘how philosophy can become general and useful for the good of the people’. Herder had been attending Immanuel Kant’s lectures at the University in Königsberg, where the famous thinker objected to the elitist institutionalisation of philosophy. Inspired by Kant’s words, Herder wrote a passionate essay entitled ‘How Philosophy Can Become More Universal and Useful for the Benefit of the People’, in which he held that the traditional philosophy usually taught in universities was too abstract to be of any real value. The main goal of philosophy, Herder argued, should be the improvement of society and the education of the people.
For Herder, the importance of humanities knowledge in social and political development was undisputed – what use was such knowledge if it didn’t have some practical application in the interest of the public good? As an historian, my interest in historical events and ideas is in the first instance concerned with how and why different kinds of knowledge was produced, and what we can learn about the present by historicising current ideas. But sometimes historical voices are worth listening to also because what they tell us is still relevant today. Herder’s remarks speak to a question that is as pertinent in 2019 as it was 254 years ago: what is the public value and usefulness of different kinds of knowledge?
Scholars in any field are rarely in doubt about the relevance and usefulness of their own research. For the medical humanities, the relationship to clinical knowledge and practice is central to the discipline, and a significant part of what we do is about contextualising, interrogating, analysing, and explaining medical knowledge and practices. But what is the role of the medical humanities in policy making? The relevance of humanities research to policy is not always immediately apparent either to academics or to politicians and civil servants. At a time when quantifiable data and measurable outcomes often take precedence over qualitative research and narrative descriptions, humanities researchers can face greater obstacles in trying to demonstrate the public and practical value of their knowledge compared with colleagues from the natural and social sciences. At the same time, as Herder suggested, what is the usefulness of knowledge if it is not, in some way, aimed at improving people’s lives and bringing about greater wellbeing (whether physical or psychological or both)? The impact might not always be direct and quantifiable, it might be subtle and gradual, it might have more to do with individual empowerment than structural change, but equally, some kinds of humanities research may also have a direct, measurable, or systemic impact on public life.
In an attempt to gain a better understanding of how humanities research is and can be used in policy making, and how I, as an historian of psychiatry, can contribute to the development of mental health policy, I applied to join the AHRC-funded course ‘Engaging with Government’ held at the Institute for Government, a leading independent think tank that scrutinises government processes and practices and aims to improve how government operates. The course, which runs for three days every year, is aimed at early career researchers in the arts and humanities who want to learn ways to use their research to engage with policy makers.
What I learnt during three intensive and challenging days went far beyond the course curriculum, and can’t be neatly summarised in a brief blog post, but I want to highlight a few points that may be of interest to researchers at the intersection of the medical humanities and the history of psychiatry and psychology, insofar as our work is concerned in one way or another with mental health past and present.
First of all, it’s useful to note that the relationship between government and parliament on the one hand and academic researchers on the other is less structured and coherent than one might wish, instead having a largely ad hoc and highly varied and changeable character, and is often dependent on individual relationships between academics and policy makers or institutions. This inevitably informs and directs what kind of research is used and for what purpose. Nevertheless, there are a number of routes available for academic researchers who want to engage with and influence policy making. These include POST, the Parliamentary Office for Science and Technology, which can be a good starting point for anyone who is new to the world of policy engagement. Beyond POST, the Commons and Lords libraries provide MPs with relevant data on current topics, and produce briefing papers, so offer a direct route for channeling research findings into the policy making process. Other avenues include submitting evidence for Select Committee inquiries, engaging with an All Party Parliamentary Group concerned with your area of research, and establishing direct contact with research staff in departmental offices. A more indirect, but potentially very useful, route is to channel your research through a relevant think tank that engages with government and parliament, or write for a policy focused project such as History and Policy.
My own research is concerned with the history of classification and diagnosis in psychiatry, and is carried out in collaboration with Hearing the Voice, the Institute for Medical Humanities’ interdisciplinary project on voice-hearing. While the work that we do has more direct bearing on clinical knowledge and practice and service user experience, there are also important implications for mental health policy, in particular in two areas.
The first of these concerns government approaches to addressing psychological distress and mental illness. The current government is expanding access to talking therapies and investing money into digital mental health services as part of an ongoing reform of mental health policy. Any new funding for mental health is welcome news at a time when the NHS is underfunded and overstretched, waiting times for psychological treatment leave vulnerable people without support, and young people are struggling with worrying levels of anxiety, depression, and suicidal ideation. At the same time, it is crucial that each person who comes into contact with medical and psychiatric services gets the support that they find most helpful. For instance, studies carried out by Hearing the Voice researchers show that the experience of voice-hearing is complex and multivalent, and doesn’t necessarily fall within the realm of psychopathology, suggesting that it cannot be easily pinned down into strict medical categories. Moreover, existing standard treatments are not necessarily the most helpful for people who hear voices. New innovative strategies such as avatar therapy have shown promising results, and chime with a more holistic, dynamic, and person-centred approach to what psychiatry refers to as ‘auditory verbal hallucinations’.
However, exploring and incorporating new treatments and support strategies requires properly funded mental health services, and equal access to such services for people across the country. It follows that medical humanities researchers whose work is concerned with the experience, diagnosis, and treatment of psychological phenomena such as voice-hearing have an important role to play in convincing governments of the multiple individual and social benefits of increasing the level and scope of funding for different treatments including new and non-medical support strategies.
The second area where medical humanities researchers concerned with mental health can have a key impact on government policy is in regard to the stigma attached to many conditions and experiences. Writing for History and Policy, Chris Millard notes that over the last few decades, government policy relating to mental health stigma has seen a clear shift from centralised, legal strategies to a fragmented approach where the focus is on influencing attitudes rather than bringing about structural change, creating an environment where the challenging of mental health stigma is chiefly the responsibility of mental health charities and advocacy groups rather than government.
The interdisciplinary nature of medical humanities research means that it is particularly well suited to addressing questions related to mental health stigma, as it draws on knowledge from a wide range of medical and non-medical perspectives. Effective destigmatisation initiatives arguably need to take a multifaceted approach that combines structural changes to mental health services (including sufficient funding) with public education about mental health, and a centering of people who are the targets of stigma, whose experiences must be at the core of any such initiatives. The kind of interdisciplinary research that is carried out by projects like Hearing the Voice, which goes beyond narrow medical interpretations of psychological phenomena, and which is guided by and carried out in collaboration with people whose lived experience are the focus of the research, has a crucial role to play in informing government policy on mental health stigma.
While there is a clear and present need for medical humanities knowledge and perspectives in policy development, that doesn’t necessarily mean that policy makers will welcome such engagement. Throughout the three days I spent at the Institute for Government, ideology was the elephant in the room. The current British government is informed by an approach to economics and the organisation of society that favours privatisation, deregulation, and voluntary, non-legal action to combat issues such as mental health stigma. Since the Conservatives came into power in 2010, this approach has been coupled with a severe austerity programme, which led a United Nations special rapporteur investigating poverty and human rights in Britain to conclude that ‘compassion for those who are suffering has been replaced by a punitive, mean-spirited and callous approach’. Beyond the UN report published last year, there is significant evidence that austerity has created tremendous suffering and contributed to mental health crises such as suicidality.
It may be the case, then, that medical humanities researchers whose policy suggestions are at odds with current government approaches have to find other ways of influencing mental health policy. One way of doing so is through a third party, such as think tanks and mental health charities, who engage with a wide range of actors beyond government. Another option is to approach individual MPs with a documented interest in mental health questions, or to engage with political parties not currently in government, with the aim of contributing to future policy agendas.
To conclude, the routes available for medical humanities researchers to influence government policy are many, but there are equally a number of potential impediments and challenges to direct and effective engagement with policy makers. Getting a greater insight into the policy making process and the ways in which academic research is and can be used in policy development has only reinforced my belief that medical humanities researchers are well placed to contribute to policy making, both directly and indirectly, across the spectrum of mental and physical health. It is, however, up to us to take an active approach to engagement with policy makers, and to show how our expertise can, to use Herder’s words, be ‘useful for the benefit of the people’.
A warm thank you to Katie Thorpe and Jill Rutter from the Institute for Government for running a brilliant and tremendously useful course, to my fellow participants for interesting and stimulating discussions and valuable feedback, and to the AHRC for providing the opportunity and means to attend.
Åsa Jansson is a Junior Research Fellow with Durham University’s Institute for Medical Humanities. Her current research charts the history of the affect/schizo dichotomy in psychiatry and is carried out in collaboration with Hearing the Voice. Past research projects include the history of melancholia and the history of Dialectical Behaviour Therapy. She is particularly interested in the events and acts that produce human experiences as symptoms of psychiatric illness.
J.G. Herder, quoted in Ulrich Gaier, ‘Kommentar’, in Ulrich Gaier, ed., Johann Gottfried von Herder: Frühe Schriften 1764-1772, Frankfurt am Main, Deutscher Klassiker Verlag, 1985.
J.G. Herder, ‘How Philosophy Can Become More Universal and Useful for the Benefit of the People’, in Michael Forster, ed., Herder: Philosophical Writings, Cambridge, Cambridge University Press, 2002.