Delivering mental health help

Rates of mental ill-health have surged in recent years; now whether that's because we're better at picking it up, or something has shifted in society that means more people are reaching breaking point, is actually irrelevant. What matters most is that affected individuals get the help they need promptly. So why, Stanford clinical psychologist Ben Miller is wondering, limit the availability of that care to a restricted set of places and practitioners? As he explains to Chris Smith, endowing others with the right skill sets could be transformative...

Ben - For the last 10 years, we've been watching a trend emerge here in the United States of people losing their lives to preventable causes. And when you unpack that, you begin to see that a lot of the reasons that people are not able to get help is that the help is just not there. We don't have a mental health workforce that is sufficient in supply to meet the ongoing demand of what our communities are lifting up as a problem. So the backdrop for our paper was that we wanted to create an approach that provided people in communities with skills to help each other. We call it community initiated care, as its care in community by community. And for community.

Chris - Cynics would say though that it ends up being "medicine on the cheap". We've replaced police officers with community support officers. In some places, for example, it's the same. You, you take a doctor and you downgrade them to someone with a bit of training and call them a therapist, and people say it's a sticking plaster, not a solution. Do you dispute that then you say that this is a valuable and sensible direction of travel?

Ben - Yeah. Let me, let me give you a couple of reasons why I do dispute that. Number one, when you look at the science behind effective psychological interventions, you'll find that close to 80% of what makes them effective is what we would call the therapeutic alliance or the relationship that you have with someone. Those relationships matter greatly in terms of having the outcomes that you would hope to see. So what we did is we reverse engineered that and we said, there are people in your community that you have relationships with all the time, that if they were just given the skills to be able to help, maybe they would, maybe they could and maybe it would actually benefit you. That's the first thing. The second thing is a lot of these folks that are in our communities are already seeing mental health problems all the time. It's happening in their day jobs. It's, it's what they're already having to face. And so by not equipping them with those skills, we're basically putting them at a disadvantage. We're putting them at a disadvantage to not be able to help those people in their lives. But we're also putting the people they're trying to help at a disadvantage because they're getting less than ideal interventional support. So our attempt here is to provide more of a blanket training for folks that are out there in communities that are already seeing these issues, that know how to respond to them when they're confronted with them.

Chris - What does your approach look like then? Could you sort of paint a picture of putting it in operation, what it involves, and how you can then measure whether or not it's any better than the status quo?

Ben - Yeah, so it, it begins with just this reframing of how we approach mental health. Not seeing it as just a disease or an illness to be treated, but really mental health is more foundational to overall health and wellbeing. So a recognition of that means that we don't have to wait till things are really bad or you've been given a diagnosis, is that we see mental health as something that could be intervened on every day. Secondly, this is really about democratising and empowering individuals to learn how to respond to problems when they're faced with them. As I mentioned already, the literature is very clear that there are certain things that we can give to people, skills that we can give to people that they can immediately use. They do not need fancy degrees. They do not need to go to, you know, multiple years of school. They can just be taught how to help someone else that might be going through some struggles in their life. And then, as I mentioned too, I think that this is a really key factor in solving some of the problems in our communities. When we are approached by someone in our life who is looking for support, we can change the trajectory of their life by being able to intervene in that moment. Very rarely do people open up and say, "I actually want to talk about all the issues that I'm facing." Very rarely do they say, "listen, I'm really struggling." Most of what happens is that you begin to notice subtle, subtle shifts. And in those subtle shifts, those are moments for opportunity for us to help. We just often don't know what to say. An example I use all the time is, is I ask folks, if your phone rang right now and it was a loved one and they said, I need help, would you know what to say? Would you know where to send them? Most people respond to, I don't know what to say and I don't know where to tell them to go. Our approach here and what we're trying to really instill within our community is that everyone should be able to know what to say and how to help someone.

Chris - And does it work?

Ben - It does. And I think when you look more broadly at the literature, we would call this task shifting or task sharing. And it's using evidence-based strategies in different ways. So it's translating those evidence-based strategies into places that we normally wouldn't use them, shifting them into places that people actually are. And the literature around task shifting for mental health is extremely strong. It's so strong that we've actually seen it adopted into certain strategies like the World Health Organisation. So I think that when we begin to look at what works, we have to say there's promise here now. And I will also say that we know what doesn't work and what doesn't work is asking people to wait weeks or months for help. What doesn't work is us being stuck on our heels, not knowing how to respond to someone who's in front of us that's in a crisis. Those things do not work and have led to some of the most egregious disparities in the mental health space, as well as outcomes that I think we've seen in our time.

Chris - Who will be recruited then? I mean, I'm not quite sure I understand who you would go after to recruit into this. Would this be, say, a person at work? Would it be anyone that wants to volunteer or are you actually seeking people out 'cause you think they'd be in an area that's, that's needy?

Ben - Well, we're, we're still in the middle of operationalising this, and I think your question is a good one, but when you begin to look at the people who have relationships with other people in communities, there are natural places where this this emerges, for example, our faith communities. Many of us, if we're looking for some guidance, we'll trust turn to a trusted person in our faith community because we know them. They, they give us guidance in other aspects of our spiritual life. There might be places that are less common, but also just as impactful. And because we have the trust there barbershops, or nail salons, places that you might go on a regular basis where you have a relationship with the person that's helping you imagine what would happen if these individuals had those skills so that when you were disclosing something that was difficult to talk about, you were talking, you're going through a, a stressful time in your life, they actually had the skills to be able to help you. So I think it's very open-ended in our article, we're very clear that community initiated care really should be for the masses, it should be for all of us. And who steps up and begins to say, well, this is something we want to prioritise, I think has got to be grounded by how you value mental health and how much you really want to equip your employees, the folks around you with those skills.