I love my optician. She is warm and gentle as she goes about her business in the small box room I have been visiting for years. I find the whole process fascinating. She is so professional, and so thorough and yet she relies entirely on me saying ‘clearer’ or ‘less clear’ to the tiny incremental changes she makes as she switches between lenses. I trust her entirely, and yet the whole process relies entirely on her trusting me. Sometimes I find it really hard to tell if it is clearer or not, and yet together we get there. I either leave with a slight alteration to help me see more clearly; or she tells me things are just fine the way they are.
It has made me think about the old, new, ongoing and at times painfully embarrassing debates about mental health and whose approach is ‘right’ or ‘best’. As professionals and therapists we are all trained differently– (sometimes small differences, and other times huge differences) – in how we understand the root causes and most effective interventions for mental health difficulties. If we think of this training as a lens through which we view these difficulties, it helps us remember that there are other lenses; and that these lenses may be more or less helpful to the person or family in front of us at a particular point in time. And that, after all, is the only thing that counts.
There are many lenses in mental health – for example the biological lens, the biopsychosocial lens, the psychological formulation lens, the psychodynamic lens, the systemic lens, the attachment lens, the Cognitive behavioural lens – to name but a few. All have demonstrated some worth to a greater or lesser extent along the way. To add to this we now have the ACEs lens and the Power Threat Meaning lens – welcome additions in a quest to make sense of what it is to be human. Especially as no-one can claim we have found the right ‘prescription’ for everyone.
When, as professionals, we look through our own particular lens, we do see clearly. Of course we do. We have been trained to – having sought the training out because we already were drawn to that light. And our passion and commitment to our particular lens is our strength – it keeps us striving for absolute clarity and improving that particular view on behalf of the people we work with. There is a risk, however, that it is also our downfall. It blinds us to the other lenses that may be more beneficial to that person or family at any one point in their journey towards clarity.
Multi-disciplinary teams, in theory, guard against this. However, in reality there is often an overpowering lens, whether it is a hospital setting, a ‘consultant led’ team, a dominant narrative or simply a lack of options as is most commonly the case. Moreover, ‘multi-disciplinary’ usually exists within one organisation (health), negating the social, cultural, contextual and political lenses that play such a significant role in the development and maintenance of, and interventions for mental health. Multi-agency lenses are essential if we are really going to see through the complexities more clearly. Even more importantly, those who have experience of using our services provide a crucial lens, or perhaps even the overview that all lenses are given a fair consideration – checking that some of the box isn’t hidden from view? Indeed a range of views is essential, as we can all become evangelical about ‘the thing’ that worked for us.
Not forgetting the historical and cultural lens that our society is drawn to view mental health through. Why, for example, despite a consistently strong evidence base, is there a consistent avoidance of the socio-economic factors that play a huge part in mental health? Far more politically convenient to locate the problem in the individual. Furthermore, we have the added complication of the evidence base. The opticians equivalent of saying ‘Most people your age benefit from this lens. No, really they do. Try it – it should work for you too’. Sometimes it does of course; and that saves everyone time and energy. But often times it doesn’t – and even if it does work is there any guarantee that another lens might not have worked better? That approach is so very different to the gentle trying and retrying and responding to feedback that my optician goes through every time I visit.
It is a hard one, of course (I will resist the temptation to talk about hard and soft lenses). In mental health services people are often at their most vulnerable and seek certainty. Especially when they have waited a very long time to be seen. The prospect that even the ‘expert’ doesn’t know which lens is ‘right’ might feel disappointing, overwhelming or even anxiety provoking in itself. There is the added complication that many therapeutic approaches are more effective if they are delivered with confidence and an assertion they will work. In my experience, however, sharing that ‘uncertainty’ confidently, with a determination to stay alongside and try alternatives (or alternative colleagues) is containing in itself. A constant checking and rechecking that the approach we are using is helping them to gain clarity. I don’t expect for one moment my optician will find the ‘right’ lens straight away – even though she probably has a pretty good idea when I walk in the door based on my previous prescription. I value her careful checking and rechecking and determined look of not knowing she has on her face throughout.
In these tough times it is a big ask to have a full box of lenses available to create a bespoke prescription for mental health; checking and rechecking the goodness of fit for each individual. It is far more convenient to have a small selection of lenses that usually work, or even one lens that works well enough for most. The cost, however, of not having all the lenses to hand is it risks us carrying on blindly working in the dark. That is something my optician would never settle for.