Writing a New Script for Mental Health (Part One)

How the Power Threat Meaning Framework sets the scene for grassroots-led mental health services Dr Anne Darcy  |  Wed Jul 06 2022
Writing a New Script for Mental Health (Part One)
In Part 1, Anne Darcy blogs about the potential of the Power Threat Meaning Framework, which recognises activism as a route to recovery

The Power Threat Meaning Framework  (PTMF) has been written by psychologists and activists who have survived our psychiatric system. They came together because they share a belief that our care systems for those in severe distress need drastically overhauled. The core argument is that thinking of emotional distress in the same way we think of physical illness does little to help and disconnects distress from its true causes. These causes are well established in research. Some big hitters are poverty, abuse and racial trauma. Having a devalued identity in the society you live in, whether that is due to class, or gender, or being labelled as mad, all have devastating impacts on the human mind. Despite this being clear in research, these are often not the factors that are talked about when we think of helping those who require psychiatric hospital stays.

An illustration outlining the various factors involved in the Power Threat meaning Framework

The power of the dominant class and culture to shape how we see things obscures the reality that is right in front of our eyes. When survivors of abuse experience suicidal crisis, we tell them they have  something called a ‘personality disorder’ and tell them this means their emotions are out of control and need subdued with treatments. This usually involves practising regulating their emotion and taking medication. Failure to progress with regulating emotions can lead to discharge without anyone ever offering them a chance to talk about what they have survived. No one asks ‘where does it hurt?’ or says ‘of course you are suffering, it makes sense after everything you have been through’. These are not platitudes. These questions and sentiments are at the core of trauma informed work.  The Power Threat Meaning Framework sees a place for specialist trauma therapy and medication. But it argues that we need to look at the way we talk about emotional distress and our modern European assumptions about what ‘madness’ is.

One of the most exciting things about the PTMF for me is that it recognises activism as a route to recovery. Finding spaces where it is safe to make sense of what has happened to you, and how it hurts, can lead to looking outwards together to the things that need to change in society. PPR know this too, and they led me to the wonder that is the ‘Rest Of The Story’ trauma informed writing group. I was drawn to this project as it also centers narrative and storytelling, and believes in the power of people coming together and changing the world around them for the better. One of the writing prompts from the group got me thinking about what a wholesale adoption of the PTMF could achieve in the longer term. I had to imagine something very out of the ordinary, because we are miles away from valuing approaches like The Rest Of The Story programme as crucial to individual and community healing. There are some powerful forces that prefer the sufferers to be blamed for their own suffering and like us to forget about the responsibilities of those with power and wealth.

I begin by imagining PPR has hatched a dramatic scheme to take control of the Northern Irish Department of Health. What if an unforeseen set of interlocking circumstances, both national and international, meant that the planets align and it works against all the odds? I slip deeper into my wishful thinking. The Health Minister has been replaced by a Citizens Assembly organised by PPR’s Right to Work Activists. Health Board staff have been invited to stay on in post, with a flat salary for everyone and a recruitment drive for experts in lived experience of social inequalities…