Psychology and Mental Health

University of Liverpool

Introduction

Why do we behave as we do?

1.

1.1

Different ways to learn article

2.

1.2

How to use FutureLearn article

3.

1.3

Meet the team article

4.

1.4

Instructions for Week 1 article

5.

1.5

Key texts article

Different ways to learn

Welcome to the course.

There are two different approaches to education; teaching and learning. Teaching involves giving
students information, with the student being something of a passive recipient. That might work
well when facts are important, but its perhaps less effective when the facts arent in dispute, its
the interpretation of those facts - what they mean - thats more important. Learning involves the
student either gathering information or developing their understanding in a much more active
fashion.

We have deliberately structured this course to encourage learning. Each week, you will be given
papers to read that will stretch and challenge your understanding of the fundamental nature of
mental health problems. As the course leader, I will offer some guidance and explain the context
to the reading materials (in videos and the captions to course articles), but I am deliberately not
giving too many facts or even that much information. Instead, I would like you to read the
articles and papers that are supplied, consider what they say, and make up your own mind.

I have included some optional steps. Sometimes these are quite long documents (such as the
British Psychological Society report on serious mental health problems, which is a full 180 pages
long), sometimes they are complex academic journal articles, and sometimes they are external
websites. Ive offered some websites in Week 1, to help people who are unused to psychological
topics orientate themselves, but they are completely optional.

Interpretation
In mental health, perhaps more than any other area of science, there are huge differences of
opinion. The nature-nurture debate is important; people differ profoundly in respect to how
much they believe our mental health and well-being are products of our biology (on the one
hand) or life-events (on the other).

I have my own views, and these will be clear, but I dont think its the business of a University to
tell you how to think. I believe that we should help you find, and then think about, the most
important scientific and professional articles published in this area, and help you think for
yourself.

As you go thorough the course, youll find that it consists of a different topic each week, some
brief videos that set the context for the week, and then some important papers. These articles
often (deliberately) disagree with each other. Your job isnt to absorb my point of view, but to
debate the different perspectives. That might - we hope - involve discussion on the interactive
comment section thats part of the FutureLearn platform.

So read, think, debate and learn. Dont just take it from me.

As an example - Wikipedia describes mental health as an absence of a mental disorder. But

the World Health Organisations definition of mental health suggests that mental health is
more than the absence of mental illness. These two statements cant BOTH be right so youll
have to think for yourself.
It might only be a small, semantic, point, but its an important one. Is mental health more than
the absence of mental illness? There are two contrasting perspectives your job is to critically
evaluate them and make your own mind up.

An invitation to think about things differently

I find learning much more exciting and engaging than being taught. But some people find it a
little unstructured. As you go through this course, you will be offered the chance to read (or
download) a paper, and my expectation is that youll read it, think about it, and discuss it with
other people. But you might not find that theres a clear gap in your knowledge that the paper is
supposed to fill; rather that the paper invites you to think about things differently.

Try not to find this anxiety-provoking and try not to be frustrated at the lack of clear structure.
Instead, try to see this as exciting, and try to see it as giving you more control over what you
learn.

Ready to start?
When you are ready to begin, click the Mark as complete button and then click the button
underneath it to move on.

Peter Kinderman

How to use FutureLearn

This may be the first course that you have undertaken on FutureLearn, or perhaps it is the first
course you have taken online. Dont worry: the platform is designed to be easy to navigate.

You can learn whenever and wherever you like, on any desktop, mobile or tablet device. You will
be learning by watching videos with leading academics as well as reading teaching material,
attempting quizzes or tests, and taking part in discussions.

Finding your way around

There are three icons at the top of each step to help you make the most from your learning
experience.
To Do

The first icon takes you to your to do list for the course youre in. This shows all the steps for
that week. You can take a look ahead to see whats coming up in the following weeks and if you
dont manage to complete all the steps in a week, you are always able to go back to previous
weeks and catch up.

You are free to learn at your own pace, but we encourage the conversation to happen around the
current weeks activities. If you still havent completed the course at the end of the final week,
dont worry! The course materials will remain open to you on the site indefinitely.

Activity

The second icon takes you to the activity feed, which shows the most recent comments posted by
learners on this course.

Progress

The third icon takes you to your progress page, where youll see what percentage of the course
steps youve completed. Your scores for any tests you have taken in the course are also shown on
this page.

Mark as complete
When you reach the end of a step and have understood everything, click the pink Mark as
complete button at the bottom. This will update your progress page, and will help you to keep
track of which steps youve done. Any steps youve completed will turn blue on your To Do list.

Comments and discussions

Learning from conversations is an important part of the FutureLearn approach. You will learn
from discussions with other people taking part in the course, by reading their comments and
responding with your own thoughts, which you can do on nearly all steps. On some steps there
will be a more structured discussion. Although they will not be able to respond to every question,
you may see comments and replies from the lead educator and course facilitators throughout the
course.

Anyone enrolled on the course can comment and discuss the course material. To see all the
comments on a particular step, click the pink speech bubble icon and the comments will be
revealed. The number next to this icon tells you how many comments there are for this step.
Found a comment which was really useful or interesting? Click the Like button!
Dont forget, whilst robust debate is encouraged, its important that you follow the FutureLearn
code of conduct and are respectful of your fellow learners.

Follow others

If you want to keep track of another learners comments easily, click the Follow button next to
their name (or on their profile page. We recommend that you follow the educators on this course.

Filtering comments

You can click to filter the comments on a step to only see:

comments by people you are following

the most-liked comments

your own comments

You might like to read these tips and tools for social learning, to you help you get the most from
FutureLearns features.

Please note

People and their problems vary greatly. None of the opinions discussed as part of this course are
designed, nor intended to be an offer to treat, prescribe or give advice to individuals with any
kind of psychological problem. If a learner believes that they have a problem that is being
discussed during the course, they should always seek advice from a qualified practitioner.

Would you like a certificate?

You can buy a Certificate of Achievement to prove what youve learned on this course.

This personalised certificate and transcript details the syllabus and learning outcomes, plus your
average test score, making it ideal evidence of your interest in and understanding of this subject.
The Certificate comes in both printed and digital formats, so you can easily add it to your
portfolio, CV or LinkedIn profile.

To be eligible, you must mark at least 90% of the steps in this course as complete.

Alternatively, you can buy a Statement of Participation as a memento of taking part.

Need more help?

If you still have a question about how the site works, have a look at the FutureLearn help pages.
If your query hasnt been answered, please dont hesitate to click the support button in the
bottom right hand side of steps to ask for help.

Meet the team

Here is the chance to find out a little more about the team that will be guiding you through this
course. It might be a good idea to follow them so you can find their comments more easily in
the forthcoming discussions.

Lead Educator
Peter Kinderman is Lead Educator, and is responsible for the course content.

Hosts
Phil Walker is your host. He worked with Peter to produce the material on this course. The host
can help you if you have any technical problems.

Contributors
Contributors have created materials for the course, but arent directly involved with the day to
day running of it. If you are interested in finding out more about our contributors, you can click
on the names below which will take you through to their Liverpool University Profiles

John Quinn
John Read
Philip Goff

Your turn to introduce yourself

Now you have met us, we would love you to introduce yourself using the comments section
below. You can like what other learners have written about themselves and if you find someone
interesting you can follow them, to help you keep in touch as the course progresses. The
comments of anyone you follow will appear in your activity feed.

Instructions for Week 1

This week introduces the course. It gives a brief introduction to both the nature (the biological
basis of our emotions, behaviour and thoughts) and the nurture (the impact of life events,
environmental factors and social conditions) approaches to our mental health and well-being.
It will introduce basic ideas of psychology and neuroscience, and also some of the philosophical
questions raised when we suggest that our thoughts and emotions are determined by external or
internal causes.

This course is designed to look at approaches to mental health treatment. If you, or someone
close to you, is suffering as a result of mental illness, you must seek professional advice. The
NHS website may offer some pointers to getting the help you need.

Week 1 Learning Objectives

After completing this weeks activities, you will be able to:

Understand the ways in which biological factors have been proposed as causes of our
emotions, thoughts and behaviour our mental health and well-being
Understand the ways in which social factors have also been proposed as determinants of
our mental health and well-being

Understand the different elements of the key arguments in the nature-nurture debate

Understand how these debates have philosophical implications for our notion of free will
and determinism

Remember

We have designed this whole course to help YOU to think about mental health and well-being;
about what causes mental health problems (and more generally about why people think and feel
as they do). We want to challenge your thinking; to make you think, and even to think differently.
So we will present you with material that should challenge and stretch your ideas about mental
health and well-being. We will try to present you with different perspectives - sometimes within
each weeks material, and certainly across the six weeks.

So youll be presented with a range of different points of view. They are all based on science; on
the analysis of data and on the logical deductions from systematic observation. Weve chosen
papers published in peer-review journals by established experts. But we - the scientists involved
in understanding and treating mental health problems - dont always agree. What we want you to
do is read these contrasting and contradictory material and make your own mind up on these
issues.
I, clearly, have one point of view (and if you read my publications, that perspective will be
obvious). I hope youll agree with my interpretation, but its more important to me that you find
the material interesting, challenging, and thought-provoking.

Ive included some links to further reading (including my own books). This is optional reading
the links are included in case you might want to follow up with additional reading, but please
feel under no pressure.

Peter Kinderman

Key texts

This course is largely built on foundations laid down in my two recent books; New Laws of
Psychology and A Prescription for Psychiatry. You do not need to buy these books to take this
course all the necessary material will be provided entirely free, but they could be options for
pursuing further general reading.

Kinderman P (2014) A Prescription for Psychiatry: Why We Need a Whole New Approach to
Mental Health and Wellbeing. Palgrave Macmillan. London.

A Prescription for Psychiatry builds from a psychosocial approach to mental health and well-
being to recommend a wholesale revision of our mental health services. Arguing that the origins
of distress are largely social, and that therefore we need a change from a disease model to a
psychosocial model, the book argues that we should reject traditional psychiatric diagnosis,
significantly reduce our use of psychiatric medication, tailor help to each persons unique needs,
invest in greater psychological and social therapies, and place mental health and well-being
services within a social rather than a medical framework.

Kinderman P (2014) New Laws of Psychology: Why Nature and Nurture Alone Cant Explain
Human Behaviour. Robinson. London.

New Laws of Psychology is an accessible psychology science book for the intelligent lay
reader. It proposes a common-sense, cognitive, account of human behaviour - arguing that our
thoughts, emotions, actions and therefore mental health can be largely explained if we
understand how people make sense of their world and how that framework of understanding has
been learned. This approach challenges notions such as mental illness and abnormal
psychology as old-fashioned, demeaning and invalid, argues that diagnoses such as depression
and schizophrenia are unhelpful, and proposes that psychological accounts offer a more helpful
way to address emotional distress.

We will include excerpts from both of these books in the freely available materials provided
during the course.

Course Content

In this first week, we'll try to understand why some people experience mental health problems
and others don't. Is this because of differences in nature (their biology), nurture (what happens to
them)... or something else?

1.

1.6

What makes us tick? video (06:54)

2.

1.7

What does cause mean in mental health? article

3.

1.8

Some statistics article

4.

1.9

Introductory chapter of 'New Laws of Psychology' article

5.

1.10

Two posts on my blog article

6.
 1.11

A psychological perspective on very serious mental health problems article

7.

1.12

The voices in my head: lived experience of psychosis article

What makes us tick?

This course has been designed to make you think, and hopefully think differently. So we have
chosen some challenging and very contrasting scientific papers that we hope will provoke and
stimulate thought. Its through these papers and not through the short videos that we expect you
to learn.

Having said that its always good to set some context for complex writing. So, as well as
offering some more straightforward introductory materials, we have also prepared some brief
videos that will set the scene, introduce the ideas, and illustrate the ways in which you might
begin to think about the ideas were discussing.

In this first brief video, I introduce one of the fundamental questions about or mental health;
nature or nurture? That could simply mean something like; are mental health problems the result
of biological processes (nature) or social in origin (nurture)? Are they the result of biological
abnormalities or are they the result of life events or other environmental factors? Or, to be a little
more specific, is the variance that we see in terms of mental health a result of variance in
biological or social factors? That is, can we explain the differences between peoples mental
health in terms of differences in biology (different people having different genetics, or different
biochemistry) or differences in the experiences theyve been exposed to?

What will you learn, and what should you do?

Watch the video, think about how much you already know about psychology, and think about
what aspects of psychology you need to learn about (or revise).

Feel free to post comments below with what you think you already know, and what youd like to
know more about.
Peter Kinderman

What does cause mean in mental health?

Nearly everybody who writes about cause in mental health discusses some variant of a
biopsychosocial model. This refers, of course, to the shared and interacting role of biological,
psychological and social factors in the development of mental health problems.

Many people in the field of mental health become quite frustrated at what they see as dualism
splitting off the brain from the mind when, in their view, there shouldnt be this kind of
distinction. In the third week of this course, well see a call from Professor Nick Craddock for a
discipline of social neuroscience, specifically bringing these ideas together.

But although nearly everybody agrees that social, psychological and biological factors are
inseparable and that all three elements are important in mental health, people nevertheless have
profound disagreements about what this means. For some experts - such as Eric Kandel (about
whom well read more in Week 2) biological or neurological factors take primacy, because they
underpin all human thought, emotion and behaviour. For others such as John Read (from whom
well hear more in Week 3) social factors are more important.

One way to think about this issue is to think about differences between people variance, in
technical language. The issue of cause might be thought of in terms of whether the differences
between people in their life experiences explain more of the differences in mental health
outcome than do differences in biological factors.

This, immediately, becomes very complex. The different kinds of variables are quantified in
different ways. We can perhaps think about a simple distinction between people who have or
have not experienced particular traumatic life events, and between people with or without a
particular genetic abnormality. That might allow us to compare the relative impact of those
factors on mental health. But other important factors are measured differently poverty or social
deprivation tend to be seen as lying on continua, and many biological factors (neurotransmitter
functioning, for instance) are also continuous.

It becomes even more complex when we add in the role of psychology. Traumatic life events, of
course, have an impact on our mental health. But not everybody exposed to such traumatic
events will suffer to the same extent; some people are more resilient than others. Some of that
resilience may come from biological differences, but it may also reflect our learning and
upbringing our likelihood of responding to a stressful life event with rumination and self-blame
is clearly going to be, in part, a consequence of our upbringing and the events weve been
exposed to in our lives.

The point is, that all these factors are absolutely vital to our mental health, because all are
intimately associated with thoughts, behaviour and emotions. We respond to events in our lives,
by appraising and sense of those events, and our brains are the organs that do this work. Perhaps,
then, the best way to think about the issue of cause in mental health is to ask whether
differences between people in terms of our mental health are best explained by differences in the
events we experience, differences in the ways in which we appraise and respond to these events,
differences in our upbringing and learning through life, or differences in the neurological
functioning of the brain, the organ with which were doing the appraising and responding.

Some statistics

Mental health statistics

MIND
The major UK Charity MIND has a wonderful website, which includes some key statistics on
mental health

Young Minds
Young Mind is Minds youth division. Its website provides key statistics about childrens and
adolescents mental health.

Some key headlines include:

around three children in each school classroom are experiencing some form of mental
health problem.
between 1 in every 12 and 1 in 15 children and young people deliberately self-harm.

there has been a big increase in the number of young people being admitted to hospital
because of self-harm. Over the last ten years this figure has increased by 68%.

most adults with mental health problems first experienced problems in childhood. Less
than half were treated appropriately at the time.

72% of children in care have behavioural or emotional problems - these are some of the
most vulnerable people in our society.

95% of imprisoned young offenders have a mental health problem. Many of them are
struggling with more than one problem.
The NHS Confederation
The NHS Confederation (in effect, a professional body for the Trusts that deliver the NHS
services in the UK) produced a short fact sheet summarising key facts and trends related to
mental health problems (June 2016). For further information you can view the fact sheet which
includes some eye-watering figures on the costs of mental health problems.

Suicide
The Centre Centre for Suicide Research at the University of Oxford has compiled detailed
statistics on deliberate self-harm and attempted suicide from all cases of deliberate self-harm
referred to the general hospital in Oxford (John Radcliffe) since 1976. You can view their report
here.

Introductory chapter of 'New Laws of Psychology'

In my recent book, New Laws of Psychology, I spend a little time discussing these ideas - the
different reasons why we behave as we do, and the relative influences of biological (nature) and
social (nurture) factors on our mental health.

The first chapter summarises much of the material, and so we decided to make it available as
reading material for the course. The extract from the chapter is available as a .pdf file to
download by clicking on the link towards the bottom of this page. An audio version is also
available in the download section below.

What will you learn, and what should you do?

This chapter sets out the key challenge of this week (what makes us behave as we do, what is
responsible for our mental health?) in a slightly longer format.

Well go over these ideas in more detail later in the course; so for this first week, Im merely
challenging you to think about these issues.

In fact, perhaps the most useful thing you could do is to make a note of the questions you want to
get the answers to by the end of the course. Its entirely possible that other people taking the
course could help answer these questions in the discussions.
Two posts on my blog

I dont want to tell anybody else how they should think about mental health and well-being, but I
do think its reasonable to let you know how I think about these issues.

So here are two posts on my personal blog which explain in simple language how I approach
these issues, and why I think this forms the basis for a more humane approach to mental health
care.

The two blogs are available as .pdf files to download by clicking on the links towards the bottom
of this page.

Peter Kinderman

A psychological perspective on very serious mental health problems

These issues - what causes mental health problems, how we could think about such issues
differently, how to help people in distress - were the subject matter of a discussion document
prepared by the British Psychological Society.

Its a readable, accessible, document. It is very much focussed on serious mental health
problems, such as psychotic experiences, which sometimes lead to diagnoses such as
schizophrenia. Thats a good thing, in this context, because it illustrates the point that this
psychological way of thinking is not only appropriate for mild, everyday worries and sadnesses,
but also applies to very serious problems too.

The whole document is a daunting 180 pages long (although very readable). Reading the whole
document is not compulsory, but it does have a short, single-page, executive summary which
gives the key material in bullet-point form (page 6).

University of Liverpool

The voices in my head: lived experience of psychosis

Dr Eleanor Longden is a successful research academic who also hears voices. She explains her
experiences, and what they mean, in a rather wonderful TED talk, available here.
Although Eleanor makes it clear that such experiences can sometimes be distressing, she also
explains how understandable, even normal, it is to have these experiences, and how its perfectly
possible to have a successful life and career.

She says, and I can only agree:

I argued, and continue to do so, the relevance of the following concept: that an important
question in psychiatry shouldnt be whats wrong with you but rather whats happened to
you.

University of Liverpool / TED

Mental health statistics

In this section, you will find key statistics about children and young people's mental health and
wellbeing.

1 in 10 children and young people aged 5 - 16 suffer from a diagnosable mental health disorder -
that is around three children in every class ( 1).
Between 1 in every 12 and 1 in 15 children and young people deliberately self-harm (2).

There has been a big increase in the number of young people being admitted to hospital
because of self harm. Over the last ten years this figure has increased by 68% ( 3).

More than half of all adults with mental health problems were diagnosed in childhood. Less than
half were treated appropriately at the time ( 4).

Nearly 80,000 children and young people suffer from severe depression (5).

Over 8,000 children aged under 10 years old suffer from severe depression ( 6).

72% of children in care have behavioural or emotional problems - these are some of the most
vulnerable people in our society (7).

95% of imprisoned young offenders have a mental health disorder. Many of them are struggling
with more than one disorder (8).

The number of young people aged 15-16 with depression nearly doubled between the 1980s
and the 2000s (9).

The proportion of young people aged 15-16 with a conduct disorder more than doubled
between 1974 and 1999 (10)

There is Key Data on Adolescence 2013 from the Association for Young People's Health
available here which has a section, Chapter 6, dedicated to Mental Health.
More detailed statistics

A more detailed analysis of the figures on depression, conduct disorders and anxiety in children
are listed below.

MEntal Disorders

The figures below are based on the finding of the latest ONS Child and Adolescent Mental
Health Survey which was published in 2004 (11).

Any figures on the number of children with these disorders are estimates based on the prevalence
rates found in this study and demographic data from the 2001 census.

9.6% or nearly 850,000 children and young people aged between 5-16 years have a mental
disorder
7.7% or nearly 340,000 children aged 5-10 years have a mental disorder

11.5% or about 510,000 young people aged between 11-16 years have a mental disorder

Anxiety
3.3% or about 290,000 children and young people have an anxiety disorder
2.2% or about 96,000 children have an anxiety disorder

4.4% or about 195,000 young people have an anxiety disorder

Depression
0.9% or nearly 80,000 children and young people are seriously depressed
0.2% or about 8,700 aged 5-10 year-olds are seriously depressed.

1.4% or about 62,000 aged 11-16 year-olds are seriously depressed.

Conduct Disorders
5.8% or just over 510,000 children and young people have a conduct disorder
4.9% or nearly 215,000 children have a conduct disorder

6.6% or just over 290,000 young people have a conduct disorder

Hyperkinetic Disorder (Severe ADHD)

1.5% or just over 132,000 children and young people have severe ADHD
1.6% or about 70,000 children have severe ADHD

1.4% or about 62,000 young people have severe ADHD

Some websites that might be useful

Here are some links to psychology websites for the uninitiated. This is a purely optional section
that is designed to fill in any gaps in your understanding of the topic. Feel free to skip this
section (and all optional steps).

1.

1.13

Websites relevant to psychology: introduction article

2.

1.14

Information on mental health from the Royal College of Psychiatrists article

3.

1.15

Jacqui Dillon; Chair UK Hearing Voices Network article

4.

1.16

Psychology on Wikipedia article

Websites relevant to psychology: introduction

For people who are new to the subject, we have selected a variety of simple links on the topic of
psychology.

Weve included some rather basic sites - the NHS, Wikipedia etc. Not everybody will begin this
course with the same level of exposure to psychology, and these sites may be helpful for some
people to bring them up to speed.

Even for me - and Im a professor of clinical psychology - these websites taught me new things.
So, for this week, Id recommend visiting these sites, and familiarising yourself with the key
issues.
What will you learn, and what should you do?

You should begin to think critically; THINK about what youre reading.

I mentioned earlier how Wikipedia describes mental health as an absence of a mental

disorder, whereas the World Health Organisations definition of mental health is more than
the absence of mental illness. I hope youll be able to critically evaluate material like this and
make your own mind up.

Mental health is a level of psychological well-being, or an absence of mental illness. It is the

"psychological state of someone who is functioning at a satisfactory level of emotional and
behavioral adjustment".[1] From the perspective of positive psychology or holism, mental health
may include an individual's ability to enjoy life, and create a balance between life activities and
efforts to achieve psychological resilience.

According to the World Health Organization (WHO), mental health includes "subjective well-
being, perceived self-efficacy, autonomy, competence, inter-generational dependence, and self-
actualization of one's intellectual and emotional potential, among others."[2] The WHO further
states that the well-being of an individual is encompassed in the realization of their abilities,
coping with normal stresses of life, productive work and contribution to their community.[3]
Cultural differences, subjective assessments, and competing professional theories all affect how
"mental health" is defined.[2] A widely accepted definition of health by mental health specialists
is psychoanalyst Sigmund Freud's definition: the capacity "to work and to love".[4]

Mental health and mental illness

According to the U.S. surgeon general (1999), mental health is the successful performance of
mental function, resulting in productive activities, fulfilling relationships with other people, and
providing the ability to adapt to change and cope with adversity. The term mental illness refers
collectively to all diagnosable mental disordershealth conditions characterized by alterations in
thinking, mood, or behavior associated with distress or impaired functioning.[5]

A person struggling with his or her mental health may experience stress, depression, anxiety,
relationship problems, grief, addiction, ADHD or learning disabilities, mood disorders, or other
mental illnesses of varying degrees.[6][7] Therapists, psychiatrists, psychologists, social workers,
nurse practitioners or physicians can help manage mental illness with treatments such as therapy,
counseling, or medication.

Mental well-being

Mental health can be seen as an unstable continuum, where an individual's mental health may
have many different possible values.[19] Mental wellness is generally viewed as a positive
attribute, even if the person does not have any diagnosed mental health condition. This definition
of mental health highlights emotional well-being, the capacity to live a full and creative life, and
the flexibility to deal with life's inevitable challenges. Some discussions are formulated in terms
of contentment or happiness.[20] Many therapeutic systems and self-help books offer methods and
philosophies espousing strategies and techniques vaunted as effective for further improving the
mental wellness. Positive psychology is increasingly prominent in mental health.

A holistic model of mental health generally includes concepts based upon anthropological,
educational, psychological, religious and sociological perspectives, as well as theoretical
perspectives from personality, social, clinical, health and developmental psychology.[21][22]

An example of a wellness model includes one developed by Myers, Sweeney and Witmer. It
includes five life tasksessence or spirituality, work and leisure, friendship, love and self-
directionand twelve sub taskssense of worth, sense of control, realistic beliefs, emotional
awareness and coping, problem solving and creativity, sense of humor, nutrition, exercise, self
care, stress management, gender identity, and cultural identitywhich are identified as
characteristics of healthy functioning and a major component of wellness. The components
provide a means of responding to the circumstances of life in a manner that promotes healthy
functioning.

The tripartite model of mental well-being[19][23] views mental well-being as encompassing three
components of emotional well-being, social well-being, and psychological well-being. Emotional
well-being is defined as having high levels of positive emotions, whereas social and
psychological well-being are defined as the presence of psychological and social skills and
abilities that contribute to optimal functioning in daily life. The model has received empirical
support across cultures.[23][24][25] The Mental Health Continuum-Short Form (MHC-SF) is the most
widely used scale to measure the tripartite model of mental well-being.[26][27][28]

Emotional issues
Emotional mental disorders are a leading cause of disabilities worldwide. Investigating the
degree and severity of untreated emotional mental disorders throughout the world is a top
priority of the World Mental Health (WMH) survey initiative,[46] which was created in 1998 by
the World Health Organization (WHO).[47] "Neuropsychiatric disorders are the leading causes of
disability worldwide, accounting for 37% of all healthy life years lost through disease.These
disorders are most destructive to low and middle-income countries due to their inability to
provide their citizens with proper aid. Despite modern treatment and rehabilitation for emotional
mental health disorders, "even economically advantaged societies have competing priorities and
budgetary constraints".

The World Mental Health survey initiative has suggested a plan for countries to redesign their
mental health care systems to best allocate resources. "A first step is documentation of services
being used and the extent and nature of unmet needs for treatment. A second step could be to do
a cross-national comparison of service use and unmet needs in countries with different mental
health care systems. Such comparisons can help to uncover optimum financing, national policies,
and delivery systems for mental health care."

Knowledge of how to provide effective emotional mental health care has become imperative
worldwide. Unfortunately, most countries have insufficient data to guide decisions, absent or
competing visions for resources, and near constant pressures to cut insurance and entitlements.
WMH surveys were done in Africa (Nigeria, South Africa), the Americas (Colombia, Mexico,
United States), Asia and the Pacific (Japan, New Zealand, Beijing and Shanghai in the People's
Republic of China), Europe (Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine), and
the middle east (Israel, Lebanon). Countries were classified with World Bank criteria as low-
income (Nigeria), lower middle-income (China, Colombia, South Africa, Ukraine), higher
middle-income (Lebanon, Mexico), and high-income.

The coordinated surveys on emotional mental health disorders, their severity, and treatments
were implemented in the aforementioned countries. These surveys assessed the frequency, types,
and adequacy of mental health service use in 17 countries in which WMH surveys are complete.
The WMH also examined unmet needs for treatment in strata defined by the seriousness of
mental disorders. Their research showed that "the number of respondents using any 12-month
mental health service was generally lower in developing than in developed countries, and the
proportion receiving services tended to correspond to countries' percentages of gross domestic
product spent on health care". "High levels of unmet need worldwide are not surprising, since
WHO Project ATLAS' findings of much lower mental health expenditures than was suggested by
the magnitude of burdens from mental illnesses. Generally, unmet needs in low-income and
middle-income countries might be attributable to these nations spending reduced amounts
(usually <1%) of already diminished health budgets on mental health care, and they rely heavily
on out-of-pocket spending by citizens who are ill equipped for it".

Activity therapies

Activity therapies, also called recreation therapy and occupational therapy, promote healing
through active engagement. Making crafts can be a part of occupational therapy. Walks can be a
part of recreation therapy.

Biofeedback

Biofeedback is a process of gaining control of physical processes and brainwaves. It can be used
to decrease anxiety, increase well-being, increase relaxation, and other methods of mind-over-
body control.[citation needed]

Expressive therapies

Expressive therapies are a form of psychotherapy that involves the arts or art-making. These
therapies include music therapy, art therapy, dance therapy, drama therapy, and poetry therapy.

Group therapy
Main article: Group psychotherapy

Group therapy involves any type of therapy that takes place in a setting involving multiple
people. It can include psychodynamic groups, activity groups for expressive therapy, support
groups (including the Twelve-step program), problem-solving and psychoeducation groups.
Psychotherapy
Main article: Psychotherapy

Psychotherapy is the general term for scientific based treatment of mental health issues based on
modern medicine. It includes a number of schools, such as gestalt therapy, psychoanalysis,
cognitive behavioral therapy and dialectical behavioral therapy.

Meditation
Main articles: Meditation and Mindfulness-based cognitive therapy

The practice of mindfulness meditation has several mental health benefits, such as bringing about
reductions in depression, anxiety and stress.[48][49][50][51] Mindfulness meditation may also be
effective in treating substance use disorders.[52][53] Further, mindfulness meditation appears to
bring about favorable structural changes in the brain.[54][55][56]

Spiritual counseling

Spiritual counselors meet with people in need to offer comfort and support and to help them gain
a better understanding of their issues and develop a problem-solving relation with spirituality.
These types of counselors deliver care based on spiritual, psychological and theological
principles.[57][unreliable source?]

Information on mental health from the Royal College of Psychiatrists

The UKs Royal College of Psychiatrists is the professional body responsible for education,
training, setting and raising standards in psychiatry in the UK. Amongst other services, the
College also provides information to the public, and therefore has useful information about
mental health issues.

The Royal College of Psychiatrists information on mental health is a very good first step.

What will you learn, and what should you do?

You will already have a good understanding of some of the key ideas about mental health and
well-being. The Royal College of Psychiatrists website should be able to give you clear
information and important statistics about the types of issues that we will be discussing in this
course although it is, perhaps, slightly slanted towards a conventional medical approach.

Jacqui Dillon; Chair UK Hearing Voices Network

Jacqui Dillon is the national Chair of the Hearing Voices Network in England and a key figure in
the Hearing Voices Movement internationally. She is Honorary Lecturer in Clinical Psychology
at the University of East London, Honorary Research Fellow in the School of Medicine,
Pharmacy and Health at Durham University and Visiting Research Fellow at the Centre for
Community Mental Health, Birmingham City University.

She is a respected campaigner, writer, international speaker and trainer specialising in hearing
voices, psychosis, dissociation, trauma, abuse, healing and recovery. Jacqui has worked within
mental health services for more than 15 years, in a variety of settings, including community,
acute, low, medium and high secure settings, prisons, colleges and universities.

Jacqui stresses the importance of understanding the meaning and sense-making in people who
have mental health problems, from the perspective of people who have psychotic experiences.
Her personal story can be found at jacquidillon.org.

I recommend that you read Jacquis personal story - which, I should caution you, does discuss
the trauma she experienced as a child, her experiences of hearing voices and her journey of
recovery. Although everybodys story is different, unique, this might help understand how we
can make sense of very serious mental health problems from a human perspective, and it might
also help offer an optimistic and positive perspective. You might want to discuss your reactions
to her story with other learners.

Psychology on Wikipedia

Wikipedia can be a useful source to use initially, but always be careful that information there is
referenced correctly.

Take a look at the Wikipedia introduction to psychology.

Also theres nothing wrong with looking at the Wikipedia pages for both mental health and well-
being.

University of Liverpool

Mental health is a level of psychological well-being, or an absence of mental illness. It is the

"psychological state of someone who is functioning at a satisfactory level of emotional and
behavioral adjustment".[1] From the perspective of positive psychology or holism, mental health
may include an individual's ability to enjoy life, and create a balance between life activities and
efforts to achieve psychological resilience.

According to the World Health Organization (WHO), mental health includes "subjective well-
being, perceived self-efficacy, autonomy, competence, inter-generational dependence, and self-
actualization of one's intellectual and emotional potential, among others."[2] The WHO further
states that the well-being of an individual is encompassed in the realization of their abilities,
coping with normal stresses of life, productive work and contribution to their community.[3]
Cultural differences, subjective assessments, and competing professional theories all affect how
"mental health" is defined.[2] A widely accepted definition of health by mental health specialists
is psychoanalyst Sigmund Freud's definition: the capacity "to work and to love".[4]

Well-being, wellbeing,[1] welfare or wellness is a general term for the condition of an individual
or group, for example their social, economic, psychological, spiritual or medical state; a high
level of well-being means in some sense the individual or group's condition is positive, while
low well-being is associated with negative happenings.

In philosophy, the term 'well-being' (and 'welfare', 'utility', etc.) refers to the manner in which an
individual's life manifests desires, objectives, and needsamong myriad more diverse variables
and how these affect the individual's perspective.

Philosophers, such as Fred Feldman and Brad Hooker, have suggested we should think of well-
being in terms of a parent's expectations for a child (aka 'crib test')[citation needed]. Philosophical study
of well-being identifies a number of different kinds of theory, such as: hedonism, desire-
fulfilment theory, objective-list theory, perfectionism, and some 'mixed' or 'hybrid' views of well-
being. Well-being features in normative ethical theories, most notably utilitarianism; one need
not be a utilitarian, or a consequentialist, more generally, to think that well-being is a moral
matter. Any plausible ethical theory will give at least some role to well-being.

In economics, the term is used for one or more quantitative measures intended to assess the
quality of life of a group, for example, in the capabilities approach and the economics of
happiness. As with the related cognate terms 'wealth' and 'welfare', economics sources often
contrast the state with its opposite.[2] The study of well-being is divided into subjective well-
being and objective well-being.

Discussion

Take this short test which tells you about yourself and then discover others on the course in our
discussion section.

1.

1.17

What do YOU think? discussion

2.

1.18

Scoring and interpretation article

What do YOU think?

Take this short interactive quiz designed to help you think about your own views on the nature,
cause and treatment of mental health problems. There are no right or wrong answers, just your
opinions. Please read each statement carefully and choose a number from 1 to 5 that best
describes your beliefs surrounding the causes of mental health problems.

Once you complete the quiz you will be given two scores (your score on the biological scale
and your score on the social scale). Keep a record of your two scores because you will need
them for the next activity

Click on the join the discussion link at the bottom of this article and post your scores in a
comment. You can also add why you think your views on mental health lead you to these
scores.

After you have written your results, read through what others have put. Find someone with
a similar score to yours, and follow them (pressing the follow button next to their
comment). Do the same for someone who has a very different score from you.

At the end of the course you will be given another short interactive survey. You will be able to
see whether your opinions on mental health have changed, and also see if there have been any
changes in those you are following.

You dont have to write your results, but it will make the course more interesting and also
introduce you to other learners here.

We have included some more details about the quiz, how the scores are derived and what they
(might) mean, in the next step.

University of Liverpool

Biological versus Sociological impact on mental health

This step is designed to help you think about your own views on the nature, cause and treatment
of mental health problems. There are no right or wrong answers, just your opinions.

Instructions

Please read each statement carefully and choose a number from 1 to 5 that best describes your
beliefs surrounding the causes of mental health problems.

If you are using a tablet, smartphone or touch device just tap on the area of the slider that you
wish to select. If you are using a PC or Mac computer you can move the slider with your mouse
or touchpad.
Mental health problems are the result of:

1. Physical or chemical changes in the brain:

Slider control for 1. Physical or chemical changes in the brain:

1. Strongly agree
2.

3. Neutral

4.

5. Strongly disagree

2. Experiences of trauma or abuse:

Slider control for 2. Experiences of trauma or abuse:

1. Strongly agree
2.

3. Neutral

4.

5. Strongly disagree

3. Poverty:
Slider control for 3. Poverty:

1. Strongly agree
2.

3. Neutral

4.

5. Strongly disagree

4. Loneliness of social isolation:

Slider control for 4. Loneliness of social isolation:

1. Strongly agree
2.

3. Neutral

4.

5. Strongly disagree
5. The way a person thinks about themselves and the world:
Slider control for 5. The way a person thinks about themselves and the world:

1. Strongly agree
2.

3. Neutral

4.

5. Strongly disagree

6. Experiences of trauma or abuse causing physical or chemical changes in the brain:

Slider control for 6. Experiences of trauma or abuse causing physical or chemical changes in the brain:

1. Strongly agree
2.

3. Neutral

4.

5. Strongly disagree

7. Poverty causing physical or chemical changes in the brain:

Slider control for 7. Poverty causing physical or chemical changes in the brain:

1. Strongly agree
2.

3. Neutral

4.

5. Strongly disagree

8. Loneliness or social isolation causing physical or chemical changes in the brain:

Slider control for 8. Loneliness or social isolation causing physical or chemical changes in the brain:

1. Strongly agree
2.

3. Neutral

4.

5. Strongly disagree

9. The way a person thinks about themselves and the world causing physical or chemical changes in the
brain:
Slider control for 9. The way a person thinks about themselves and the world causing physical or
chemical changes in the brain:

1. Strongly agree
2.

3. Neutral

4.

5. Strongly disagree

10. Physical or chemical changes in the brain changing the way a person thinks about themselves and the
world:
Slider control for 10. Physical or chemical changes in the brain changing the way a person thinks about
themselves and the world:

1. Strongly agree
2.

3. Neutral

4.

5. Strongly disagree

11. Experiences of trauma or abuse, changing the way a person thinks about themselves and the world:
Slider control for 11. Experiences of trauma or abuse, changing the way a person thinks about
themselves and the world:

1. Strongly agree
2.

3. Neutral

4.

5. Strongly disagree

12. Poverty changing the way a person thinks about themselves and the world:
Slider control for 12. Poverty changing the way a person thinks about themselves and the world:

1. Strongly agree
2.

3. Neutral

4.

5. Strongly disagree
13. Loneliness or social isolation changing the way a person thinks about themselves and the world:
Slider control for 13. Loneliness or social isolation changing the way a person thinks about themselves
and the world:

1. Strongly agree
2.

3. Neutral

4.

5. Strongly disagree

There are no right answers, but once you have made your choices, youll be able to see your
scores, and how they compare with those of other people taking this course.

This part of the quiz is designed to investigate your views surrounding the components that cause
mental health problems.

Scoring and interpretation

The quiz on the previous step was developed at the University of Liverpool, based on several
undergraduate students research over a number of years.

Its well known that there are many different viewpoints on the nature and causes of mental
health problems - thats what this course is all about!. There has also been some research on what
people think the nature and causes are (which is a slightly different issue). The bio-psycho-social
model (which Ill discuss in detail later in this course) implies that there are three main factors,
but other research suggests that there are many more different perspectives. In particular, work
by Bill Fulford and Anthony Colombo suggests that there are at least six different conceptual
models used by professionals in mental health services, and it seems reasonable to assume that
the general public have views that are at least as complex as this.

So when I started trying to develop a simple assessment measure, I used a very wide range of
possible questions (covering all the elements of Colombo and Fulfords approach). But, when we
analysed the results of people completing earlier versions of this quiz (using a technique called
factor analysis) it seemed clear that there were two main explanatory approaches revealed by
peoples responses.

In technical terms, there were two dominant factors - although its important to bear in mind that
these arent choices; people who score highly on one factor can also score highly on the other,
too. The first was biological - characterised by high scores on questions such as Mental health
problems are the result of physical or chemical changes in the brain - and the second was social
- characterised by high scores on questions such as Mental health problems are the result of
experiences of trauma or abuse.

The quiz is scored in a very simple way. Six questions (1, 6, 7, 8, 9 & 10) contributed to the
biological sub-scale, and seven questions (2, 3, 4, 5, 11, 12 & 13) contributed to the social
sub-scale.

Because there were different numbers of questions in the two sub-scales, and because people can
score high (or low) on both sub-scales, you shouldnt read too much into the raw numbers. But
we can say something about what the numbers mean on the basis of previous results.

When we ran this course previously, we had (anonymous) data from over 10,000 people. That
revealed that the average score on the biological sub-scale was 21.3 and the average score on
the social sub-scale was 28.4.

That might give you some idea as to what your scores mean - if you score higher than 21 on the
biological scale, it means that you are slightly more likely than the average person (on this
course) to agree with biological explanations for mental health problems.

Of course, there was a huge range of scores (in fact, on this quiz, the range was particularly
broad) with 95% of scores on the biological sub-scale falling between 12.9 and 29.6, and 95%
of scores on the social sub-scale falling between 20.6 and 36.2.

Well continue to do work on this, to see whether it has value as a research instrument. For
now use it as an educational tool, and as a way of initiating discussion.

I may need some help !

Help if you need it

1.

1.19

I may need some help! article

I may need some help!

This course is designed to look at approaches to mental health treatment. If you, or someone
close to you, is suffering as a result of mental illness, you must seek professional advice. The
NHS website may offer some pointers to getting the help you need.
Youve reached the end of Week 1. Next week, we will focus on biological and neurological
approaches to mental health and well-being. If you want to get started, visit the Week 2 To Do
list now.

University of Liverpool