An Ounce of Prevention: A History of Social Psychiatry, 1939-Present

In 2010 I attended an international conference, entitled 'The Social Determinants of Mental Health' and held in Chicago. Its focus was to address the socioeconomic factors, ranging from poverty to violence, believed to cause mental illness. The participants, including David Satcher, the former US Surgeon General, not only advocated a more socially-informed approach to understanding mental health, but also wanted to launch a political movement that would place prevention at the heart of mental health policy and clinical practice.

Such an approach to mental health was not new, but its history has not been written and so was unknown to most of the conference participants. Building on the mental hygiene and child guidance movements of the early twentieth century, and reaching its peak during the 1950s and 1960s, the psychiatric and political movement known as social psychiatry similarly advocated a preventive approach to mental illness, which stressed alleviating social deprivation and inequality. But, although social psychiatry would become a major force within American psychiatry and politics, influencing both presidents of the American Psychiatric Association and the legislation of Presidents Kennedy and Johnson, it faded away in the subsequent decades, as biological approaches to mental illness became the dominant force in American psychiatry.

Given the World Health Organisation's recent warnings that mental illness will become the world's most common malady within twenty years (Mental Health Atlas, 2011) - not to mention the escalating social and economic cost of such conditions - it is not surprising that preventive approaches to mental illness are again attracting attention. This project seeks not only to analyse a neglected chapter in the historiography of psychiatry, but also to inform current attempts to address the social determinants of mental health by examining the successes and failures of social psychiatry.

The project is divided into three sections. The first examines the intellectual origins of social psychiatry, including its roots in the mental hygiene and child guidance movements of the early twentieth century. Widespread interest in social psychiatry escalated not only because it addressed concerns about the rising rates of mental illness, but also because it represented an interdisciplinary collaboration between psychiatrists and social scientists that inspired a wide audience in academic and public policy circles. The project will address the historical factors involved in this cooperation, and assess both the benefits and disadvantages of such an interdisciplinary approach to mental health. The second section of the project examines the zenith of social psychiatry, as it threatened to eclipse psychoanalysis and biological psychiatry (which stressed neurological explanations of and pharmaceutical treatments for mental illness) during the 1960s. Unfortunately for social psychiatrists, however, the interest in preventive approaches waned during the 1970s and 1980s, as psycho-pharmacology became more popular amongst both psychiatrists and their patients, and economic and political pressures deflated the socially progressive zeal of American politicians and mental health professionals. The third section of the project will examine not only the decline of social psychiatry, but also explore why preventive approaches to mental illness have once again found favour in both the US and elsewhere.

The non-academic beneficiaries for this project fall into three categories: mental health professionals and those involved in mental health education; mental health policy makers; and sufferers of mental illness and the general public.

Mental Health Professionals/Educators: Mental illness remains one of the most intractable and frustrating problems facing health professionals; not only are disorders ranging from depression and schizophrenia to autism and ADHD controversial and difficult to explain and treat, they also appear to be on the increase, according to the World Health Organization (WHO) and other organisations. Given these difficulties, mental health professionals have often turned to other fields of inquiry for insight and inspiration. While psychoanalysts engaged with philosophy and literature, and biological psychiatrists turned to neurology and pharmacology, social psychiatrists learned from the social sciences and, to an extent, history. It is hoped that this project on the history of social psychiatry will similarly find an audience in mental health professionals. In particular, the project aims to encourage people working in the field of mental health to incorporate historical insights into their understanding of mental illness and, particularly, how investigators of the past explored its causes. This will be done through broadcasting, blogging and the planned interdisciplinary symposium on the history and future of social psychiatry.

Mental Health Policy Makers: Mental illness causes a tremendous burden upon the state. According to the NHS, 23% of adults in the UK suffer from at least one mental disorder, costing the economy £100 billion per year (Centre for Mental Health, 2010). In the US, the Center for Disease Control and Prevention estimate that half of all Americans will be afflicted by mental illness at some point in their lifetime. WHO has similarly predicted that mental illness will become the globe's most common health problem within twenty years. Given these costs, preventing mental illness has emerged once again as a primary objective of governments intending to reduce future health care costs. By explaining the successes and failures of social psychiatry, the findings of this project will have a considerable bearing on future attempts to prevent mental illness. Through connections already made in both the US and the UK (such as the Adler Institute, the Scottish Chief Medical Officer, MSPs, MPs, and the Industry and Parliament Trust) and via the planned symposium, policy briefings will be set up to share the research findings and establish networks for future research and exchange of ideas.

Sufferers of Mental Illness and the General Public: Often forgotten amidst the debate and controversy that surrounds mental illness are those who suffer from it, either directly or as friends and family members of sufferers. Through broadcasting and public engagement activities, this project seeks to empower those dealing with mental illness by informing them about its history. Indeed this has been the case with my previous work on ADHD and food allergy. Comments made in response to my blogs on Psychology Today, my broadcasting on Radio 3's Night Waves and my public lectures indicate that those suffering from chronic health problems, such as allergy and mental illness, value the insights provided by historical investigation of their conditions, and I am confident such will be the case with this project.