The promise (and potential pitfalls) of a public health approach in clinical psychology

David Smail’s work provided an excellent example of how one might view individual distress within its social context, a context which ranged from the level of interpersonal relationships to the forces of global capital. In this paper, I review how individualised solutions to emotional distress are increasingly preferred over collective or structural approaches. Within medicine the discipline of public health has proved to be a useful counter-balance to this tendency. I discuss some of the benefits offered by adopting such an approach in mental health, while also acknowledging the need to address some of its problems (e.g. the rather uncritical use of heterogeneous diagnostic categories of varied validity and reliability).

DAVID SMAIL’S work provided an excellent example of how one might view individual distress within its social context, a context which ranges from the level of interpersonal relationships to the forces of global capital. In this article, I will discuss the way in which individual ‘technical’ solutions (medication and individual psychological therapy) are increasingly used in response to psychological distress. I will briefly review long-standing criticisms of this approach, in particular that such interventions are reactive (rather than preventative) and assume that causes (and thus remedies) lie within the individual (rather than in the structural conditions of society). Within medicine, the discipline of public health has proved to be a useful counter-balance to this tendency. Such population-based and preventative approaches are relatively rare within British clinical psychology. In this article, I will discuss some of the potential benefits offered by adopting such an approach in mental health. I will examine some of the obstacles which might be faced in adopting a public health orientation in clinical psychology, and consider the potential pitfalls of such an approach. Lastly, I will discuss how we might move forward, considering, in particular, implications for the training both of clinical psychologists and of public health practitioners.

This is a pre-publication version of the following article: Harper, D. (2017). The promise (and potential pitfalls) of a public health approach in clinical psychology. Clinical Psychology Forum, 297 (September), 23-32. https://doi.org/10.53841/bpscpf.2017.1.297.23