Health is not only a medical matter

23 September 2020

My passion for the study of human behaviour and mental health has been present ever since I can remember, but it was not until I began my undergraduate degree (not in psychology) that I realised the great deal of work there is left to do behind a clinical psychologist’s door. 

I completed my undergraduate degree in Global Health and Biomedicine at King’s College London, a degree programme which started in 2014 with the aim to look at health from both a medical and social science perspective. We were the first class graduating from this degree and I am thankful to have had the privilege to be part of this programme. It educated me on the importance of the social determinants of health, and the significance of taking a holistic approach to improve both your physical and mental well-being. Our undergraduate motto was 'Health is not only a medical matter'. 

As I learned about both neuroscience and mental health in the context of war and social ruptures, it became apparent to me that what my professional future had to be. The Psychology MSc programme accredited by the British Psychological Society (BPS), which I attended at the University of St Andrews, is an amazing opportunity for those who have not taken psychology as an undergraduate degree but have later on realised their mission in this field.

To South America

Those with a clear goal of becoming a Clinical Psychologist will all share the same question: ‘when will I get in?’ It is definitely a long path, none of which looks the same, but coming from a different country with a different process to reach the title of Chartered Psychologist I now realise the huge benefit that having experience before applying has had on shaping the way I view mental health today.  

Having my undergraduate motto in mind, I decided to experience for myself what this meant in practice. I graduated in 2018, and while I wanted to get experience in psychology right away, I also wanted to fulfil my dream of traveling to South America before committing to a long and demanding professional career. I decided to combine both of these wishes and travelled to join an NGO in Brazil as a mental health support worker for cancer patients aged +45 attending chemotherapy sessions. 

The patients I worked with had travelled up to 6 hours to arrive to Casa Maria, an NGO funded house with two bedrooms, each of them hosting nine people. Chemotherapy treatment in Brazil is only available at very specific public hospitals, and you are lucky if they happen to be near you. For most, travelling is the normal. During the treatment, they remained in the house and shared a room with no heating with 18 other patients they had never seen before. The luckiest ones, who were very few, could afford having one family member by their side for a little while before having to go back.

I worked to reduce the impact of the unfamiliar environment that they faced as a result of having to move to a tempory housing facility to access cancer treatment. I actively listened to their illness experience, but there was something more to it than just the anxiety around the disease and its unknown future. Their experience was also embedded on the idea of facing unknown surroundings. 

There is a soothing aspect in being able to live at home while going through such difficult situation, because the change in your daily routine is less apparent. My patients lived in a developing country, with limited resources for chemotherapy treatment, in an NGO funded house with little to no privacy, without heating, and most of them did not have a familiar face to look at.  

Beyond treatment and towards prevention

It is inevitable to see the transformation that mental health has undergone in the UK. Activism for its destigmatisation and encouragement to access mental health services has been pronounced over the last decade, and I could not be happier to have seen that for myself. But if we look beyond this shift, we would be able to see that there is more we can do. Prevention, not only for physical illness but also for mental well-being, is key in how we interpret and treat mental health. 

An important concept that I learned during my undergraduate days was that a range of mental health conditions are not a timeless fact. Mental health lays within an individual, but it also fluctuates as the surroundings change. In our current pandemic climate, working from home has almost become the new norm and has been a way for employees to experience its ups and downs. For a single mother it should be reasonable to be able to work from home so that she can reduce the stress levels associated with single-parenting and a lack of support network for their children. Those who live with their grandparents, and who are unable or unwilling to move them elsewhere, should have the right to work from home if they can do so efficiently. Employment and working conditions, two of the WHO considered main determinants of physical and mental health, need to readjust to provide families in need with flexible working hours. 

In the article 'How medicalisation lost its way' (2006) David sheds light on how physicians can rapidly convert a social or political issue into an individual’s problem. Co-dependency, such as alcoholism, is an example of this. In such case, a medical framework is needed to avoid thinking “I blamed myself on aspects of my life because there was nothing there for me to identify with”. By giving a label to a condition we can also treat mental illness on an individual level, but its medicalisation should not prevent the exploration of its potential social causes. 

Psychological and pharmacological approaches remain the first line treatments in mental health services, and in many cases, there cannot be interventions without the two of them overlapping. But we need to ensure that as mental health professionals we use our power to advocate for socioeconomic policies that will directly improve and prevent mental health illness. By making prevention our ally, we can work to reduce the impact that social determinants have on mental health conditions. 

In the case of my patients in Brazil their experience with cancer, as difficult as it is, could have been shaped by a more sustainable mental health support network. People need the solid foundations to face a new environment, instead of relying on volunteers who come and go. 

On reflection 

My role as a mental health support worker for cancer patients in Brazil, aside from giving me an insight to its very different health system, also encouraged me to develop an anthropological understanding of their illness. It made me realise that the same illness can manifest differently across individuals of the same clinical cohort.  

To provide an outstanding level of care, we also need to advocate for policies that will care for individuals at home right from the start. The more experience we get, the deeper we will dig into the roots of mental health. We must strive to become well-rounded professionals working together to improve patients’ lives and use our experience to flourish as great and reflective Clinical Psychologists. 

Lisa Frending [email protected]

ABA Tutor

Park House School
Tram House School