The 7 trends that will shape the future of mental wellbeing.
These trends will have far-reaching implications for the domain of mental ill-health and the related but distinct field of positive mental health and wellbeing. It’s important we understand where we’ve gone wrong, and the opportunities for us to create a much brighter future.
1) Transformation of psychological and behavioural science research
After investing billions of dollars in syndrome-focused strategies and solutions for mental ill-health, many governments, research bodies and professional organisations are actively questioning the value, merits and returns on their investments.
The Research Domain Criteria (RDoC) – the initiative developed by the US National Institute of Mental Health (NIMH) – aims to be a biologically valid framework for understanding mental disorders. The RDoC is an attempt to create a new taxonomy for mental disorders by bringing the power of modern research approaches in genetics, neuroscience and behavioural science to the problem of mental illness.
The Diagnostic and Statistical Manual of Mental Disorder (DSM-5), long the bible for many psychiatrists, clinical psychologists and psychologists is no longer the criteria by which the NIMH will evaluate funding of future clinical trials.
These changes will have dramatic implications for research funding, clinical trials and the subsequent models and processes for the diagnosis and treatment of mental ill-health and mental disorders.
The future of intervention science we can hope will rely less on seeing intense emotions and feelings as pathological, and more on the context and the person-centric processes for understanding them.
2) Transformation of the university and professional training of clinical psychologists and psychologists
Just as we saw the generational time lag of Freudian psychology dominate university and teaching institutions globally pre and 30 years after the 2nd World War, we are currently dealing with the time lag of mental ill-health, the DSM and its permeation in the training of psychiatrists, medical doctors, clinical psychologists and psychologists. This training instilled the belief that mental disorders can be treated through pharmacology and/or syndrome-treatment approaches. Edward Shorter, a distinguished professor of psychiatry and the history of medicines outlines in hi brilliant book “How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown” not only how Freudian theory dominated psychiatry but how genuine diagnosis and treatment breakthroughs were both ignored and inaccurately discredited.
In order to prepare the next generation of practitioners, a complete transformation in the education and qualification processes will be required. The current approach, if alone judged on the merits of the incidence of mental ill-health, has been a failure. But when examining other success measures such as efficacy of treatment approaches, innovation and quality of life of patients and clients, it has been a failure there too. For too long practitioners have focused on a medical model and a uni-dimensional approach which failed to place the person, their life context and goals as the priority.
In the future we hope that practitioner training is multidisciplinary – rather than simply medical – and incorporates the practical way in which people live their lives by having greater understanding of the body-mind connection, positive relationships, culture, spirituality, finances, careers and prosocial engagement.
3) Demise of the DSM and syndrome-based approaches to mental ill-health
The latent disease model of psychiatry has dominated the mental ill-health industry for the last 70 years, despite the World Health Organisation attempting to prosecute the case for a biopsychosocial approach for mental health and wellbeing.
This medical approach to mental health completely ignored the ground-breaking work of Corey Keyes and his colleagues which validated the dual-continuum model and saw mental illness and mental wellbeing as being related but distinct concepts and therefore requiring different approaches.
The rise in the power and pervasiveness of the DSM has also seen a rise in the power of “Big Pharma.” A consequence has been a dramatic rise in the pharmacological only treatment approach to mental ill-health. As Allen Frances, MD – the former Chair of the DSM-IV Taskforce has stated “We are now in a battle to stop the widespread medicalisation of normal feelings and emotions.”
In his book “Saving Normal”, Frances says “Stigmatising a healthy person as mentally ill leads to unnecessary and harmful medications. It also shifts responsibility for our mental wellbeing from our own naturally resilient brains into the hands of big Pharma.” According to Frances, this current diagnostic inflation converted millions of normal people into mental patients.
Many well-intentioned individuals have been on an un-ending quest to link treatments to syndrome and this has clearly failed. We have more data than ever, but the evidence suggests far from seeing a decline in the incidence of mental ill-health, it is rising. In addition, many of the current protocols lack treatment specificity and have failed to identify the key components and processes of change.
This approach has also “blinded treatment developers to the key role of normal psychological processes of behaviour change and the centrality of pragmatic outcomes desired by consumers such as social effectiveness or quality of life instead prioritising the referred list of signs of symptoms.” (Greenhalg, Howick, & Maskrey, 2014).
In 2018 the British Psychological Society (BPS) published “The Power Threat Meaning Framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis.” because they believed the DSM was “fundamentally flawed.” One of the core tenets of the new BPS Framework is that human beings are fundamentally social whose experiences of distress and troubled or troubling behaviour are inseparable from their material, social, environmental, socioeconomic and cultural contexts. There is separate “disorder” to be explained, with context as an additional influence.
Further the Framework said that all indigenous forms of understanding distress have useful aspects and there can be no global psychiatry or global psychology. Patterns in emotional or behavioural difficulties will always reflect prevailing social and cultural discourses, norms and expectations including accepted conceptualisations of personhood.
In other words, this syndrome focus has reduced the human condition and the biopsychosocial context of human life to a consensus-based dictionary of signs and symptoms. It does not sufficiently take into account the person, their history, their context, learning and the process and capacity for change.
In October 2020 Steven C Hayes and Stefan G Hoffmann published the book “Beyond the DSM” which challenges the assumptions and approach made by the DSM, and provides a vision and plan for an evidence-based, process-based approach to individualised care. This groundbreaking book recognises the complexity of human suffering and human prosperity and shows that the future of Mental Health lies in evidence-based treatment around both treatment models and change processes – rather than syndrome-based diagnosis.
4) Increased awareness, understanding and capability to support & educate people suffering the impacts of trauma on their whole person and community wellbeing
The ground-breaking work in the Adverse Childhood Experiences (ACE) study by Michael Felliti and Robert Anda, laid the groundwork for a new western lens to be applied for the understanding of the victims of trauma (highly stressful or abusive events or experiences).
Instead of being classified as a person with something wrong with them because of perceived maladaptive behaviour, Felliti and Anda’s work shone the light on the more important question to be asking victims of trauma, which is “what happened to you?” rather than “what’s wrong with you?” Their transformational research has had such an enormous impact not only on victims of trauma, but also on how professional bodies view trauma in the psychiatric and psychological world.
Since their ground-breaking work the field of trauma-informed psychology has grown dramatically. It reflects a greater understanding of the experience of trauma sufferers and offers a more compassionate, person-centric approach which does not see trauma and mental illness as destiny.
However, these findings were nothing new to many indigenous peoples around the world who knew firsthand the impact of trauma on themselves and their communities. Instead of being understood, many indigenous people were categorised and medicalised by the treating professionals who failed to see the cause and effect relationships to institutional barriers, racism, disadvantage and poverty on poor mental health.
With this increased awareness, understanding and capability we can expect to see more trauma-informed clinicians, social workers, educators, coaches and parents.
5) Rise of personalised, scalable & measurable technology that informs biopsychosocial wellbeing strategies
The rise of the “Quantified Selfer” is nothing new to the entrepreneurs in Silicon Valley but this technology is now widely available through applications and innovations from an ever-expanding list of health apps and trackers.
The use of such devices is widely expanding and has been particularly prevalent during COVID-19. Whilst many of the apps are physiological in their focus, tracking everything from blood oxygen, heart rate variability, sleep, arrhythmia and even noise exposure, the future trends will offer more than this uni-dimensional approach.
With the integration of artificial intelligence we will see a stronger focus on values, meaning, in person connections, quality relationships, finances, behaviour change, nudging and rituals and habits. The “fight to be first” to develop scalable products with high levels of penetration is a multi-billion dollar race that the big technology and health care firms are desperate to win.
The payoff for the consumer is that they will have access to their own data (in real time) with tools and strategies that reflect their wellbeing priorities and aspirate behaviours. The trade-off being who owns their data and what do they do with it.
6) Rise of wellbeing as a profession and the rise of the professional wellbeing specialist
Over 30 years ago if someone had told you that becoming a Personal Trainer would be a widespread career aspiration and the industry would have government regulations, professional qualifications, a code of ethics and be recognised internationally as a professional industry, you probably would have been extremely sceptical. And 30 years ago, that scepticism was pervasive because Personal Training was not a profession, was unregulated and its growth was in its infancy.
In 2020 the rise of wellbeing as a profession, is also in its infancy. You can expect that there will be professional associations, government regulations, industry code of ethics and a growing acceptance of wellbeing as a “new age fad” but a credible and meaningful profession.
Likewise, we will see the rise of the Wellbeing Specialist who is professional qualified, equipped with the multidisciplinary skills to enhance the whole-person wellbeing of their clients. In the future they will be as essential to the wellbeing of their clients, as today’s personal trainers are to their clients.
7) Transformation of wellbeing service delivery at a similar scale as the current health, fitness and personal training sectors
In the future we’ll see an entire industry dedicated to the delivery of holistic wellbeing services to clients on a scale that we now accept for physical fitness and personal training.
These new locations and centres will meet the unique demographic and cultural needs of their clients, organisations and communities. They will offer services that include self-awareness and self-regulation; emotional competence development; positive relationship and parenting training; positive ageing; spiritual development; cultural connection; financial literacy and planning; community engagement; career awareness and development and environmental connection and care.
The challenge for governments and societies is to ensure access and affordability of these services to ensure they don’t simply become the domain of the wealthy but are seen as critical social infrastructure.
The future has already begun.
These trends are already underway. But at the moment they’re on a scale that makes them difficult to see as a connected whole. However, when view them together we can see that a new era will soon be upon us and that is why so many stakeholders are fighting so hard to protect the status quo.
As with any movement which has people’s fundamental interest at heart, it becomes not a question of “if” but “when”.
On World Mental Health Day, it should fill us with aspiration and hope that the future looks brighter than the past.
About the author:
Steve Johnson is CEO of the Wellbeing Science Institute. He is a qualified psychologist and the author of the world’s first holistic elite athlete wellbeing management qualification.