De-medicalising public mental health with the Power Threat Meaning Framework

Aims: To propose that the language and concepts in public mental health are often medicalised and to suggest that the power threat meaning framework (PTMF), can be a useful resource for those wishing to take a de-medicalising approach. Method: Examples of medicalisation from the literature and from practice are discussed and key constructs in the PTMF are explained, drawing from the report which presented its research base. Results: Examples of medicalisation in public mental health include: the uncritical use of psychiatric diagnostic categories; the 'illness like any other' approach in anti-stigma campaigns; and the implicit privileging of biology in the biopsychosocial model. The negative operations of power in society are seen as posing threats to human needs and people make sense of such situations in varied ways, though there are some commonalities. This gives rise to culturally available and bodily enabled threat responses which serve a variety of functions. From a medicalised perspective, these responses to threat are characteristically seen as 'symptoms' of underlying disorders. The PTMF is both a conceptual framework and a practical tool that can be used by individuals, groups and communities. Conclusion: Consistent with social epidemiological research, prevention efforts should focus on preventing adversity rather than 'disorders' but the added value of the PTMF is that varied problems can be understood in an integrated manner as responses to a variety of threats whose functions could be met in different ways. Its message that mental distress is often a response to adversity is comprehensible to the public and can be communicated in an accessible way.