CHAPTER FOUR: ANALYSIS, RESULTS AND DISCUSSION
4.3 Theme Two: Crisis Management and the Medical Model
4.3.2 The Neoliberal System’s Reliance on the Medical Model and its Limitations
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rather than mutual care or community concern. Dawson et al., (2020) states that while policies and procedures driven by neoliberalism and biomedical approaches remain dominant within the healthcare system, it will be challenging to adopt
alternative approaches that are flexible to the needs of service users, such as tailored individualised care plans.
Participants #53, #11, #17 and #23 all highlighted examples of the pervasive nature of the biomedical model throughout the system, expressing that it is the primary, and sometimes only, approach used when caring for young people. We can also observe the medical model as a prevalent phenomenon, due to the lack of, or displacement of alternative models. Participant #17 stated that within the current system it is “the DSM or nothing”. The DSM refers to the Diagnostic and Statistical Manual of Mental Disorders, currently in its 5th edition (American Psychiatric Association, 2022;
Nelson, 2019). According to the participants I spoke to, my own experience working in the mental health system, and the existing literature, the Aotearoa New Zealand mental health system utilises medical diagnostic tools such as the DSM or the International Classification of Diseases, Eleventh Edition (ICD-11), to determine mental health conditions and the subsequent course of treatment (Brown et al., 2023;
Otago University, 2010; World Health Organisation, 2023).
The reasons for the prevalence of the biomedical model within the current mental health system are clear, the biomedical model and its standardised approach
reinforces ideas of efficiency. However, as many participants expressed frustrations and concerns due to the prevalence of the biomedical model, we must analyse what Nelson (2019) calls diagnostic dissonance and the impact that the biomedical model has on the care young people receive. Nelson (2019) defines diagnostic dissonance as a deep conflict between mental health professionals’ theoretical orientations and the dominant presence of the biomedical model and the DSM. Participants in Nelson’s (2019) study expressed similar concerns to the ones outlined in this research, “I hate the DSM……it limits and doesn’t define the complexity of what I see in the room
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with me. Its labels and I hate doing that...It was meant to be a tool for clinicians, to have a language to describe symptoms and coordinate care. Now it’s a labelling machine” (pp. 939).
That participant quote from Nelson (2019) describes a mental health professionals experience of diagnostic dissonance and arguably reflects what participants #17 and
#11 are also expressing. “You know, it’s all too much about the DSM five now, not enough about real care, and what stuff does to you. What trauma does to you” (Participant #17),
“the healthcare system is very diagnostic, its labels, its putting people in boxes. And if you don't fit into a box, you aren't getting guaranteed treatment” (Participant #11). These quotes are clearly depicting a system where a diagnosis is the primary goal of mental health support and is sometimes a requirement to access further support. Under the operation of neoliberalism this biomedical approach is rationalised, due to its focus on standardisation and the encouragement of streamlined care plans rather
approaches tailored to individual differences.
However, labelling or diagnosing individuals doesn’t always directly contribute to improvements in mental wellbeing, often it can have the opposite consequence.
Participant #17 outlines how “the psych’s and all those guys are very much diagnose and medicate. And I just don't believe that's necessary every time, certainly it's good sometimes, but not every time”. Participant #17 echoes the claims of many other participants who highlight how the medical model may be necessary for some individuals, however, others may need a more holistic approach (Participant #17, #35, #53, #11), a Kaupapa Māori approach (Participant #53, #17), a transdiagnostic model approach (Participant
#11), or other approaches that are explored in theme five and six. The message that all participants portrayed was that flexibility to provide the young person what they needed wasn’t possible in a system that was focussed on standardisation, through using the DSM.
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A focus on diagnosing and labelling individuals also has wider social ramifications.
The medicalised process of diagnosing individuals with mental health challenges, indicates that an individual is flawed or diseased, further contributing to
stigmatisation and misunderstanding (Boggs, 2014; Martin et al., 2000; Nelson, 2019;
Thachuk, 2011). This medicalised process places emphasis on the label itself, often creating blind spots for mental health professionals, individuals, families, and
society, who focus on the diagnosis instead of considering social, cultural or political influencing factors (Martin et al., 2000; Nelson, 2019; Thachuk, 2011). This
preoccupation with disorders, conditions, intervention and medication, stigmatises behaviour that upon reflection might actually be considered ‘normal’ or ‘common’
(Boggs, 2014).
The neoliberal model of operation and its fixation on standardised practices, impacts the individuals seeking support from the system, and wider social perspectives concerning mental health in general. Alternatives to the medical model and its focus on diagnoses are explored in theme five and six when we analyse participant’s suggestions for the mental health system moving forward and the sociological frameworks that deepen these understandings. Examples of this include the Transdiagnostic model (Frank et al., 2014), an increase in Kaupapa Māori
approaches, an increased focus on collaborative care and the insights that disability scholars bring to understandings of regulatory and cultural norms and their
connection to socially constructed labels (Brady & Franklin, 2023; McLaughlin et al., 2016).
4.3.3 A Fragmented System and the Impact on Young People – A suggested Move