It’s a stressful world and we can become overwhelmed. But at what point does sadness become depression, and stress an anxiety disorder? In Default Depression, author Anthony Smith examines the medicalisation of common human experience.
Default Depression builds a compelling case for an extensive shift in how we support people in psychological and emotional distress – away from the damaging tendency to medicalise and medicate, towards a more nuanced and evidence-based approach.
In this guest piece, Anthony writes about the Situational Approach, which reconceptualises human distress as a response to a difficult situation, rather than as an illness.
Read his piece in full below.
The key conceptual framework underpinning Default Depression is what is known as the Situational Approach.
The Situational Approach re-conceptualises a broad spectrum of human distress not as illness at all, but rather as the understandable human response to stressful situations (situational distress – the difficulties associated with adverse life events) where medical intervention is largely unnecessary – and may, in fact, be harmful. In so doing, the Situational Approach also opens up a whole new potential for meaningful community engagement in the endeavour of psychological support, preventative mental health, and suicide prevention. This approach acknowledges the predominant association of situational distress rather than mental illness, with suicide (though in some cases the two are linked), and is principally informed by and responds to risk factors of a broad spectrum of difficult human experiences across the life span.
The Situational Approach directly challenges the current narrative of ‘mental illness’ that underpins our mental health system.
It also challenges the current approach to suicide prevention where the conflation of mental illness and suicide (putting the main focus on ‘illness’), has distracted much suicide prevention activity from the broader risk-associated spectrum of highly challenging, albeit common, life events and consequent experiences. The Situational Approach recommends a public health approach to suicide prevention which emphasises an ‘upstream’ perspective: one that focuses on risk and protective factors in order to prevent the kinds of intense or prolonged distress that can escalate into suicidality. This important prevention work complements the ‘downstream’ approach, which focuses on dealing with crises and their aftermath.
There are now many academics, service providers, and community leaders who support the merits of the Situational Approach because of its potential to achieve outcomes that current approaches have been unable to attain. They also recognise its priorities of putting consumers and communities at the centre of suicide prevention efforts, and its emphasis on fundamental mental health reform, rather than a mere tinkering around the edges of an ailing mental health system.
To improve our work in suicide prevention and mental health, the Situational Approach advocates for new expertise and new, informed leadership to steer policy development, funding allocation, research, organisational change and community program activity toward a completely revitalised, more effective activity. This new leadership should be engaged across all relevant settings and sectors including the health/ mental health system, welfare and support services, research and industry, and the workplace generally.
Above: Anthony Smith, Senator Kerrynne Liddle and Aaron Violi MP at the launch of Default Depression in Canberra, 2023
Anthony Smith, former board member of Suicide Prevention Australia, is at the forefront of a movement that aims to change the way we consider mental health and suicide prevention. He is co-author of papers and reports promoting the Situational Approach, a concept that offers a fresh way of considering mental health by taking situational factors (such as economic and social disadvantage, and workplace stress) into account when engaging with people experiencing distress.
For more than two decades Anthony has worked across Australia with networks such as primary health, the life insurance industry, men’s sheds and human resources, and at the community level in suicide prevention and research, built on collaborative work with a regional coroner’s office.
Love the Situational Approach to depression, anxiety, etc.
I think we can learn a lot by revisiting the community mental health services provided by teams of mental health professionals that started in SA in the late 1960’s e.g Carramar on Greenhill Rd Parkside, a state government funded community mental health centre with “walk- in “ appointment & assessment that enabled many to set their own goals for better mental health through connection with others, sharing support, & creative activities both practical & artistic.