The educational challenge of mental health

This paper poses a series of fundamental educational challenges about mental health. First, it questions whether 'mental health' is a valid concept, in the light of debates over mind/body dualism. If the concept is valid, should the absence of mental health be seen as an illness, an adaptive strategy or simply a statistical eccentricity? Fulford's concept of 'failure of intentional action' is commended as a philosophical basis for unravelling these issues. Secondly, the paper considers whether diagnosis is a simple or complex process, and whether it can be an objective activity or one which involves a strong subjective element. The current and potential value of multiaxial classification systems are discussed. Thirdly, themes concerning mental health treatment are introduced, covering problems with consent and patient preference, the evidential basis of interventions, and the range and limitations of possible treatments. Finally, the paper reviews the educational processes needed to meet these challenges effectively. It recommends the development of multifaceted educational programmes, nurturing a spirit of critical enquiry and personal awareness and, above all, the recognition and toleration of the uncertainty and complexity which lie at the heart of successful medical practice.