Maslow and health
We recently held an event within our area Clinical Commissioning Group on ‘social prescribing’. This looked at ways of addressing the self-care agenda and also the exhortations of NHS England in its ‘Five Year Forward View’ (1) to make a ‘radical shift towards prevention’. Since that event where we considered how we might collaborate with local councils and voluntary sector (including the faith community), I have been reflecting on which needs we are addressing in the traditional medical model. My mind turned to Maslow’s hierarchy of needs and my conclusion was that we address some aspects of the hierarchy and not others. We tend to focus on the physical and the physiological and even the cognitive needs in terms of mental health but we don’t do so well with the need for belonging & relationship & certainly not with people’s need for ‘self-actualisation’.
My conclusion was that we need to get much better at finding ways to help our patients get more connected. Evidence suggests that isolation and loneliness may have a bigger adverse impact on health than smoking and obesity. How do we identify loneliness and isolation? Mental health and it’s symptomatology will often result in withdrawal and isolation and singleness due to relationship breakdown, bereavement and moving area or country are also common risk factors.
What about self-actualisation, our need for meaning and purpose? I conducted a survey of patients in my surgery asking whether their illness experience had caused them to question the meaning and purpose behind the experience. I also asked whether they would regard themselves as being in good general health, whether they had a long term condition or whether they had been treated for a mental health problem. Of the 175 patient questionnaired one third said that their illness had caused them to question issues of meaning and purpose BUT two thirds of those who had been treated for a mental health problem confessed to such existential questions.
So what might the learning be? I would suggest we need to find ways to sign post our patients to means of social connection and be aware that those with mental health issues may well have underlying existential questions associated with their experience.
1NHS England Five Year Forward View’ https://www.england.nhs.uk/ourwork/futurenhs/nhs-five-year-forward-view-web-version/5yfv-exec-sum/
2 Maslow, Albert A Theory of Human Motivation (originally published in Psychological Review, 1943, Vol. 50 #4, pp. 370–396).