In The Happiest Place On Earth, A Revolution In Mental Health Care
Mental health crises are making headlines across the world. And even pre-Covid, in 2017, the WHO recorded a 13 percent jump in mental health conditions and substance use disorders compared to the previous decade. While health systems strain to keep pace, Helsinki-based social entrepreneur and Ashoka Fellow, Markus Raivio is advancing a new approach that assumes health, not illness, and turns to peers before practitioners. Ashoka’s Ana Sáenz de Miera spoke to Raivio to learn more.
Ana Sáenz de Miera: Markus, you’re challenging a core assumption of many psychotherapists: that those who suffer from mental health conditions need professional fixing. Are you really saying that if I have a friend with severe depression, he shouldn’t be medicalized and go to psychotherapy, he should instead join a rock band?
Markus Raivio: Well, yes and no. Without dismissing all the benefits of professional treatment, what I am saying is that it’s crucial that he also finds an activity that’s meaningful for him, that gives him hope and purpose. If it’s a rock band, great. The sickness and health discussion currently lacks an important dimension. People ask, are you sick or healthy? Perhaps a more holistic way of assessing mental fitness would be to ask: Despite whatever is happening in your mind, can you work and have dreams? Can you express love to another person? Because there are a lot of people suffering from mental health illnesses who love, contribute, lead meaningful lives.
Sáenz de Miera: Yes, very true. How did your interest in mental health start?
Raivio: With the story of my grandmother, Helli, who suffered from schizophrenia. She was traumatized by Russian bombings in Helsinki during World War II. To alleviate her symptoms, her paranoid thoughts, she was given a lobotomy. It was a Nobel Prize winning treatment at the time. But the treatment took away her ability to walk, to converse with her closest friends and family, to work, to love. This was the price for some abstract idea of “health, life without symptoms.” When I learned of her struggle and this story, I thought: “that is too high a price to pay. I am sure I can come up with better and more humane ideas than this.”
Sáenz de Miera: So that set you on a path to find a better way to “treat” mental health conditions?
Raivio: Yes. I became a music therapist, and early in my career, I led bands and choirs of young adults with different mental health issues. But soon I began to ask, do they even need a therapist to be there? Do they need me? To test this idea, I asked a patient, a participant in the guitar group, to take over while I left the room. When I came back, the atmosphere had become more playful and relaxed. I started to see then that one way to support these people is to let them support each other. Not only in traditional peer-support groups, where the dialogue is disease-based, but by inviting them to do what they love, to share the things they love. Today Kukunori, the association I started in Helsinki in 2012 has established 17 “culture houses,” representing almost 17,000 people who struggle with mental health.
Sáenz de Miera: What exactly is a culture house?
Raivio: The idea behind the culture house is that the mind is not something inside my brain, it’s something between you and me. It’s relational. So how can we nurture that space? When someone comes to a culture house, the discussion is about what people can do, their interests and skills, their intrinsic motivation. What do you play? I play guitar. How well? I only know three chords. That’s okay, three chords are enough to tutor your own group. Or, if you like doing photography, we will train you to be the photography group tutor. You remember that old song: “A little less conversation, a little more action”? Well, we named our first culture house ‘Elvis’ for that song. We wanted to give people something meaningful that they can act with, give to someone else: a skill, an experience. Usually the careers that people end up pursuing have nothing to do with the skills they are sharing and teaching at the culture house, but having something to give to others. Altruism becomes fuel for meaning, for life.
Sáenz de Miera: How would you convince doctors in my country of Spain, for example, to implement this approach?
Raivio: You know, for the fourth year in a row, Finland has been ranked as the happiest country in the world. And yet, it also has the highest rate of mental health challenges. So how are we so happy? A factor may be that we’re embracing this recovery model approach to mental health. So I would start by telling the doctors that. From the outside our approach might seem naive, even “hippie.’ But we have data to show that it works. We have done a lot of social return on investment analyses from our culture houses. And we can see that people who go to culture houses need less hospitalization and public health care, and they apply for work and school at higher rates.
Sáenz de Miera: So the savings argument is strong?
Raivio: Very strong. Poor mental health is estimated to cost the world economy two to five trillion dollars per year due to hospitalization and reduced productivity. And the mental health crisis is accelerating; health care services can’t meet demand. Professionals in Spain and everywhere else see the numbers increasing, and many feel powerless to meet the need. So we have to build platforms where non-professional people suffering from mental health challenges can support each other.
Sáenz de Miera: How has Covid affected awareness of mental health issues? Do you think this awareness is making people more open to approaches like yours?
Raivio: We did have to find new solutions during the pandemic. It was interesting to see a lot of culture houses migrating to Discord or Slack channels, because you can actually increase the scale of outreach. It’s a very good place to have 24/7 peer support. Also very good for people who don’t leave home. Even before the pandemic, there were a lot of people suffering in – and from – isolation and too afraid to venture out.
Sáenz de Miera: An important moment for your work and insights, Markus. What are your plans going forward?
Raivio: My colleagues and I want to share Kukunori’s success so others can benefit – even outside Finland. I also want to keep opening diagnosis-free spaces, where participants can celebrate their power and their gift to contribute to the well-being of others. I hope our guided functional peer support model, GFP, will help dismantle the traditional notion that being diagnosed with a mental health challenge means a person is broken. We say instead: Let’s design our systems with a new principle in mind: every person has the power to give, to contribute. For the health of all, let’s unlock more ways for people to give.