The contribution of coaching to mental health care: an emerging specialism for complex times
Sarah Corrie and Andrew A. Parsons
Everyone experiences challenges to their emotional well-being at some point in their lives. Given that mental health1 is central to both our quality of life and our ability to function, we can be confident that as coaches we will, at some point in our careers, encounter issues relating to emotional well-being in the requests that our clients make of us. This might be directly (i.e. the client sitting in front of us), indirectly (e.g. coaching a manager who is supporting staff with mental health problems), or systemically (e.g. working with the senior leadership team of an organisation that wishes to address high levels of sickness and staff turnover or who wish to promote mental health awareness within their company culture). And of course, we may well, at some point, confront a mental health issue in ourselves.
Working with emotional well-being has long been a feature of life coaching. In other areas, including business coaching, the domain of mental health and emotional well-being is still something of an emerging conversation with many unanswered questions concerning the role that coaches could or should adopt, if any. This chapter turns a spotlight on some of the questions, concerns and opportunities that arise from moving into this domain. We examine the collective state of our mental health by drawing on relevant statistics and the questions for coaching to which these statistics give rise. We then make the case for coaching in mental health and offer ways of conceptualising and responding to our clients’ emotional well-being needs when we find ourselves confronted with them. We also propose that the time is ripe within mental health care for a paradigm shift and argue that coaching has a critical role to play in this regard. In support of this paradigm shift we present two specific propositions: (1) that mental health can be usefully conceptualised as an example of what has been termed a ‘wicked2 problem’ that requires transdisciplinary innovations in thinking and practice and (2) that an approach known as ‘salutogenesis’ (we explain this in more detail later in the chapter) provides one potentially valuable framework for enabling coaches to move into this domain with gr eater confidence and clarity about their contribution.
Why coaches need to know about mental health
Mental health problems are widespread. Statistics from the World Health Organization (WHO) indicate that approximately 450 million people are living with a mental health problem (World Health Organization, 2001). In England, approximately one in six adults has a common mental problem (McManus et al., 2016). Further, it has been estimated that 20 percent of adolescents experience a mental health problem in any given year (World Health Organization, 2003), with 10 percent of children and young people (aged 5-16 years) having a clinically diagnosable mental problem (Green et al., 2005). In excess of 20 percent of adults aged 60 and over are living with a mental or neurological disorder (World Health Organization, 2019)? In summary, these statistics build up a picture of why mental health problems have been identified as one of the main disease burdens worldwide (Vos et al., 2015) and there can be little doubt that mental health is a growing public concern. Thus, it is reasonable to infer that coaches cannot easily side-step mental health issues even if they wished to. However, coaches are not mental health specialists and so the cunent rates of incidence and prevalence raise questions including, should coaches have a role in working with mental health problems? If so, what might this role be? What knowledge, skills and competences are needed to ensure that coaches are able to make infonned decisions about how to work with clients where a mental health issue features in their presentation? How can coaches know when and how to sign-post clients to other services? Additionally, if coaches do have a role to play in working with clients with mental health issues what implications might this have for the training, development and supervision of the workforce?
Given that we will almost certainly encounter them in some of our clients, it seems reasonable to propose that every coach needs at least a foundational level of knowledge of mental health issues if for no other reason than to be able to detect their presence and determine when coaching may not be appropriate. However, the question of detection is neither simple nor easy. Consider, for example, the case of Maureen, a client whom we ask you to imagine you are coaching and whose interactions with you give rise to unanticipated questions and dilemmas about how to proceed.
Box 5.1 Conceptualising Maureen’s situation
Three months ago, Maureen4 was promoted to the role of service manager within a large multinational service company. She is 46 years old. The company is eager to develop a ‘coaching culture’ and Maureen’s line manager suggested that Maureen take up the opportunity of coaching provided by an external coach, to help her transition into her new role.
Your first meeting with Maureen goes well and you agree some specific areas to work on, in conjunction with her line manager. These include supporting the team in working cohesively during a period of organisational restructuring and supporting Maureen in developing her new role. You notice that Maureen seems a little agitated at times but overall the meeting feels positive and you are confident that you have agreed a clear contract for the coaching that is to follow.
At each session, Maureen indicates that she is finding coaching helpfill. However, at your fourth coaching session, you notice that Maureen appears quite hot, fidgety and a little dishevelled. She begins to reveal concerns that she says she has felt able to tell no one else. She tells you that she has been feeling increasingly low over the last three months or so and is not enjoying her work. She says she is prone to bouts of tearfulness that have no obvious trigger, that her concentration and memory are poor, and that she is concerned she could make a mistake that proves costly for the organisation.
Maureen has no idea why she is feeling the way she is - she has a good life, finds her career rewarding and was looking forward to the promotion for which she has worked so hard. She is worried that her difficulties with concentration and memory might be symptoms of early onset dementia (she is currently the main carer for her elderly mother who has Alzheimer’s disease). She says she has begun to wonder whether she should have been promoted and is not sure what to do about her concerns. You are someone she trusts and feels able to confide in and so she asks your advice . . .
As her coach, how should you make sense of, and respond to, the type of information that Maureen has disclosed? Her willingness to share her distress is a sign of trust in you, but her disclosures do not directly fall within the remit of the agreed coaching contract. On the one hand, then, it is a detraction from what you have both agreed to focus upon. On the other hand, it may well be the very reason that Maureen needs support.
There are a number of different potential responses to this scenario. The first might be to continue with the coaching contract as agreed and see if you can work around the issues that Maureen is describing. An experience of psychological disruption is not uncommon during life transitions and she has, after all, just begun a new and more demanding role. A second response might be to temporarily halt the coaching and refer Maureen to her occupational health department or her GP, explaining that before you proceed, you both need to establish whether a medical intervention (such as medication or even a brain scan) is warranted. You may decide to talk with Maureen about accessing additional support, including her own line manager, especially if there are concerns about making mistakes that could prove detrimental to the organisation.
Alternatively, if you are a dual-trained coach and already have a working knowledge of common mental health problems, you might decide to engage in some further information-gathering to determine whether her difficulties are consistent with a presentation of depression or anxiety. Aimed with this information, you could then discuss with greater confidence whether coaching or therapy would be best suited to her needs and sign-post her to relevant services if necessary. Then again, you might decide you want to ask some further questions about her physical health. For example, when was the last time that she had routine blood tests? Would it be helpful to see her GP to talk about a blood test to rule out thyroid dysfunction (a potential cause of some of the symptoms she is describing)? You might also be mindful of her age - some of the difficulties she describes are consistent with the menopause and so you might decide that as part of being diligent in your efforts to help her, you need to enquire about changes relating to her hormonal health.
All of these are potentially legitimate courses of action and thus, when we work with a client who is experiencing emotional depletion, we need to decide what, in the context of the coaching contract and our role as coaches, we are entitled to ask about and what falls outside of that boundary. We also need to consider how wide-ranging our knowledge needs to be in order to help our clients with the issues that they are facing. And of course, we need to decide who is best placed to deliver the service that is needed - ourselves, a coaching colleague with a different skillset or a professional from another discipline altogether.
Ensuring that we are able to make an informed decision in each case is no easy task and will vary as a function of our individual preferences, resources, prior training and the client's own context and needs. Nonetheless, the accurate detection of a mental health problem is likely to afford a number of benefits. For example, we are less likely to be thrown off track by issues that our clients introduce that were not part of the original coaching contract (as in the case of Maureen) and will be better able to recognise when clients need sign-posting to a mental health service. A good level of foundational knowledge of common mental health problems also enables us to think though whether, when and how coaching might help and to design a more effective intervention plan. Finally, recognising the presence of a mental health problem in a client and being able to talk openly with them about your concerns for their well-being may ultimately prevent a looming crisis.
Towards an understanding of mental health
Mental health is neither dichotomous (i.e. present or absent) nor static. Although there are diagnostic criteria for specific, widely recognised disorders, mental health exists on a continuum with each individual having their own baseline level of ‘wellness’. Moreover, each of us moves along the continuum as a function of a variety of internal and external factors as well as what we, personally, can manage. Depending on a client’s overall resilience, repertoire of coping skills, general psychological problem-solving skills and other protective factors (e.g. a caring life partner and good level of social support), even high levels of distress over a temporary period might be managed effectively by the client and so pose no obstacles to any coaching contract that has been agreed. In such cases, the approach taken by the coach and client may be as simple as acknowledging the presence of a specific issue and then working around it in pursuit of the client’s coaching-related goals. However, there will be other instances where a coach is likely to be left questioning whether more intensive input is needed. In these instances, it is important for the coach to have a set of criteria for informing their decision-making about how best to respond.
The emerging interest in mental health coaching (Bishop, 2018; Buckley & Buckley, 2006: Corrie, 2016, 2019a, 2019b; Szymanska, 2018) suggests the need to attend to a range of indicators when attempting to make sense of our clients’ emotional well-being needs. In broad terms, indicators of problems that are more likely to require referral to a mental health professional are those where distress is having an obvious, demonstrable impact on the client or those around them. This might be because the client’s distress (1) is occurring too frequently, (2) is too easily activated, (3) is too intense for the client to manage effectively, (4) takes too long for them to return to a state of equilibrium, (5) is too disruptive for the client or for those around them or (6) is related to issues of risk (to self or others).
Drawing on the six criteria outlined above, it has been suggested that in building up a picture of the client in front of us, there are three key areas that can usefully inform our decision-making about the type of intervention from which a client might optimally benefit (Come, 2019a, 2019b). These are as follows:
In relation to what a coach might see and experience when working with a client, it is important to pay attention to how a client looks physically, how they present in the room and how we feel in their presence (Corrie, 2019a, 2019b). Obvious physical warning signs might include looking unwell, appearing unkempt, seeming out of breath or being markedly under- or overweight. Attending to a client’s physical presence can also draw our attention to important non-verbal clues such as whether they are able to sit still, pause, and reflect as our conversation with them unfolds or whether there are signs of agitation, restlessness or pressure on speech (signs of agitation often manifest in a tendency to speak very fast whereas when mood drops significantly, speech can be significantly slowed as a function of reduced cognitive efficiency). Finally, it is important as part of this criterion to consider your own internal reactions to the client. How do you feel when you are with them? What types of thoughts and feelings are evoked in you (perhaps especially attending to reactions that would not be typical for you when working with other clients)? For example, do you find yourself feeling agitated or ‘speeding up’ in your interactions with them? Do you feel tired or irritated in their presence?
These types of reactions can represent important potential clues as to what a client might be experiencing and need.
A second criterion concerns paying careful attention to how the client describes their situation (Come, 2019a, 2019b). The client being able to provide a coherent account of their perceived needs and aspirations that can form the basis of a coaching contract is a cognitive skill in its own right. Corrie advocates that how the client tells their story is one means of establishing how well able they are to reflect on and articulate their internal world. For example, what is the form and flow of the person’s communication? What is their capacity for sharing information? Does the narrative have a coherence and structure that makes it easy to follow or is their story fragmented or disconnected in some way? How a client tells their story can also provide clues as to their locus of control and their perception of any coping and rescue factors that are available to them in the situation. It is important to remember that marry mental health problems are characterised by a temporary deterioration in cognitive functioning and problems with concentration and memory' are common features of both depression and anxiety. It is useful, therefore, to explore any difficulties with attention, concentration or memory', especially if you are concerned that the client may not be aware of mistakes they are making in the workplace.
In relation to tire third point earlier, what is not said (and which you may want to ask about explicitly), the coach is encouraged to reflect on those concents that it may be difficult for the client to share out of a sense of embarrassment or shame (Corrie, 2019a, 2019b). Although some topics may not be appropriate to tire coaching context, it can be useful to enquire about the client’s typical approaches to problemsolving and methods of self-care (e.g. do they tend towards proactive methods of addressing life challenges or do they' adopt avoidant methods of coping?), as well as commonly known impactors of mood such as the consumption of caffeine, alcohol and recreational drugs. As part of this, asking a client about signs that their emotional well-being is compromised or that they need support can reveal a great deal about self-awareness, self-reflective capability and general life skills that as coaches we may want to help our clients to acquire. Equally, asking about strengths and resources they have available to them and whether they aie using them builds up an understanding of the client’s approach to challenges and opportunities.
Having built up a clearer picture, the coach must then decide how to synthesise the information obtained into a coherent understanding of a client’s needs that has implications for the type of service subsequently offered. In deciding when to work with a client and when to refer to another professional, we have found it usefill to use the Health Awareness Tool (Corrie, 2019b) that is presented in Figure 5.1.
The purpose of this tool is to help a coach, in partnership with their client, consider the intersection of two broad domains - resources and functioning - and to consider whether the client is high or low on each of these as a basis for deciding whether coaching is the optimal first line intervention. Used as a framework for facilitating discussion, the coach and client can consider which of the four quadrants overall most accurately reflects the client’s cunent position.
The Health Awareness Tool (Corrie, 2019)
High Functioning Low Resources
Low Resources Low Functioning
Figure 5. / The Health Awareness Tool, developed by Sarah Corrie (2019) and adapted for this book in monochrome
The original, colour-coded model draws on the analogy of a system of traffic lights. Thus, the quadrants are coloured red, amber or green as a function of whether the coach and client need to stop (red) in order to reflect on what is most needed, whether they can proceed with caution (amber) or whether the process of coaching can proceed (green). In the monochrome diagram above, the quadrant labelled ‘Struggling’ is the red zone; the quadrants labelled ‘Existing’ and ‘Managing’ represent the amber zones and the quadrant labelled ‘Flourishing’ is the green zone. Where a client is high in both resources and functioning, there is grounds for confidence that coaching is a potentially helpfill intervention in relation to pursuing a coaching contract (the green light gives the go-ahead). Thus, as noted earlier, a coach may be working with a client who is experiencing quite high levels of emotional distress. However, given that they are functioning well (e.g. they are able to function effectively at work, are capitalising on leisure pursuits and are enjoying then- relationships) and have a good degree of resources (e.g. then overall resilience is high, they have a good repertoire of coping skills, a caring life partner and good level of social support), they fall within the green quadrant.
hi contrast, if a client is well-placed hi neither then resources nor then functioning, this is likely to place them within the red quadrant, the zone of struggle, indicating a need to pause the coaching - at least until further avenues have been considered. It is likely that additional input and support will be needed for the client to reach a stage where they are able to benefit optimally from what coaching may provide.
When a client is high on one dimension but low on another, the coach and client are in the amber territory. Here, the client may be managing day-to-day or simply existing but will not currently be in a position to flourish. Attention may need to be given to ways of enhancing either functioning or resources before the original aims of the coaching contract can be pursued with confidence. Alternatively, both parties may decide to proceed with the coaching but build in additional checks along the way (e.g. there is an agreement that the client will consult with their GP or occupational health) to ensure that the work provided is meeting the client’s needs optimally.
Of course, neither functioning nor resources are static. Using the Health Awareness Tool is not about diagnosing the presence of a mental health disorder but rather about building a picture of a client’s level of well-being and need. Nonetheless, we have found it to be helpful in enabling a conversation about potentially sensitive areas of a client’s experience as a way of helping clients take greater ownership of the decision-making process. Whatever system we use, by developing a set of criteria we can have greater confidence that we are using a systematic approach that can help us decide whether otu’ particular coaching offer is best suited to a client’s needs at a specific point in time.
Mental health as a wicked problem: why coaches are necessary for the mental health workforce
In Chapter 4 of this volume, Corrie makes the point that many of the critical issues confronting us as a society are taking the form of a new type of challenge. Conceptualised as ‘wicked problems’ (Brown, Hanis, & Russell, 2010), these types of challenge share a set of features in that they are highly complex and eiuneshed. occur’ in a context of continual change, are unprecedented in the obstacles they present and involve multiple stakeholders who have different priorities and needs. They are also resistant to traditional approaches to problem-solving and tend to shift with each solution implemented giving rising to unintended consequences that create new challenges.
Commonly cited examples of wicked problems include climate change, tenor-ism, poverty and immigration as well as challenges confronting the welfare and health care system. Features of contemporary life including the impact of modem lifestyles, an ageing population, expanding and disruptive technologies, institutions and economies facing upheaval as well as the changing ways in which our working lives are configured, all influence the issues with which oitr clients present us and represent the consequences of living in a ‘wicked world’.
It is our view that the mental health needs of humankind also represent a wicked problem. Consider, for example, how in 2008 England introduced the ‘Improving Access to Psychological Therapies’ (IAPT) initiative aimed at increasing the accessibility of empirically supported psychological interventions for common mental health problems (Clark, 2011). Although these interventions are now more available than ever before, they have not appeared to stem the escalating emotional distress of the population, as evident from the statistics cited earlier in this chapter. Moreover, the requirement of IAPT services to meet pre-determined targets has necessitated the creation of an entirely new type of workforce trained not as psychotherapists, psychologists or counsellors but as practitioners who deliver empirically supported interventions for specific clinical presentations. This raises questions concerning the identity and positioning of this workforce relative to other mental health professionals, as well as questions about who will regulate them once they are qualified. As Come and Lane (2015) observed, the nature of the workforce delivering psychologically informed interventions and the context in which those interventions are delivered is changing, characterised by both tighter state expectation and regulation and the simultaneous deprofes-sionalisation of service provision.
Thus, there is now a greater range of empirically supported interventions for mental health problems than ever before and an expanding workforce being trained to deliver these interventions (enabled by public funding). Yet despite this, the statistics are not indicating improvements in global emotional well-being and as the workforce expands, questions arise concerning training, standards and credentialing. The opportunities and pressures that arise from introducing initiatives to tackle the mental health crisis are precisely those typical of wicked problems where a solution implemented to meet one type of need raises dilemmas in another.
However, the fact that the mental health workforce is changing and broadening to embrace the contribution of a wider number of professional groups suggests that coaches, too, might have a valuable role to play in working with mental health issues - directly or indirectly. In a world that is volatile, uncertain, complex and ambiguous (Barber, 1992), we need to be more creative in how we conceptualise and work with client issues of this nature. As Einstein stated, ‘The significant problems we face cannot be solved with the same level of thinking that created them’ (www.quotes.net/quote/9226). Working in a wicked world requires both commissioners and providers of health care to separate job title from professional competence, forcing us to look across traditional professional boundaries in order to create new partnerships in knowledge generation and service delivery. In this context the key question ceases to be, ‘Does this person need coaching or therapy?’ and becomes, ‘What skillset, knowledge-base and competences are required to meet this client’s needs?’ This paves the way for a more fundamental re-examination and re-definition of the role for coaching in mental health care.
Reconceptualising the role for coaches: salutogenesis as a potential organising framework
So far, the focus of this chapter has been on recognising signs of depletion in our clients and how, as coaches, we might respond. By focusing on the type of issues that may characterise the presence of a mental health problem and that might signal the need to refer a client to another specialist, we have located the discussion within the currently dominant views of mental health and its ‘treatment’. However, coaching has the potential to bring fresh perspectives to how we conceptualise working in this domain. In particular, the values and perspectives that coaching contribute may offer a timely challenge to authorised views of service delivery introducing novel ways of bringing the client ‘centre stage’ in the process of building relationships with mental health services. Moreover, in the context of a world characterised by wicked problems, a challenge to authorised views of service delivery that understand clients’ needs as remedial in favour of interventions that are developmental would pave the way for what we believe is now essential - namely, a paradigm shift in mental health care in which coaching has a vital role to play.
Moving away from traditional thinking about the client receiving ‘therapy’ or ‘coaching’ allows us to think about the needs of the client in a different way. Instead of conceptualising the task as one of alleviating dis-ease, we can shift our focus to one of health (saluto) promotion (genesis). Salutogenesis, a term introduced in the 1970s-1980s by the medical sociologist Aaron Antonovsky, is focused on building generalised psychological, social and physical/material resources. The ability of an individual to build and access these resources enables the maintenance and promotion of their health, even in difficult states of ‘tension’ (Antonovsky, 1979). The salutogenic approach is consistent with the WHO definitions of health and mental health (World Health Organization, 2004, 2014). Furthermore, it has been proposed as a suitable framework for describing a complete state of health where approaches that prevent and treat disease can be viewed alongside those that also promote and protect the health of individuals (Keyes, 2014).5
At the heart of his model, Antonovsky described a ‘sense of coherence’ which fosters a global orientation of confidence that both internal and external environments are predictable and that things will work out reasonably positively. This orientation reflects the individual’s view of life and their sense of capacity to deal with the situations in which they find themselves. A high sense of coherence, therefore, promotes ‘good health' even where individuals have experienced traumatic life events. For example, Antonovsky’s early work involved investigating the experiences of the menopause amongst different cultural groups in Israel including Jewish women who had survived the Holocaust (see Antonovsky, 1987). Over the last 40 years, sense of coherence measures have been developed in over 40 countries and languages. However, current thinking is now directed to the transdisciplinary nature of salutogenesis as an umbrella term to integrate many different theories and approaches that impact the ability of an individual to relate to self and others (Eriksson & Mittelmark, 2017). Sense of coherence is one of these, and potentially related to several others. How the individual learns to develop and utilise their resources to develop their sense of coherence is a continual and life-long learning process at the heart of salutogenesis (Eriksson, 2017).
Salutogenesis can be defined in narrow, broader and global terms (Mittel-mark & Bauer, 2017). Its narrow definition is consistent with the early interests of Antonovsky, with a focus on sense of coherence and its measurement as the key component of health. A broader definition encompasses an orientation to health promotion rather than reducing health risks and preventing disease. This orientation provides a different language and set of assumptions for how both individuals and organisations approach situations. For example, instead of classifying health or disease, a salutogenic orientation conceptualises a health continuum which offers a novel way of thinking and of making inferences from observations. Thus, rather than emphasising the need to reduce risk factors and pathology, the emphasis is on promoting the identification and use of resources to support health whilst focusing on the person as a whole (Antonovsky, 1996). The broadest sense of the definition encompasses the model of salutogenesis which outlines genetic, constitutional and psychosocial resistance resources that are shaped during life experiences. These resources can be characteristics of individuals and/or groups that offset the impact of stressors to maintain sustainable health (Antonovsky, 1979). Aligning the salutogenic framework with the Health Awareness Tool (see Figure 5.1) provides a means of further building the resources needed to enable the person to thrive.
The salutogenic framework highlights the interplay between personal, social and environmental resources and the learning through the experience of life stressors of how they can be utilised. The ability to develop and utilise these resources creates the sense of coherence through life. These resources could also be described as mental capital; that is, the sum of an individual’s cognitive, emotional, genetic, early biological programming and life experiences (Jenkins et al., 2008). The salutogenic framework predates the development of the positive psychology movement but the integration of both approaches with the social constructivist viewpoint leads to better alignment and the generation of health and well-being (Joseph & Sagy, 2017). It may also offer a different perspective on the role of intrinsic motivation (Deci & Ryan, 1985) in maintaining subjective well-being. Salutogenesis in its broader definitions could, therefore, act as a transdisciplinary framework to integrate multiple approaches to support health and well-being (Eriksson & Lindstrom, 2006; Eriksson & Mittelmark, 2017).
Adopting multiple and varied perspectives and exploring a wide range of potential solutions is an important aspect of tackling wicked problems. Embracing the salutogenic framework creates an opportunity for coaches to play a significant role in supporting mental health and well-being. Coaches support the development of mental capital and the utilisation of the client’s personal resources to promote health. Within this perspective, it is important to note that the coach’s role is not remedial (i.e. to provide a ‘fix’ for a client’s well-being). Rather, it is developmental in that coaching creates a context for learning that allows the client to become more aware of their environment and to actively participate in shaping it.
Coaching and mental health: the role of a specialist coach in supporting learning, selfdevelopment and relations with others
Coaching processes have developed over the last 30 years. Initially privileging the achievement of goals (the so-called first generation), subsequent perspectives have emphasised supporting the client in reaching their own solutions (second generation) and more recently a co-creative approach working with values, identity and integrating experiential and existential perspectives through reflection and application (third generation) (Stelter, 2014). Devising collaborative dialogues as part of a coaching process will provide an opportunity for the client to reflect, assimilate new learnings and apply these to their situation. A specialist third generation coach may, therefore, be able to support assimilation and development of new perspectives of self and others. Interestingly, this coaching approach has been observed in the development of workplace coaching over the last 30 years. Conversations that occupy this collaborative style of conversation produce a focus on both performance and well-being of the employee (Grant, 2017).
Coaching models have been developed that align to the salutogenic framework’s sense of coherence (Gray, Burls, & Kogan, 2014) and utilised to develop resilience programmes with a small number of individuals that reported benefit (Gray, 2016). A salutogenic approach to coaching also appeared beneficial in a case study involving developing resilience in a senior manager (Gray, 2017). Despite the small numbers involved and the narrow focus on sense of coherence, these studies highlight the potential to develop a salutogenically oriented approach to clients’ learning and development. The opportunity is to develop a wider learning perspective that captures not only the sense of coherence construct but also the salutogenic model and lifestyle orientation manifest in everyday situations. The third generation style coaching approach focusing on values and learning through discussion (Stelter, 2014) appears well-placed to develop the framework for coaching in this arena. Stelter (2014), for example, has proposed areas of practice that would be essential for specialist coaches. These include an understanding of organisational theories, the ability to expand the reflective space through use of questions, open narratives and metaphors, a focus on values, identity and motivations and their link to actions (Stelter, 2014; Stelter & Andersen, 2018).
Coaching approaches that explore cognitive, emotional, physical and spiritual perspectives which are linked to purposeful actions may also feature within this salutogenic orientation (Spence & Deci, 2013). Additional skills for the coach may include having the ability to access and share a life perspective that aligns with the salutogenic orientation. The availability of supervision would also be essential, as working in the arena of mental well-being will require the processing of potentially difficult information necessitating support and the development of appropriate learning and recovery strategies for the coach themselves.
The coach as mental health specialist: new horizons, new directions
Not every coach will want to work with mental health issues or concur with the stance taken by the authors of this chapter. Certainly, we are not advocating a ‘one size fits all’ approach. Nonetheless, there is evidence that some coaches are becoming increasingly confident about recognising and perhaps even working within this domain. For example, in a survey of members of the British Psychological Society’s Special Group in Coaching Psychology (Corrie, 2017), 95 percent of respondents indicated that they were confident they could accurately detect a mental health problem in a client. In addition, 93 percent stated that they would be confident about what action to take if they suspected that a client had a concern of this nature. However, 88 percent of the sample also said that they would welcome an opportunity to undertake further training in this area. Although generalisation of the findings is restricted by sample size (the survey data were gathered from a sample of 96 respondents), they hint at a growing awareness that coaches will encounter mental health problems in their practice and an emerging willingness to engage effectively with an increasingly diverse range of needs. So, for coaches who do have an interest in moving into this area what are their options?
First, it is important to identify that mental health coaching is not established territory. Those wishing to work within this field will need to be comfortable with adopting the role of the pioneer, facing questions about the range and scope of their expertise and a need to innovate and justify emerging practices in the face of potential opposition. Second, if mental health does indeed qualify as a ‘wicked problem’ then we might anticipate the need for greater cross-disciplinary, collaborative and transdisciplinary models of working. Those who are drawn to working in this area are perhaps also likely to relish the opportunities (and challenges) that come from developing novel approaches to practice and service delivery. These novel approaches will also likely draw upon methods that enable the coproduction of knowledge that brings together the voices of diverse stakeholder groups whose expertise originates from experiences and training quite different fr om that of coaching professionals.
Given that mental health is a multifaceted experience and multi-layered in its impact on self and others, we might reasonably assume that our offer of service can be equally multifaceted. A coaching approach may adopt both a prevent/ treat orientation and a promote/protect orientation. Thus, we might conceptualise the role of coaching in mental health as occupying a range of potential positions along a continuum of involvement and influence. At one end of the continuum, coaches might adopt the role of advocate for mental health at a national level. The developmental agenda that underpins coaching along with the skills in facilitating conversations in which coaches are trained might enable dialogues that make a difference - amongst the public, in lobbying and pressure groups, in the media and at the level of policy development.
Moving along the continuum are opportunities for shaping the knowledge and responses of organisations who wish - or perhaps need - to embrace a culture of well-being and flourishing. Working with organisations, we might seek to enable conversations that promote a shift in culture in which emotional well-being increasingly becomes a daily, enacted value. Coaches may also seek to contribute their expertise specifically to health care systems, specialising in coaching clinicians and leaders in health care systems to move from expert to empowerer, building transparent and collaborative systems, supporting the development of relationships across health and social care and creating meaningful approaches for building staff resilience and well-being.
Those with an interest and specialist knowledge in this area could also contribute to the work of professional bodies who need to be invested in the wellbeing needs of their members. Although not a direct focus of this chapter, the statistics relating to the prevalence and incidence of mental health problems as well as the reality of living and working in a wicked world suggests that coaches will need to attend to these factors within themselves, not solely in terms of maintaining fitness to practice but also in terms of developing methods of self-care that will sustain them over the course of their lives and careers. There may be those who choose to specialise in researching and developing interventions that are tailored to the mental health and emotional well-being needs of coaches themselves.
However, the previous section on salutogenesis also suggests the potential for a more radical paradigm shift as health care increasingly embraces person-centred care over and above the notion of working exclusively with any diagnosed illness. Such a paradigm shift could open a variety of opportunities for coaches. In her scoping review of mental health coaching Bishop (2018), for example, suggests that coaching could have a role to play in medication withdrawal given the success of coaching in smoking cessation. Becoming experts in the delivery of mental health first aid would also be an avenue for influencing understanding and responding in others.
An even more radical departure from traditional thinking could take the form of a coaching workforce who are identified and registered as specialists in the field of mental health and who carve out a unique contribution alongside other mental health professionals. In some instances, this may take the form of delivering coaching as an adjunctive intervention alongside other, more traditional mental health interventions such as psychotherapy and medication, or delivering coaching interventions tailored for individuals living with mental health issues. Dualtrained practitioners (i.e. those trained as both coaches and therapists) are already an emerging group and are well-placed to participate in some of the innovations outlined earlier. However, over the longer-term coach training programmes may be commissioned to offer formal, certificated professional development opportunities that train experienced coaches in the specialist knowledge and qualifications they need in order to lay claim to an ultimately protected title of ‘mental health coach’.
These are just some of the many ways in which the field of coaching and the professionals who make up this workforce might move into the mental health arena. Initially, it will be up to each of us to create a ‘personal brand’ in which we are able to make the claim for being specialists by practice and to create methods of learning and development that reflect the work we are increasingly called to deliver. This would introduce further diversity within the coaching community. However, coaching has always embraced diversity and so arguably, it is well-placed to champion new forms of practice at the cutting edge of human need. Any developments of this nature will, of course, have significant implications for the training, credentialing, supervision and continuing professional development of coaches and ultimately, progressing coaching within this field will require the full participation of both training institutions and the professional bodies. Challenging conversations will lie ahead. And yet this is also consistent with the spirit of our times - one in which we are coming to terms with the fact that the old ways of conceptualising and responding to our collective well-being needs are no longer sufficient. As a field coaching is uniquely placed to question, facilitate, challenge, collaborate, co-produce and empower all those who are trying to generate effective responses to what is one of the greatest challenges of our times.
Despite the advancements that the human race has made on so many levels, the number of individuals who are living with significant levels of emotional distress appears to be increasing. Innovative approaches to conceptualising and working with mental health issues are going to be essential if we are to find sustainable solutions to this complex area of human need. This chapter has been based on the potentially controversial premise that coaching has an important, emerging role to play in working with mental health issues. In particular, we have sought to raise awareness of how common mental health problem might present in our clients, how we can enhance our awareness of the warning signs of reduced well-being and how to increase our confidence in responding appropriately when a mental health problem becomes evident.
We have also argued that the time is ripe for a paradigm shift, one in which coaching has a potentially central role to play. The complexity and scope of issues emerging in relation to our collective mental health calls for responses from a range of disciplines working collaboratively rather than as silos. The solutions to wicked problems, of which we consider mental health to be one, will require the development of transdisciplinary relationships that can contribute novel approaches to knowledge generation from a willingness to draw upon a plurality of perspectives. As part of a transdisciplinary agenda, we believe that coaching has a unique contribution to make to the tapestry of services and service providers to which the wicked problem of mental health may be giving rise. We hope that this chapter might help start the conversations that are needed for this paradigm shift to come to fruition. The potential is enormous if we are willing to embrace it.
Antonovsky, A. (1979). Health, stress, and coping. San Francisco: Jossey-Bass.
Antonovsky, A. (1987). Unraveling the mystery of health: How people manage stress and stay well. San Francisco: Jossey-Bass.
Antonovsky, A. (1996). The salutogenic model as a theory to gtride health promotion. Health Promotion International, 11(1), 11-18.
Barber, H. F. (1992). Developing strategic leadership: The US Army war experience. Journal of Management Development. 11,4-12.
Bishop, L. (2018). A scoping review of mental health coaching. The Coaching Psychologist, 14, 5-15.
Brown, V. A., Hanis, J. A., & Russell, J. Y. (2010). Tackling wicked problems through trans-disciplinary imagination. London: Earthscan.
Buckley, A., & Buckley, C. (2006). A guide to coaching and mental health: The recognition and management of psychological issues. New York: Routledge.
Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders. International Review of Psychiatry, 23,375-384.
Corrie, S. (2016). Promoting self-care in a complex world: What every coach should know. Paper presented at the SGCP Coaching Psychology Workshops and Conference, London.
Corrie, S. (2017). SGCP research network. What role do coaching practitioners have in working with mental health issues? Results of a survey. The Coaching Psychologist, 13(1), 41-48.
Come, S. (2019a). Broadening our horizons: Why coaches should specialise in mental health. Paper presented at the International Conference of Coaching Psychology 2019, London.
Come, S. (Producer). (2019b). What do coaches need to know about mental health? Webinar for the Special Group in Coaching Psychology.
Come, S., & Lane, D. A. (2015). Things to keep us awake at night: The challenges of being a psychologist in the UK. Psychology Aotearoa, 7,140-144.
Deci, E. L., & Ryan, R. M. (1985). Intrinsic motivation and self-determination in human behavior. New York: Plenum.
Eriksson, M. (2017). Tire sense of coherence in the salutogenic model of health, hr M. B. Mittehnark, M. Eriksson, J. M. Pelikan, G. A. Espnes, S. Sagy, G. F. Bauer, & B. Lindstrom (Eds.), The handbook of salutogenesis (pp. 91-96). Cham, Switzerland: Springer Nature. http://doi.org''978-3-319-04600-6_l 1
Eriksson, M., & Lindstrom, B. (2006). Antonovsky’s sense of coherence scale and the relation with health: A systematic review. Journal of Epidemiology & Community Health, 60(5), 376-381.
Eriksson, M., & Mittehnark, M. B. (2017). The sense of coherence and its measurement. In M. B. Mittehnark, M. Eriksson, J. M. Peiikan, G. A. Espnes, S. Sagy, G. F. Bauer, & B. Lindstrom (Eds.), The handbook of salutogenesis (p. 97). Cham, Switzerland: Springer Nature. http://doi.org'T0.1007/978-3-319-04600-6_12
Grant, A. M. (2017). The third ‘generation’of workplace coaching: Creating a culture of quality conversations. Coaching: An International Journal of Theory, Research and Practice, 10(1), 37-53.
Gray, D. (2016). Developing resilience and wellbeing for healthcare staff dining organisational transition: The salutogenic approach. International Journal of Evidence Based Coaching and Mentoring, 14(2), 31-47.
Gray, D. (2017). Developing leadership resilience through a sense of coherence. Contemporary Leadership Challenges, 15. http://doi.org/10.5772/64611
Gray, D., Burls, A., & Kogan, M. (2014). Salutogenisis and coaching: Testing a proof of concept to develop a model for practitioners. International Journal of Evidence Based Coaching & Mentoring, 12(2), 41-58.
Green, H., Mcginnity, A., Ford, T, & Goodman, R. (2005). Mental health of children and young people in Great Britain 2004. Basingstoke, Hampshire: Palgr ave Macmillan.
Jenkins, R., Meltzer, H., Jones, P. B., Bruglra, T, Bebbington, P., Farrell, M.,... Knapp, M. (2008). Foresight mental capital and wellbeing project. London, UK: The Government Office for Science.
Joseph, S., & Sagy, S. (2017). Positive psychology in the context of salutogenesis. In M. B. Mittehnark, M. Eriksson, J. M. Pelikan, G. A. Espnes, S. Sagy, G. F. Bauer, & M.-L. Lindbohm (Eds.), The handbook of salutogenesis (pp. 83-88). Cham: Springer.
Keyes, C. L. M. (2014). Mental health as a complete state: How the salutogenic perspective completes the picture. In G. F. Bauer & O. Hammig (Eds.), Bridging occupational, organizational and public health: A transdisciplinary approach (pp. 179-192). Cham: Springer.
McManus, S., Bebbington, P, Jenkins, R., & Brugha, T. (Eds.). (2016). Mental health and wellbeing in England: Adult psychiatric morbidity survey 2004. Leeds: NHS Digital.
Mittehnark, M. B., & Bauer, G. F. (2017). The meanings of salutogenesis. In M. B. Mittehnark, M. Eriksson, J. M. Pelikan, G. A. Espnes, S. Sagy, G. F. Bauer, & B. Lindstrom
(Eds.), The handbook of salutogenesis (pp. 7-13). Cham, Switzerland: Springer Nature.
Spence, G. B., & Deci, E. L. (2013). Self-determination theory within coaching contexts: Supporting motives and goals that promote optimal functioning and well-being. In S. David, D. Clutterbuck, & D. Megginson (Eds.), Beyond goals: Effective strategies for coaching and mentoring (pp. 85-108). Abingdon, UK: Gower.
Stelter, R. (2014). Third generation coaching: Reconstructing dialogues through collaborative practice and a focus on values. International Coaching Psychology Review, 9(1), 51-66.
Stelter, R., & Andersen, V. (2018). Coaching for health and lifestyle change: Theory and guidelines for interacting and reflecting with women about their challenges and aspirations. International Coaching Psychology Review, 73(1), 61-71.
Szymanska, K. (2019). Coachee mental health: Practice implications for coaching psychologists. In S. Palmer & A. Whybrow (Eds.), Handbook of coaching psychology, 2nd ed. (pp. 567-577). Abingdon, Oxon: Routledge.
Vos, T., Barber, R. M., Bell, B., Bertozzi-Villa. A., Biryukov, S., Bolliger, I., . . . Dicker, D. (2015). Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 336(9995), 743-800.
World Health Organization. (2001). Mental disorders affect one in four people. World Health Report. Retrieved from www.who.int/whr/2001/media_centre/press-release/en/
World Health Organization. (2003). Caring for children and adolescents with mental disorders: Setting WHO directions. Retrieved from www.who.int/mental_health/media/ enZ785.pdf.
World Health Organization. (2004). Promoting mental health: Concepts, emerging evidence, practice: Summary report. Retrieved December 20, 2019 from www.who.int/ mental_health/evidence/en/promoting_mhh.pdf
World Health Organization. (2014). Basic documents. Retrieved December 20,2019 from http://apps.who.int/gb/bd/PDF/bd48/basic-documents-48th-edition-en.pdf#page=l
World Health Organization. (2019). Mental health of older adults. Retrieved from www. who.int/en/news-room'fact-sheets/detail/mental-health-of-older-adults