nursingforsocialjustice

Health as an Inclusive Concept

Health seems like it should be an inclusive concept. To be healthy, it’s simple right? To be free from illness or injury. This should include all the things that lead to illness and injury. Yet, somehow, health has been divided and categorized into “mental” and “physical.”

We talk about mental health as if it sits apart from the rest of human experience, as though the mind can be separated from the body. But the body keeps the score, as we often say in mental health nursing, and the mind never leaves the body behind. So why do we continue to organize care as if they are distinct? I’m going to preface all of this by letting you know that this mind/body, physical/mental debate in health and medical science is not something I just made up, it’s a long standing issue in health care. It even has a name: the Cartesian Dualism.  This also isn’t my first kick at the can at writing about this. 

The Limits of the Medical Model

Much of our modern healthcare system is built on the medical model. It’s a structure that has saved countless lives through diagnosis, treatment, and control of disease. But it also comes with limits.

The medical model views health primarily through pathology: what is wrong, what can be fixed, what can be controlled. It is hierarchical by design, with physicians, often specialists, at the top, and other disciplines arranged in a system of referral, report, and order.

In mental health care, this model can feel especially strained. If our overarching structure is built upon hospital systems organized through medical logic, can we ever really move beyond it? I would like to think that we can band together as a nursing discipline and move to greener pastures and more holistic understandings, but this will be an uphill journey. 

Even now, decades into what’s called recovery-oriented care, we still tend to view psychiatrists as the “most responsible practitioners.” But is that always the best for the patient and family, or the care team, or health care? If recovery is a process defined by the person, not the provider, then who is “most responsible”? The language itself implies hierarchy, control, and ownership over care.

Where does that leave nurses, social workers, occupational therapists, recreational therapists, and other unregulated health care staff and clinicians? Most importantly, where does this leave people with lived and living experience?

The Models We Work Within

The recovery and psychosocial models of care emerged, in part, to challenge the dominance of medical authority. They emphasize hope, autonomy, and connection rather than symptom control alone. But how do they fit within institutions still structured by medical hierarchies?

Can a hospital truly be recovery-oriented if its policies, reporting structures, and risk management processes remain rooted in medical frameworks?

For nurses, this tension sits at the core of practice. Nursing has long been described as both an art and a science. We draw on multiple ways of knowing, empirical, ethical, aesthetic, and personal. We see the whole person in context, not just a diagnosis. Yet we also practice within systems that expect us to complete clinical documentation, administer medication, and monitor and assess according to largely biomedical parameters.

So where does nursing fit? Are we part of the medical model, or do we offer something distinct, something that bridges the divide between the biological and the human? I am also not the first nurse who has thunk these thoughts. If you want to read a spicy commentary on this complicated relationship (maybe handcuffs) of psychiatric nursing Dr. Time Wand recently wrote about this in the International Journal of Mental Health Nursing.  

Mental Prisons: Seclusion and Chemical Restraint

These questions are not abstract, they show up in daily practice in real and troubling ways.

Take the use of seclusion and restraint. We monitor seclusion carefully, how long a person is in the room, whether it’s justified, and whether it aligns with policy and human rights standards. But what about chemical restraint? Why don’t we monitor that with the same scrutiny?

Is it because medication is seen as treatment rather than control? Or because restraint delivered through a pill or injection feels less visible?

The World Health Organization has, over time, taken a stronger stance on coercive practices, urging a shift away from seclusion, restraint, and involuntary treatment wherever possible. Yet these practices persist, often justified in the name of safety.

Are hospitals, then, becoming holding tanks of safety—places where containment is equated with care?

Nurses and Medication: A Changing Relationship

The evolution of nurses’ relationships with medications tells part of this story.

Decades ago, nurses were gatekeepers of medication administration, following physicians’ orders closely. Over time, our roles expanded. Nurses became educators, advocates, and critical thinkers around medication rights. We learned to question whether medications were used therapeutically or simply to maintain order.

But as psychopharmacology advanced and documentation became tied to legal accountability, the balance between advocacy and compliance became more complex.

There’s also a cultural pull toward the clinically supported evidence-based, randomized controlled trial type of solution. Seemingly, medication can offer rapid relief in crisis (though probably not as rapid as we think and potentially equally as traumatizing), but it can also obscure deeper emotional and social needs. Cognitive and behavioural therapies take time. They require relationships, reflection, and trust. They are not quick, and they don’t always fit neatly into 15-minute check-ins or 30-minute rounds.

So what happens when systems reward efficiency over connection? When our metrics of success focus on reduced length of stay or medication adherence instead of meaningful recovery and quality of life?

Reimagining the Structure of Care

If we want to build systems that reflect a holistic understanding of health, we may need to rethink the structures themselves.

Perhaps care should not be “delivered” at all, as if health were a package dropped off at someone’s door. Maybe it should be co-created. What does that mean? It means we take our foundational principles of therapeutic relationships and build them together, through partnership, shared decision-making, and collective accountability. We centre the notion that this is a relationship in which we are also co-learning, from each of our respective places of experience.

What might mental health services look like if they were organized around nursing values rather than medical hierarchies? Nursing sees health as relational, contextual, and dynamic. We know that safety comes not from control but from trust. Healing is not just about symptom reduction: it’s about meaning, connection, and belonging.

A nursing model, one grounded in compassion, ethics, and lived experience, could change the fabric of mental health care. It could shift power, language, and policy toward something more human.

Returning to the Question of Health

If health is to be truly inclusive, it must embrace the whole person and the conditions that shape wellbeing: poverty, housing, belonging, trauma, and purpose.

It must also include the wellbeing of those who provide care. Systems that neglect the humanity of their workers cannot sustain the humanity of those they serve.

So perhaps the question is not simply why health is divided into mental and physical, but how we can reunite them. How we can rebuild systems that recognize the inseparability of mind, body, and community. How we can ensure that care, especially mental health care, is not about power or control, but about partnership, compassion, and hope.

Maybe the real recovery we need is not just for individuals, but for the systems themselves. Recovery is a process that we engage in perpetually, from the divisions and hierarchies that have fragmented what it means to be human.