Using the Power Threat Meaning Framework in Mental Health Nurse Education

Scholars call for international mental health nurse curriculum to shift to a rights-based approach and teach the Power Threat Meaning Framework


A new article, published in Nurse Education Today, outlines how the Power Threat Meaning Framework (PTMF) can be used in mental health nursing education. The article is written by Alec Grant, an independent scholar, and Jonathan Gadsby, Teaching and Research Fellow for Learning Disabilities and Mental Health Nursing at Birmingham City University in the UK. The authors outline PTMF, describe how it will benefit the international field of mental health nursing to adopt this framework and provide recommendations for implementing it in nurse education programs. Critiquing the current model for nursing education, the authors write:

“Like people in general, nurses and their educators are comfortable wrapped in ideological blankets and work hard to protect their narrative fidelity. For many, this includes fidelity to an illness model that has directed and justified their professional behavior for seven decades or more.”

Photo Credit: Max Pixel

The authors suggest that PTMF is at the “heart” of a “human rights-based revolution in conceptualizing and understanding psychological distress.” This movement is supported by the United Nations Office of the High Commissioner for Human Rights Special Rapporteur, Dainius Pūras, who has critiqued the dominance of a medical model in mental health and an over-reliance on psychiatric medication.

According to the authors, PTMF “is grounded in the core assumption that people actively make sense of their lives in interdependence with their relational, social, material, cultural and spiritual environments.” PTMF focuses on the relationship between four dimensions that influence psychological distress: the operation of power, threats derived from negative operations of power, socially produced meaning, and threat responses that are people’s survival reactions to power. The authors highlight that PTMF is designed to “describe what people may do in certain contexts, not symptoms or disorders that they ‘have.’”

In this way, the PTMF is intended to be “free of the western culture-centrism associated with the APA and WHO diagnostic systems” and could provide an alternative to these medicalized psychiatric diagnostic systems (e.g., DSM, ICD). The authors critique biomedical models for being “decontextualizing, marginalizing, and by extension stigmatizing and ‘othering’” of people with psychological distress. According to the authors, a biomedical model results in “epistemic injustice,” which is a violation of “the individual as an expert knower of their lived experience.”

“The revised role of biology in the PTMF… is also an acknowledgment of the problematic nature of contemporary genetic science, which does not support the largely reductionist perspectives of biomedical psychiatry,” write the authors.

The authors call for PTMF to become the foundation of a rights-based, international mental health nurse curriculum. Rather than nurses being “conduits for ideological powers,” the authors think that “the PTMF makes it necessary for nurses to also develop as intra-disciplinary activists.”

“This places a need for nurses to develop their role as curious co-inquirers, in the service of helping users become more sophisticated in recognising the interrelated links between power, threats, threat responses and the development of ameliorating factors,” state the authors.

The authors acknowledge barriers to implementing PTMF curriculum in nursing programs. They state, “it is still arguably the case that the discipline of mental health nursing seriously fails to grasp the depth of trouble that diagnostic psychiatry is in.” They discuss that it would be difficult to make a one-time paradigm shift in nursing education, but also share concerns that step-wise changes “brings the danger of diluting the framework to the extent that it does little to challenge the bio-orthodox status quo.”  As a start, they propose that nursing students are trained in PTMF and that pathologizing vocabulary be dropped from the curriculum.



Grant, A., & Gadsby, J. (2018). The Power Threat Meaning Framework and international mental health nurse education: A welcome revolution in human rights. Nurse Education Today, 68, 1-3. (Link)

Previous articleDoubt is Our Product
Next articlePsychiatrist’s Depression Shapes His Treatment of Young People
Shannon Peters
MIA Research News Team: Shannon Peters is a doctoral student at the University of Massachusetts Boston and has a master’s degree in mental health counseling. She is particularly interested in exploring the impacts of medicalization and pathologizing the experiences of individuals who have been affected by trauma. She is engaged in research on the effects of institutional corruption and financial conflicts of interest on research and practice.


  1. “it is still arguably the case that the discipline of mental health nursing seriously fails to grasp the depth of trouble that diagnostic psychiatry is in.” As is also the case for the psychiatrists and pretty much all the “mental health professionals.”

    What do you do when you have entire groups of industries that are completely delusional? Who are ironically running around like lunatics declaring all who don’t agree with them “delusional.” Especially when they are multibillion dollar industries, and we all know, “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

    And the “mental health industry” has been given the right to murder anyone they want, for any reason, outside the law, by our government. Resulting in what has become an American Psychiatric Holocaust, primarily of child abuse victims, according to the “mental health industry’s” own medical literature.

    We are living through a Psychiatric Holocaust of our society’s weakest members. “A society will be judged on the basis of how it treats its weakest members.” The “mental health professionals” really need to be red pilled and woken up! They’re destroying America, particularly our children.

    We need to take away the psychiatrist’s right to force drug people. “Power tends to corrupt and absolute power corrupts absolutely,” so giving ANY group of people the right to defame, drug, torture and murder at will, and outside the law, was a wildly stupid idea.

    The entire DSM should be flushed down the toilet, where it belongs. But at a minimum the DSM5 change, that makes the completely iatrogenic, ADHD and antidepressant induced, pathway to a “bipolar” diagnosis acceptable, needs to be rescinded. No doubt that was the psychiatric industry’s way of saying FY to Robert Whitaker, and work to proactively prevent a huge wave of needed malpractice suits. Perhaps “bipolar” should be removed from the DSM, since it’s now largely an iatrogenic illness, not an illness with a “genetic” etiology.

    Both neuroleptic induced deficit syndrome and antidepressant and/or antipsychotic induced anticholinergic toxidrome need to be added to the DSM, which should allow for the removal of the “schizophrenia” diagnosis. Given NIDS creates the negative symptoms of “schizophrenia” and anticholinergic toxidrome creates the positive symptoms of “schizophrenia.”

    Given the enormous percentages of child abuse victims labeled with the DSM disorders. Child abuse, which is currently classified as a “V Code” in the DSM, and is NOT an insurance billable disorder. Which has resulted in millions of child abuse victims being mislabeled with the billable, but scientifically invalid, DSM disorders. Child abuse should be made a billable “disorder,” although it’s actually a crime. But child abuse victims deserve to be helped, rather than defamed, drugged, tortured, murdered and in any way possible, psychiatrically silenced en mass. Which is what today’s “mental health professionals” are currently doing.

    And I will point out that when our society has a group of multibillion dollar, primarily child abuse covering up, “mental health” industries. These industries are, of course, also aiding, abetting, and empowering the child abusers, which is harmful to our society as a whole. And has resulted in our society having run amok child trafficking and pedophilia problems, even according to world leaders.

    Let’s hope and pray today’s “mental health industry” will soon get out of the pedophile protection business. All people should be disgusted by this enormous societal problem.

    Report comment

    • The thing they would get over: “For many, this includes fidelity to an illness model that has directed and justified their professional behavior for seven decades or more.”

      Emphasis added.

      This recovery from an “illness model” doesn’t exclude fidelity to a “traumatic injury model” in their imaginations I would think, and, therefore, PTMF represents a perceived need for additional psychiatric nurses and, with them, another way to fall into the “mental health” trap.

      Report comment

          • I don’t know if you have personal experience with chronic childhood trauma, but I certainly would not argue with someone who said I’d been traumatically injured because that would at least acknowledge that I was not genetically inferior or brain diseased and that reacting poorly to abuse is expected. It’d be pretty heartless to tell someone who scored a 9+ on the ACES scale like I have that they hadn’t been traumatically injured.

            Report comment

          • It seems that just because the term “mental illness” is deliberately twisted around and its figurative nature concretized we shouldn’t always have to automatically reject every metaphor as dishonest. While “illness” is not a concept applicable to a mind, I don’t think it necessarily follows that “trauma” is not a term applicable to emotional as well as physical states. I do oppose words such as “psychosis” however, as they clearly pathologize a mental or emotional state. I just don’t know of another word that communicates what is meant by “trauma,” which I don’t think automatically equates with “mental illness.” But it’s a very fine line.

            Report comment

    • It would take some mental gymnastics to reconcile what the ‘PTMF’ contains and retain any adherence to a medical view. But I suppose people are nothing if not adaptive! The ‘PTMF’ at least realises that people’s true needs are outside any support services provided which need to operate as an adjunct to securing those resources.

      Report comment

  2. That’s what I’ve always thought.

    There’s only a few thousand psychiatrists in the UK so they don’t spend much time with people anyway. It’s nurses that know the people personally.

    Nurses are degree qualified people and they should practice the skills. If things work out everyone might be happy.

    Report comment

    • Is it? Seems to me that “the framework” is being used here to perpetuate “mental health.” At first I thought that the photo of the nurse with stethoscope was an ironic “Onion”-style put-on, but I guess not.

      This new permutation of “mental health” ideology apparently continues to euphemize and mystify the roots of alienation/trauma in the capitalist socio-economic structure, rather than clearly identifying them as such, and continues to focus on effects (victims) rather than causes, thereby guaranteeing a continuing supply of the former.

      This reminds me in an eerie way of when the clearly defined principles of the mental patients liberation/anti-psychiatry movement started to be watered down by the rhetoric of the “consumer” industry, which became more & more generic-sounding till it became meaningless, then counter-productive. Not saying this is the same thing but, as I sense a slight anti-anti-psychiatry backlash at MIA at the moment I think it’s something to consider, and guard against.

      Report comment

        • There should (hopefully) be a difference between the talking treatments and the neuroleptic treatments.

          I’m not too sure what the Power Threat Meaning Meaning is; in the same way that I don’t understand how “talking to your family” can improve your “Health” – but Open Dialogue has definitely been proven to work.

          I don’t support the term “Psychosis”, though.

          Report comment

          • There is definitely a difference between “treatment” which involves confinement and segregation from the community, or pseudo-hospitalization, and “treatment” which is freely given and received (i.e. literally, not just the tainted promise behind a plea bargain, voluntary.)

            Of course, there is a difference between talk therapy and drug therapy, but so often, as people don’t understand the dangers from the drugs, the two go hand in hand. It is only in exceptional cases that you find doctors who refrain from using the prescription pad, if at all, to excess.

            Somebody sells treatment, somebody else buys this treatment. The seller is accounted a success if he or she has a large number of buyers. Success in the buyers case is always a matter of continuing to buy. His or her “consumer/user” status is contingent upon buying. Cessation of “consumption”, of course, is not an option. You can’t be accounted a good “consumer/user” through stopping your “consumption/usage”.

            As the object is actually “consumption”, and not “health”, there can be no end to it. “Mental health” is the carrot on a stick. “Mental health” being a matter, simply enough put, of refusing to “consume” “mental health treatments”.

            Report comment

        • I wouldn’t equate alienation with trauma. Doing so skirts this idea of psychological trauma, or social “sickness”

          So what word would you use other than “trauma” (and rage) to describe your state of mind or being if, say, you answered the door and the cops burst in and shot your dog?

          Report comment

          • OK. Still holding off on the possibility that the experience would stay with you in a way that seriously affected your day to day life, and that one description of that state would be “traumatized”?

            Report comment

          • I’m still alive, OldHead. I have known people that are not around any more. If we were talking wartime experience, sure, it would stay with me awhile; however trash that pathology business, it’s something I can live much better without. I just see trauma, and especially “psychological trauma”, as another way to slap a pathological label on people who are physically healthy (i.e. to lie).

            Report comment

          • If you weren’t alive this would be largely moot. Anyway, I totally get the danger of “trauma” being pathologized. You can be physically healthy and still blown away emotionally so, if not “trauma,” how would you describe such a state?

            Report comment

      • I sense with the way consumer/user bondage to treatment is being encouraged here at MIA, and how comments that don’t promote that kind of playing up to medical fraud and malpractice are vanishing, more than a slight pro-treatment bias on this website, OldHead. No wonder Dragon Slayer (and a few other brave souls) may have departed, perhaps, for a hell of a good network next door.

        Report comment

  3. Mental health nurses- and what if someone do not represent their mental health assumptions? This is psychological facism, psyche means much more than only “normal’ – apollonian ego. So they will destroy everything which is beyond mental health strategy , which means, all human psyche – dionisian traits, psychological Hades and so on. Only apollonian ego is considered to be one healthy perception, the rest are illegal – Gypsy, Poles, Jews, Black, Russians =mentally ill.
    There should be PSYCHE DEFENDERS againts ego apollonian psychological fundamentalism. Mental health means – white Aryan race power in psychological world, the rest are to be exterminated. Because the only legal perception is to be rational ego apollonian member of society. Mentally ill are UNRECOGNIZED psychological minorities, like black (and so on) in a death camp ruled by invisible today (because of the lack of humanistic phenomenology of the psyche) – apollonian ego dictators. They are victims of primitive language and very low knowledge about the psyche in primary Greek meaning, because apollonian ego is psychologically blind, and have the least psychological perception – THE PERFECT BRAINLESS AUTHORITARIAN SLAVES. There is hierarchy in the psyche reality, and apollonian ego is on the borders of psyche (Apollo perceptionis out of touch with psyche) and they pretend they are the rulers, because of economical/semantics power they have over the PSYCHOLOGICAL minorities, in the middle of psyche there is death, no economics or authoritarian assumptions about mental health useless ideology. Middle finger of the most “severe mentally ill ” (slave)should be their god. Psyche logic is greater and far more different that authoritarian antypsychological psychopatic kind of perception. They have no knowledge about phenomenology of the psyche, their psychological world/perception starts and ends on money/economics which they consider to be the most valuable and ONLY ONE .And we should noticed this, that they who wants to rule the psyche are the least psychological, and they use language and economics to destroy the more valuable psychological minorities, which are also the poor ones IN MATERIALISTIC WORLD RULED BY EGO FUNDAMENATLISTS. Authoritarian world is the psyche worst enemy, because rationalists and theologians/spiritualists science law technology relligion(apollonian)have got nothing in common with human psyche,and human psyche is evil/satan or problem/sickness for them. Psyche means nothing for mental health representants, but those consider mentally ill should pray to their psychopatic apollonian ego. Never do this. Never pray to those who prey on psyche. There’s no good and bad in the ku klux klan, because Ku KLux KLan is evil.. Mental health in psychology means the same as Aryan race in materiallistic world. Remember that those considered normal gave Nobel Prize to a A HUMAN KILLER .Read Hillman -because he loves human psyche and psychiatrist loves only money and their power over those, they consider -useless and weak.Apollonians = your dirty authoritarian games against human psyche are a disgrace. Remeber that dionisian/hades powers awaits. No one ever wins with them. No one.

    Report comment