We should be talking more about our mental health. Princes William and Harry have been encouraging us to do it. Celebrities and athletes are opening up. And this week Norwich City football club even used an advertised kit launch to raise awareness of mental health.
The culture is changing and that is a good thing. As a society we are getting steadily better at acknowledging the mental health challenges each of us face. Public attitudes towards mental health are becoming steadily more progressive. At the time of the NHS’s foundation in 1947, mental health remained stigmatised; those with mental health problems were often seen as “defective” and shipped off to “lunatic asylums”. The prevailing atmosphere prompted Aneurin Bevan, the founder of the NHS, to refer despairingly to the “isolation of mental health from the rest of the health services”.
Yet there remains “a gap between the rhetoric and reality” when it comes to mental health, as a 2018 report by the King’s Fund put it.
The public sphere may seem awash with celebrities and influencers waxing lyrical about their mental health struggles – at times it seems as if we are all trapped in one long loop of “awareness raising”. Yet usually absent from such conversation is any acknowledgement of the structural impediments that stand in the way of individuals getting the help they need. There is a widening gap between the increasingly ubiquitous rhetoric urging us to “open up”, and the lack of material resources society allocates to those struggling with their mental health.
I found this out for myself in the months following lockdown. I spent 2020 in Somerset looking after my elderly grandmother. For 12 months I had face-to-face contact with just a handful of other people, mainly other close relatives. I also spent several months during that period being maliciously stalked by a deranged online troll. My grandmother, who I was incredibly close to, subsequently passed away just as the worst of the pandemic appeared to be receding.
Needless to say, all of this took its toll on my mental health. During Covid I became habituated to a constant hum of background anxiety. For many months I struggled to get out of bed in the morning. Performing even the most basic tasks seemed futile. I waited patiently for the dark clouds of despair to pass as the worst of the pandemic subsided, but my dark mood continued to linger for many months, affecting every aspect of my life.
That’s when I decided to seek help. I decided not to “suffer in silence”, just as the various mental health campaigns say. I spoke to my GP and she recommended counselling. Ultimately she would prescribe me an antidepressant; however she believed (and I agreed with her at the time) that it would be beneficial (at least initially) to try to address the root causes of how I felt instead of putting me straight on to medication. I was referred for NHS counselling, and then I waited.
And I waited and waited. Six months passed and still I had not heard anything. I was more than ready to “open up” about my mental health. Indeed, I had fully bought into the idea that talking to someone about my problems was superior to bottling them up. Yet there appeared to be nobody in the NHS who was willing to listen. And so in the end I decided to pay privately to see a therapist. This was pricey but I was lucky to have some spare cash available. On the other hand, I despaired for those less fortunate than myself. What, I wondered, happens to them?
The answer is that they languish on waiting lists. Or if they do receive help it is often of poor quality. According to the 2020 annual survey from the Care Quality Commission (CQC), people are consistently reporting poor experiences of NHS community mental health services, with few positive results. It is estimated that eight million people in England with mental health problems are unable to get specialist help because they are not considered sick enough to qualify. This is in addition to the official waiting list for NHS mental health care, which stands at 1.6 million people. This figure includes 374,000 under-18s.
The pandemic has exacerbated the demand for mental health care. The Centre for Mental Health think tank estimates that 8.5 million adults and 1.5 million children will need additional support for mental health problems because of the pandemic. A report released at the end of 2020 by the mental health taskforce at the Department of Health and Social Care warned that mental health providers were seeing a sharp rise in new patients following the onset of the pandemic. According to the Office for National Statistics (ONS), depression rates have doubled since the start of the pandemic.
As things stand there simply isn’t enough money allocated to mental health provision in the UK. Mental health accounts for nearly a quarter (23 per cent) of the disease burden in the UK but receives only 11 per cent of NHS spending. NHS Providers, a membership organisation for the NHS hospital, mental health, community and ambulance services, says the amount spent on mental health provision in England needs to increase from £14.3bn to at least £17.2bn to cope with rising demand and deal with the backlog from the pandemic.
Warm words from celebrities and members of the royal family may help to further erode the stigma attached to mental health disorders, however they do little to improve access to the material assistance that many people need. Mental illness may not discriminate – princes William and Harry have talked candidly about how the death of their mother, Princess Diana, has affected them. But it is the poor and the unemployed that are disproportionately likely to struggle with mental health problems.
Talking about mental health, therefore, means talking about financial health. Poverty and joblessness are strongly correlated with poorer mental health outcomes, and a lack of funding for NHS mental health services mean that services relied upon by the poor are often poor services.
We might seek to address some of the wider root causes of depression and anxiety. As Richard Wilkinson and Kate Pickett, authors of The Spirit Level, have written in the Lancet, “greater inequality is associated with higher rates of mental illness, especially depression and anxiety disorders”.
There is a growing gap between sanctimonious mental health rhetoric – “be kind”, “talk to someone”, “open up” – and the glaring lack of material support provided for mental health in the UK. Celebrities, members of the royal family and small-state conservatives may be reluctant to talk about the structural barriers that prevent ordinary people from getting the help they need when it comes to their mental health. But that is precisely where any awareness-raising campaign worth its salt should begin.