On Mental Health Awareness
This piece is intended as a prelude to an article about the current mental health crisis and the plight of the mentally ill in the UK. Use this link to proceed directly to the main article. There is a also a link at the foot of this page.
In a speech in January, the Prime Minister, Theresa May, said that for too long, mental illness had been “a hidden injustice in our country”, and pledged to transform the way mental health problems are dealt with “right across society”. This year has also seen a number of ‘mental health awareness’ campaigns being conducted through the various media.
There has been some concern in the UK, regarding what has been described as both a mental health crisis and a mental illness epidemic. According to a 2017 BBC report based on NHS digital statistics, at least 1 in 6 adults in England will experience a mental health problem at any given time . Of particular concern to many were reports in the Guardian (June/July 2018) stating firstly that schoolchildren are suffering from an ‘epidemic’ of mental illness and secondly that young people’s mental health is a ‘worsening crisis’ [2;3]. Furthermore, these represent the age group in which many long term conditions become established.
Their teachers are also struggling. The Independent (January 2018) reported that more than half of teachers have been diagnosed with mental health issues while the Guardian (April 2018) reported a 35% increase in teachers seeking mental health support over 12 months [4;5]. The extent of the problem is evident when statistics for both children and adults are combined. Whereas in the past many might have believed that mental health issues were something only affected others, today it is likely that we all know a family member, friend, colleague or neighbour who experiences mental health problems.
The response of the NHS Chief was to blame social networks [6;7]. Of course, the CEO was primarily referring to the mental crisis amongst the young. Cyberbullying and trolling are often held responsible for the mental problems experienced by young individuals. Concerns have also been expressed about excessive internet use (to the exclusion of other activities) and ‘social media addiction’. The latter is not a formal clinical diagnosis and is perceived by some as meaning excessive social media use . But others have suggested that it may go further than that with, to give just one example, the allure of ‘Likes’ and ‘retweets’ providing much needed validation for some users . There are even suggestions that such features were deliberately and perniciously introduced by some social media platforms for financial gain .
However, to focus attention on social media is to ignore the many other and more obvious contributory factors that affect the wider population including the pace of major changes in lifestyle, austerity, exploitative conditions of employment, the reduction or complete withdrawal of state benefits, accommodation issues, lack of both personal and financial security plus increased levels of intolerance and bullying, amongst other potential causes. In particular, stringent cuts in public services have considerably reduced the availability of the help and support that the most vulnerable in society would have turned to in the first instance of any problem. It is then left to the already struggling police service and NHS to pick up the pieces of the resultant catastrophe.
Police ‘spend 40% of time on mental health’
Click image for video link (opens in new tab)
Service Provision and Funding
Raising awareness that at least 1 in 4 of us will experience mental health problems during our lives is one thing. Treating the problem is another. The various media pieces also describe a lack (or even absence) of availability of mental health services in many areas. Most media reports focus on a particular area making it difficult to see the national picture. Both lack of staff and (mainly) lack of funding are cited as being responsible for the problems. The Independent (November, 2017) reported ‘damning findings’ by the Care Quality Commission (CQC) showing that 26 per cent of people who had fallen into a mental health crisis during the previous year said they did not feel they got the help they needed from care services. In the same report, the latest annual survey of community mental healthcare also showed that a quarter of respondents reported they had not seen workers from their mental health services often enough to meet their needs in the previous year. Long and potentially damaging waits for treatment were also reported . These figures represented a decline in service over previous years for which lack of funding was blamed. Although this report related to patients with acute mental illness, it does raise questions about lower level services which might be seen as less of a priority.
In 2014, The Guardian polled its readers and reported “battles for diagnosis, lengthy waits for treatment, an over-reliance on drugs, and, frequently, an abject lack of compassion” as the picture of NHS mental health care being painted by people with mental health problems, their families and professionals. The respondents had described a system that was “profoundly broken” and the incoming president of the Royal College of Psychiatrists, Prof Sir Simon Wessely, had suggested people would be “absolutely appalled and screaming from the rooftops” if those going without treatment had a serious physical condition rather than mental health problems .
Stung by criticism that for decades mental health has been a ‘Cinderella service’, the NHS launched its Five Year Forward View plan in the same year (2014). The plan was not specifically about mental health services but provided a blueprint as to how NHS services could be restructured across the board in order to meet financial constraints and cover a £30 billion gap between NHS resources and demand. The plan envisaged much less healthcare being provided in hospitals and much more in community settings . Four years into that plan, the NHS now claims that an additional 120,000 people are receiving specialist mental health treatment and that a significant increase in “talking” therapies will result in 60,000 more people receiving treatments for common mental health conditions by the end of this year . These treatments for common conditions are primarily short courses (6 – 8 sessions) of CBT focused on a single symptom. According to the Health & Social Care Centre (2016) the average provision is 6.4 sessions per patient. This will fall far short of addressing the crisis.
The 2017 BBC report included an announcement that extra money had been earmarked for mental health services in England (with additional investment in other parts of the UK). This meant that, by 2020-21, £1.28bn more would be spent in real terms than had been spent 2015-16 . The announcement received criticism because an analysis by the King’s Fund health think tank had found that 40% of mental health trusts in England had actually seen their budgets cut in 2015-16.
There was also criticism because, according to ministers, the ‘extra’ money was to be spent primarily on Accident and Emergency departments and crisis teams rather than in improving the availability of the low and medium level treatment that would help to prevent many crises and emergencies from developing. In the long-term, this will prove more costly for the NHS and state. For other reasons it will also prove to be costly for those suffering mental illness and their families.
It is interesting to note that the article about the increased funding appeared on the BBC News website in September 2017. It was therefore a surprise when the increase in mental health funding to be spent on A&E departments and community crisis teams was announced (again) in Chancellor Philip Hammond’s budget speech on Monday (29th October, 2018) and featured prominently in the BBC News coverage throughout the day. I was left wondering how much mileage the government expected to get out of regurgitating the same announcement over and over. At very least, it demonstrates disingenuousness on the government’s part and the BBC should also be criticised for failing to point this out to its viewers.
The 2017 BBC article also stated that while mental health accounted for 23% of NHS activity, it only accounted for 11% of the NHS budget. This means the mental health budget is less than half (0.48) of what might be expected. I recalled being given a similar statistic as an indication of the extent to which mental health is the poor relation of the NHS in 1973, during the introductory lecture of a course in ‘Abnormal Psychology’ that I attended as part of my teacher training. Then, the corresponding statistic was two thirds of what might be expected (0.67). At the time it was assumed that matters would improve over the years but my calculation shows that the current level represents a 28% decline in mental health budget, relative to activity, since 1973. Likewise there are issues with mental health research funding.
NHS Digital – “Only 1 in 3 of those with a mental illness in England are receiving treatment “ 
The failure to provide adequate mental health services and the provision of therapies that are perceived as brief and trivial in comparison to the severity of the problem, only serve the mentally ill in increasing their sense of abandonment and lack of hope.
There were some improvements in attitudes towards the mentally ill between 2009 and 2016 but even so, 20% of people were still unwilling to work with or live nearby a sufferer of mental ill health and 30% were unwilling to live with a sufferer . Despite the improvements, nearly 9 in 10 people who have had mental health problems report they have suffered stigma and discrimination.
Perhaps as a result of the void in provision of mental health services, various bodies and commentators have made suggestions, albeit well-meant, that demonstrate a lack of awareness of problems faced by the mentally ill. This is perfectly understandable because many symptoms might sound the same as those we might all experience from time to time and people cannot reasonably be expected to understand the problems unless they experience them for themselves (which would be wholly undesirable of course). Besides, sufferers will often find that no normal vocabulary exists with which to describe how they feel. When the media propagate these suggestions under the headline of ‘mental health awareness’ this would appear to represent a contradiction.
Some have suggested that lifestyle changes such as diet and especially taking exercise could be therapeutic and there is no denying that a healthy diet and exercise are beneficial to health in general. Mental health problems are complex and under any given ‘umbrella’ diagnosis, the symptoms may differ between individuals. There may, for example, be changes in appetite while mental exhaustion can lead to difficulties in organising and performing simple tasks like shopping and cooking. There may even be difficulties in leaving the house. Stress and anxiety are sometimes causes of myalgia, the symptoms of which include muscle and/or joint pain, weakness and exhaustion. This happens because the muscles are already overworked from stress and further exercise will not only be gruelling but may be counterproductive. Activities that make other people feel good or happy are unlikely to fulfil the same purpose for depressed people who are unable to produce enough serotonin to serve as a reward. These are just a few examples and this is not to say that people with mental illness never eat healthy food or exercise. Some will do so meticulously. In either case they are probably managing their diet and physical activity as best they can.
Another frequently heard suggestion involves the help and support of others such as family and friends. For many sufferers there simply is no one else to help. Even supportive families and friends cannot always be expected to understand the nature of the illness and are often in denial about its severity simply because they care. Besides, mental illness often involves an element of unresolved anger where family and friends may feel they are in danger of becoming the ‘whipping posts’. An environment away from immediate family and friends will provide a ‘safer’ place to explore such issues with a qualified therapist. Nor should we forget that families also suffer when a member has a mental illness.
It is presumably as a result of this crisis that various ‘mental health awareness’ campaigns have been prominent in the media in recent times. Most of these aim towards a preventative role in improving the nations mental health by tackling stress. Very few are focusing on offering help and support to those affected by mental illness. These are both worthwhile aims but surely one outcome of any mental health awareness campaign should be an improved understanding of the problems faced by those with a mental illness. One of the best things that many could do to support someone they know who has a mental illness would be to both listen to them and to try to understand.
The voices of those who suffer mental illness could contribute much to an awareness of mental health issues yet are the voices that are most likely to be omitted from the debate. I admire the courage of those celebrities who have come out in describing their experience of mental illness in public and through the media. Their statements have impact because people have listened to them. Even so (and we should not think less of them for this), they tend to be people whose wealth and fame can provide options for support and therapy that are not available to most people. Thus their experience will not be fully representative of the struggles faced by many others.
While most mental health problems will not make someone less intelligent, they can be disabling in other ways. Communication skills (including speech) can be adversely affected by the effects of trauma and cognitive dysfunction (such as concentration and memory problems) in addition to the symptoms already described. Some also fear that if they communicate effectively and this is discovered by a vindictive DWP, then they will have their benefits stopped. For example, if they were able to effectively communicate by means of a letter, they might then be deemed fit for clerical work. Of course, such attitudes exhibited by the DWP and witnessed in ‘capability for work’ assessments, fail to acknowledge how particularly arduous the task was for the sufferer or how long it took for that person in comparison to others. Nor does it recognise that sufferers may experience better days as well as worse ones.
The attitude of some capability for work assessors when dealing with the mentally ill is summed up in this very recent news report from the Disability News Service – LINK (opens in new tab).
A friend was recently moved to write an article about the plight of people suffering from mental illness in the UK. This included accounts of the experience of two people who had received NHS treatment. When my friend reported that being an ‘unknown’ writer, there seemed no obvious route towards publication of the article, I offered to host it on this site.
The article can be read here –
Likewise, I would be interested in hosting other accounts of experience of mental health treatment (or the availability thereof) during the last ten years in the UK. Accounts of any length and format will be useful. Contact me using the contact form (from the main menu) to contribute.
References & links:
 September 2017, BBC News Health
 June 23rd 2018, The Guardian
 July 31st 2018, The Guardian
 January 2018, The Independent
 April 2018, The Guardian
 June 2018, alphr Health
 June 2018, The Telegraph
 May 2028, Psychology Today
 July 2018, BBC News Technology
 November 2017, The Independent
 October 8th 2014, The Guardian
 October 23rd 2014, The Guardian
 July 21st 2018, The Guardian
 2016 National Attitudes to Mental Illness Survey, Time to Change
 ‘Children’ chart – BBC from NHS, Open Government licence
 ‘Funding’ chart – BBC from Kings Fund, CC non-commercial licence
 ‘Walking Man’ – pxhere, CC0 licence