Mental health awareness isn’t enough

This is an article from the upcoming second issue of the New Economics Zine. You can read the full issue here

This week is Mental Health Awareness Week, one of several annual events in the UK and internationally to draw attention to mental health issues and concerns. February marked the annual Time to Talk day, a day aiming to encourage all of us to be ​“more open about mental health – to talk, to listen to and change lives”. This is a common response to mental health these days, with celebrity endorsements galore. Even members of the royal family have launched their own campaign — Heads Together — to ​“end the stigma around mental health” by changing ​“the national conversation about mental wellbeing”.

Talking about mental health is clearly very important: it can help us cope with illness and can undermine the stigma that has been too prevalent for too long. And especially now, when fear, worry and concern related to Covid-19 is sweeping the globe and levels of stress and anxiety are high.

People feel more able to talk about mental health than ever before and we are now looking for support from our friends and family and from health services. Given the increased propensity to talk about mental health you could conclude that things are on the up for the 25% of people who experience a mental health problem each year. But too much emphasis on talk risks covering up less encouraging trends.

First off, both mental and physical health have been deteriorating for some groups of people, because the conditions in which we are born, grow, live, work and age are worsening. Our broken economic model is at the heart of this. Neoliberalism is making us sick. And as research by the Mental Health Foundation point out, the current pandemic, lockdown and associated measures are likely to ​“reproduce and intensify the financial inequalities that contribute towards the increased prevalence and unequal distribution of mental ill-health.”

Talking about mental health won’t help, unless it extends to the talking about the reasons why so many experience mental ill health, and what collective action we can take to address those drivers.

Secondly, as the stigma around mental health clears, more of us are seeking care when we need it. This, along with the rise in ill health, is driving demand for mental health services. While it’s clearly a good thing that people are no longer suffering in silence, mental health services do not have the resources to help everyone who make contact with them. What’s the point in encouraging people to be open about mental health and seek support if that support is not available?

Mental health has never been as high a political priority as physical health, and the result has been less money for mental health services. Mental health accounts for 28% of the burden of disease in the UK but mental health services receive only 13% of NHS spending. Funding for mental health research is particularly poor. Currently the NHS spends only about £9 per person affected by mental illness – which has remained roughly unchanged in the last decade. This contrasts to cancer research where total spending equates to £288 per person affected.

The result of underfunding is wide ranging, including long waiting lists for support and a workforce stretched to breaking point. It has even been reported that some commissioners insist that patients have to have had suicidal thoughts before they can be referred for support in an effort to keep costs down. Services for children and adolescents are particularly overstretched: around 75% of young people experiencing a mental health problem are forced to wait so long that their condition gets worse, or they are turned away and are unable to access any treatment at all.

And for many during this pandemic, it has become even harder to access care. A recent survey by the Rethink Mental Illness found that 42% of respondents said their mental health had got worse during the crisis because they are getting less support from services.

If you do manage to access care, treatment tends to be one size fits all, with most receiving Cognitive behavioural Therapy (CBT) through the Improving Access to Psychological Theories (IAPT) programme. While this is the right treatment for some, it isn’t suitable for everyone. Only one in five people who undergo treatment have a reliable recovery and 40% drop out after starting the course.

Recent years has seen an increased commitment to valuing mental health equally with physical health, supported by commitments to increase funding. The NHS long-term plan – which sets out how extra money for the NHS is to be spent – commits to increasing mental health spending by at least 2.3 billion a year by 2023/​24.

But these commitments are not enough. The Health Foundation notes that commitments ​“will mean simply maintaining the status quo which sees just four in 10 people who need it receive mental health support”. Mental health services would need an extra £0.7 billion (30% extra) on top of the cash promised just to increase this to seven in ten. Doctors still identify insufficient funding for mental health services as one of the most significant barriers to providing optimal mental healthcare.

Talking about mental health is clearly very important. But in a time when the wider conditions in which we live drive increasing rates of mental ill health and health services are unable to cope with increasing demand, talk is not enough. We need to address the drivers of mental ill health and ensure universal access at the point of need to high-quality mental health services.

This is an extract from the New Economics Zine issue 2. Read the full issue here

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