Front page articles on mental health have become a regular occurrence. This week we learned that Britain’s biggest police force received a phone call relating to mental health every five minutes last year. And James Munby, head of the high court’s family division, hit the headlines this month referring to the case of girl X – a suicidal teenager for whom no secure bed was available. Munby wrote: “If this is the best we can do for X, and others in similar crisis, what right do we, what right do the system, our society and indeed the state itself, have to call ourselves civilised?”
I confess that my heart lifted as I listened to Theresa May standing outside No 10 just over a year ago. In her first speech as prime minister she referred to the “burning injustice” of “not having enough help to hand” if you suffer from mental health problems. Could it be, I thought, in those anything-is-possible post-referendum days, that the Brexit vote had somehow landed us a leader with a genuine social conscience. But then I had not yet become accustomed to the total breakdown of the relationship between words and meaning.
As a writer, my task is to make the gap between words and meaning as small as possible. Increasingly, politicians appear to have precisely the opposite objective. Words signify nothing – or rather they signify whatever you like; they do not connect to any sort of objective reality. So when, for example, the prime minister called mental illness a “hidden injustice”in our country, we need to understand that patient groups, doctors, professional bodies, charities and carers’ groups have for years been screaming at the government about a crisis in mental health funding. “It’s a car crash,” said professor Sue Bailey, former president of the Royal College of Psychiatrists, in 2014. “The system is in crisis, and we need people to listen.”
The extra £1.3bn for mental health, announced with great fanfare last month, needs to be understood to mean “extra” not in the sense of additional funds, but in the sense of already promised money, coming from existing NHS budgets, to be directed to providing an additional 21,000 mental health staff. The Royal College of Nursing remains sceptical, and who can blame it? Between 2010, when the coalition government came to power, and July 2016, the number of mental health nurses working in the NHS in England fell by 6,610, or almost 15% of the entire workforce.
As for repeated government claims of “record levels of spending on mental health”, it is hard to establish the facts as the Department of Health stopped publishing its annual study of spending on mental health services in 2013. Analysis by the health thinktank the King’s Fund found that in 2013-14 and 2014-15, 40% of mental health trusts saw budget reductions. These cuts, coupled with soaring levels of demand, have turned the issue of mental health into a full-on public scandal.
The clamour for help is driven by multiple factors, including greater awareness of mental illness, and broader societal pressures. Some of these have little to do with government policy: the rise of social media and other changes in technology, resulting in far less face-to-face contact, have strongly affected young people. According to Jean Twenge, professor of psychology at San Diego State University, the number of US teenagers spending time with friends nearly every day dropped by more than 40% between 2000 and 2015, with rates of loneliness sharply increasing.
Other pressures are the direct result of government policy. Consider the huge stress caused by changes to disability benefits, and to the way in which entitlement to such benefits is assessed. Take the case of Michael O’Sullivan, whose suicide was found by the coroner to have been triggered by the “intense anxiety” caused by his fit-for-work assessment by the Department for Work and Pensions.
O’Sullivan, who had long-term depression and agoraphobia, was found able to hold down a job by the doctor assessing him on behalf of the DWP, who discounted the views of O’Sullivan’s own doctors. Research led by Benjamin Barr of Liverpool University suggests that almost 600 suicides could be linked to the fit-for-work tests between 2010 and 2013, plus almost 300,000 extra cases of mental ill health and increased use of antidepressants.
Reductions in benefits, being unable to pay the rent, growing debt, and pressures at work: all these also have a huge impact on wellbeing. For someone with mental health issues, the resultant stress can be enough to turn a manageable situation into an unmanageable one. I can think of three such instances in the last year just from within my own acquaintance. Three hospital (or crisis centre) admissions triggered by problems with benefits and housing; one of those three people also lost their job.
It’s good that mental health is being talked about, but we need to ensure we are talking about the right things. Greater public awareness is welcome, if it covers the full range of problems. (Celebrities appear to be queuing up to disclose their battles with depression. But when was the last time you heard an actor or model disclose their schizophrenia diagnosis?) Otherwise there’s a danger of merely shifting the stigma line. We need proper investment to redress decades of underfunding and respond to increasing demand. But we also need to consider how we can create a society more conducive to mental wellbeing. We cannot afford to ignore the well-established link between social inequality and mental ill health, between housing and benefits and wellbeing, between the pressures we place on young people and the problems they develop. If we do, all our talk risks signifying nothing.
• Clare Allan is an author and creative writing lecturer who writes on mental health issues