There are lots of reasons to be anxious at the moment: the recession, ISIS, ebola, the rise of far right parties across Europe. But there’s one big reason to be cheerful, and to be proud of UK public policy: mental health.
The UK is leading the way globally in recognizing mental health as a major policy priority. It led the way back in 2007 in making talking therapies available on a mass scale through the NHS, for free. The Improving Access for Psychological Therapies programme is not perfect at all – waiting times are too long, the types of therapy on offer are too narrow – but it’s still so much more than any other country is doing.
And gradually, UK politicians are waking up to the fact that mental illness should be taken just as seriously as physical illness, and that just as much money should be put into it. Mental illness accounts for 28% of the disease burden in this country, but only receives 11% of the NHS budget. That needs to change.
If you look at mental health through the prism of well-being economics, the moral imperative to do more for the mentally ill becomes even more powerful. The impact of mental illness on personal well-being is actually more profound than for many physical illnesses – yet we do far less to tackle problems like depression or anxiety than we do for physical illnesses. We suffer in silence, and hide our mental pain in a way that would be considered perverse if it was physical illness.
I’d highlight three areas where mental health policy is improving at the moment, and three areas where improvement is desperately needed.
Firstly, companies are beginning to take mental well-being seriously – but it’s only just beginning. Human resources departments tend to do one half-day session on ‘resilience’ once a year for their staff, and these sessions could be on anything – they’re not always evidence-based. A lot more could be done, but the momentum is in the right direction.
Secondly, I think British male culture is beginning to change in its attitude to mental illness. Men are slightly less likely to get mental illness than women, but they’re worse at dealing with it, less likely to seek help, and more likely to kill themselves. The reason to be cheerful here is the way male sports are beginning to lead the way in taking mental health seriously – in rugby, football, cycling, tennis, cricket, boxing and other bastions of macho culture, things are changing and sportsmen are becoming ambassadors for a more emotionally intelligent male culture.
Thirdly, community education about mental health is improving – although again, only very gradually. Public Health England recently emphasized how important adult education is to preventing mental illness, but I don’t get a sense that Clinical Commissioning Groups in local authorities really know how to do community education in this area. However, I’m optimistic we will work this out – informal adult education is, in some ways, flourishing in this country, despite the austerity assault on libraries, through groups like the Reader Organization. We need to work out how to link this up better with the NHS.
Three areas where a lot more needs to be done:
Firstly, the understanding and treatment of psychosis, and particularly schizophrenia, still seems woeful to me. This isn’t anyone’s fault necessarily – it’s a very hard condition to treat. All we can do is try and put more money into research, both of new drugs and particularly of talking therapy approaches. We need to be better at treating people when they first have a psychotic episode, because the trauma of being sectioned can really impact their long-term chances. And we need to work out how to help people with psychosis get back into work and community life – at the moment, they are often very marginalized and isolated. They’re the forgotten people of our society, the unpeople.
Secondly, child psychotherapy services could be a lot better. Again, more investment here could save a lot of money further down the road. Teenagers are too often sectioned in adult facilities a long way from their families. And, at the less extreme end of the spectrum, this government still doesn’t know how to teach emotional intelligence in schools. The last ten years have seen education policy in this area go backwards, not forwards. We’ve become more obsessed with winning the ‘global race’ in exams rather than taking care of our young people.
Third, mental health in prisons seems to me an area that could be radically improved. The example of Wormwood Scrubs, where prisoners are locked up in cells on their own for most of the day because of staff shortages, is a particularly dire example. Again, the prison population are unpeople, invisible, off the policy radar.
Finally, I’d suggest the historic neglect of mental health policy is a consequence of materialism. Our ruling philosophy for the last 200 years has, to some extent, ignored the mind, ignored consciousness. The physical is what is real, therefore physical illnesses are given much more attention and money. That’s beginning to change. We’re waking up to the mind, to consciousness, and how it can make life a heaven or a hell.
And as we wake up to consciousness again, we’re also returning to spiritual traditions where there is much wisdom about consciousness and how to heal and transform it. I’m not being hippy here. The two best and most evidence-based approaches for emotional disorders are CBT and mindfulness-CBT, which emerged directly from the ancient philosophies of Stoicism and Buddhism, respectively. We’re also discovering that spiritual experiences through psychedelics can be profoundly healing for mental illness. There’s a paradigm shift happening. This is a reason to be cheerful.
I think the next stage of this paradigm shift could be to connect taking care of our selves with taking care of our planet. Rediscovering a good relationship with our inner nature is profoundly connected, I suggest, to rediscovering a good relationship with nature as a whole.
At the moment, mental health policy is still quite atomized, individualized and Cartesian. But people are slowly beginning to understand how healthy it is for us to spend time in nature, to rediscover a sense of connection and relationship to nature and to other animals. Stoicism, the source of CBT, made this connection between taking care of one’s inner nature and discovering a connection to Nature as a whole. We’re beginning to make that connection once again.