Mental health care is still awaiting its revolution

This week David Cameron announced the government’s intention to invest almost £1billion in mental health services in an attempt to revolutionise treatment. In particular, Cameron identified the need of specialist care for children and young people, women suffering from perinatal depression, and teenagers affected by eating disorders. He announced additional measures such as introducing mental health services in all hospital emergency departments.

Cameron’s pledge has been praised as the first time a Prime Minister has openly addressed mental health in a speech, and the resolutions have been welcomed by the Royal College of Psychiatrists. The disorders targeted in the pledge, in particular, eating disorders and perinatal psychiatry, lack services at present.  Clinicians and service users are acutely aware of the problems. Many people with anorexia get admitted privately far away from home and cannot rely on community support. There is a poor service provision for perinatal illness overall, antenatal and postnatal care do not coordinate, and not many mother-and-baby beds are currently available. Thus, the commitment to improving the situation is a much needed response to existing gaps.

Cameron’s speech has also received criticism as there are further gaps in current mental health services that the pledge is not committed to fill. Norman Lamb, Liberal Democrat MP, said that the commitments made by the Prime Minister on Monday fall short of what was promised by the coalition in 2014, and Luciana Berger, Labour shadow minister for mental health, maintained that Cameron committed to “too little too late”. She highlighted that the government was responsible for significant cuts to mental health services in the last five years, a point powerfully reiterated by Neha Shah in the Independent yesterday where such cuts are linked to austerity policies.

Both the praise and the criticism directed at the Prime Minister invite us to reflect on the need to achieve parity of esteem between mental and physical health. As my colleague Michael Larkin has convincingly argued, there are striking differences between the services available to young people with cancer and those available to young people with psychosis, for instance, despite NHS policy recognising that mental health is as valuable as physical health. This is because measures to implement parity of esteem have not been funded and implemented effectively to date.

From a philosophical standpoint, can we justify adopting a different attitude towards physical and mental health, or committing greater resources to one rather than the other? I seriously doubt it. We are not minds stuck into bodies, where our minds and bodies have neatly distinct needs and priorities. We are persons. Whatever happens to us in the course of our lives, make it cancer or psychosis, losing our job, receiving happy news, or eating too much, has consequences for our wellbeing overall, and affects the way we feel, the way we respond to our environment, and the way we pursue or lose track of our goals.

Mental health issues are not just in the mind, but they are the product of our past and present experiences, our physical health, our relationships, the opportunities we grab and those we miss.

That is why the pledge, though welcome for increasing mental health funding and keeping mental health on the political agenda, does not sound like the revolution we were expecting. It is a drop in the ocean with respect to the all-important target of achieving parity of esteem unless it is followed by a more systematic commitment to the idea that the object of healthcare is persons in their entirety and complexity.

Professor Lisa Bortolotti

Department of Philosophy