What is the crisis in mental health?
By Karen Newbigging
Mental health has increasingly been in the news in recent months. This week we hear that Head Teachers are calling 999 to get access to help for pupils experiencing mental distress because of the lack of adequate provision of child and adolescent mental health services. The Girl Guiding Association’s latest Girls’ Attitudes survey found that nearly half of those who responded had experienced mental health issues, with self-harming one of their greatest health concerns alongside depression and cyber-bullying. The CQC has recently identified that accessing help for a mental health crisis continues to be highly problematic, with a recent Panorama investigation arguing that cuts in funding and reduction in bed numbers were placing Britain’s mental health services in crisis. This framing of mental health in crisis, at a personal and social level, is becoming a recurrent theme, so much so that it currently dominates mental health in the news, represented by images of personal distress and accounts of people failing to get the help they need. In this blog I reflect on the nature of the crisis in mental health, offering a counter-narrative to the call for more specialist services.
At one level, the mental health crisis fits with the World Health Organisations’ assessment that mental health problems, specifically, depression, is set to become the second contributor to the global burden of disease by 2020. Not to detract from this, it is also the case that the rhetoric of calamity is often used in mental health to gain political attention and mobilise public support for an aspect of health care that is less well understood, has suffered from historical underfunding and, despite efforts by Time to Change, is still stigmatised (Rochefort and Cobb, 1994). The framing of mental health in crisis was used by New Labour, with the crisis framed as a risk to public safety with rare, but high profile, incidents involving people in mental distress repeatedly evoked by the media. The current crisis is being articulated in terms of unmet needs and the impact in human, service and financial terms of failing to meet these needs. The contributory factors are readily identified in terms of a lack of parity in spending on mental health compared to physical health with planned cuts to mental health services, cuts to Local Authorities, the voluntary sector and proposed welfare reform all taking their toll on mental health. Consequently, anxiety is mounting about the fate of mental health services in the Comprehensive Spending Review in a health policy context focused on acute care, and where mental health may be an easy target, as it so often is.
The verdict is that mental health is in crisis because the system is in crisis and the solution is greater investment in better services – more professional help, easier access, and placing mental health on a par with physical health. In the demand for action, there is a danger of solutions that have popular and political appeal - more investment in psychological therapies to reduce the welfare benefit bill - whilst the support for people with complex, longstanding mental health problems is both reduced and increasingly fragmented. Indeed, we are seeing an unprecedented rise in the numbers of people subject to compulsion under the 1983 Mental Act, with people from specific Black and minority ethnic communities continuing to be disproportionately affected.
All this points to the need for a fundamental rethink of what constitutes a good comprehensive rights-based mental health system that provides the support that people want. This requires a major cultural and organisational shift from what we have traditionally delivered. It requires local people and communities to work together to understand what mental health means and the part that local communities, voluntary sector services and non-mental health services can play in supporting good mental health and responding in a mental health crisis. Inevitably this rests on an understanding that mental health and distress are part of living, greatly influenced by our social situation, and not solely the province of mental health specialists. The Girl Guide Association report identified gender stereotyping, sexism, fear of physical, emotional and sexual harm as well as anxiety about mental wellbeing as underpinning mental health for girls. This means social action and requires us to exploit our understanding of the factors influencing population mental health and interventions to improve it; to systematise preventative approaches and early intervention across public sector services so that mental health is all of our business, not just for economic prosperity, but to reflect common values of human worth and social justice. These system responses need to build individual capacity and resilience; promote connectedness, wellbeing and recovery and ensure people experiencing mental health problems have the support they define as needed.
In an ongoing context of underfunding, the mental health pendulum has swung backwards and forwards between attention on the larger numbers of people with relatively short-lived mental health problems and those with longer-term and more far-reaching difficulties. As the pendulum swings, so does our framing of what the crisis in mental health really is and the call for the type of services we need shifts. It begs the question as to whether the real crisis in mental health is our lack of consensus about what a good mental health system looks like and the lack of political will, at all levels of government and public services, to lead the system transformation required.
Rochefort, D. A., & Cobb, R. W. (1994). The politics of problem definition: Shaping the policy agenda. Kansas: Univ of Kansas.