Tuesday, 27 December 2011

The importance of being mental

Here's some facts to get started:
  • Anti-depressants are the most commonly prescribed drug in the USA. [source]
  • 25% of people in the UK will have mental health issues at some point. [src]
  • 10% of children in the UK have a mental health problem. [src]
  • Britain has one of the highest self-harm rates in Europe. [src]
  • 90% of UK prisoners have a mental disorder. [src]
  • Some of the world's most prominent celebrities suffer from mental health problems. [src]

I had the pleasure of meeting Andy Burnham a few weeks ago. One of the things which most stood out from the Q&A session was his proposal of modernising the NHS to ensure that it adapts to the health needs of modern Britain. This adaptation would include putting mental health issues at the heart of the service - something I can't stress enough.

One in four of us suffers from some kind of mental illness. I'm part of that 25% of the population, having been diagnosed with anxiety (particularly social anxiety) and OCD early this year. As a subset of this I am prone to low self-esteem, sometimes mild paranoia, and occasional mild depression. I was surprised to learn that the number of people with mental health problems is as high as 1 in 4, meaning if you think of 4 people you know, statistically one of them will have some kind of mental issue. It could range from minor and occasional to constant and utterly debilitating.

So it was pleasing for me to hear Burnham talking about the importance of mental health - actually it was  pleasing to hear anyone talk about mental health at all. Having sought assistance for my problems, I was able to access Cognitive Behavioural Therapy - CBT. This isn't psychiatry - it doesn't seek to delve into your unconcious and solve your problems by unravelling your childhood, but it focuses upon providing methods to cope with your issues and reduce them. Previously I was, in large part, controlled by my issues, now I feel largely in control of them. NHS mental health services changed my life. No-one with mental health issues is ever really cured - and I'm far from being cured - but I can lead a life I am much happier with now than I could before. This is most notable in my level of social engagement. Having spent almost all of my life avoiding social interaction outside of school, it was only really 2011 that I gained the confidence to actually go out and engage in ordinary social activity.

I'd like to give a brief outline of my issues impacted upon me. It's often difficult to think fully about this, because they become so ingrained that it's easy to stop realising that it's not normal behaviour. A few examples I can currently think of are: avoidance of social situations; avoidance of public transport; repeated checking of things; counting and physical rituals; unwanted intrusive thoughts; avoidance of eye contact in some situations; consistent self-criticism; and irrational beliefs that others are judging/criticising/talking negatively about me. These were things which disrupted my life - and still do to a lesser degree than previously - but I don't seek to overstate them or garner sympathy; my problems were and are nowhere near as bad as some people suffer from, and they are greatly reduced now I've had treatment.

Unfortunately during my therapy it became clear that mental health is largely neglected in the NHS. The waiting times between being referred and starting treatment is incredibly long, especially bearing in mind that during that time one's mental state can deteriorate and make life more difficult. It seems that the already long waiting times are likely to rise given that mental health is an easy place for the axe to cut;
services go on behind the scenes and aren't considered a top priority, particularly in a time of squeezed budgets.

But they should be. Simply protecting funding for mental health services wouldn't be enough; what's needed is a profound change in the way the NHS views mental health, and more importantly, the way the public views mental health. There is still very much a stigma attached to the issue; people - particularly men, it seems - feel they would be showing weakness to acknowledge that things aren't right and seek help. Something urgently needs to be done, and I draw my inspiration here partly from Burnham's thoughts.

1. Putting mental health at the heart of the NHS:
The best example I can give you of how poor funding for NHS mental health services are is something my therapist said during our final session. He knew I was going to university and would be taking Politics modules. He said that, if I ever get into a position of political power, not to forget mental health services, because they're so neglected and forgotten and in need of attention.

Andy Burnham didn't have any specific policies to outline on how mental health could be improved - which is understandable at this stage of a party in Opposition - but he did say that it needs to move to the heart of the NHS, and not just be left on the outskirts. With a shrinking working class and more people taking on potentially stressful white-collar jobs, the demands we make on the NHS are changing. Whilst obviously physical health remains of the utmost importance, mental health is becoming increasingly vital to ensuring wellbeing. Neither can physical and mental health be viewed in isolation; there is a very much a two-way link between them. Poor mental health can lead to a reduction in contact with the outside world, reduced interaction with other people, reduced exercise, etc. This then creates a vicious circle; if you're feeling lonely and detached, your mental problems will just worsen because you lose confidence.

I think doctors and other healthcare professionals need to be very much included in this shake-up. Perhaps they need to be better-trained to recognise the symptoms of mental illness and be made aware of the solutions. Whilst I'm very grateful to my doctor for his referral and assistance, he also offered me pills, which I turned down. I'm concerned that if patients with problems are simply offered tablets, they will accept them, take them, feel a bit better and pursue it no further. Whilst this might help alleviate problems, I do not believe medicine should be the first port-of-call for mental issues. Understanding your illness, learning to cope with the problems it creates, and creating a strategy to control your symptoms and lead a freer life are  most important in tackling problems. Pills just can't fix it, and I don't believe they're a long-term solution.

Because mental health services are so underfunded and inaccessible, it's difficult to access them again once your treatment has finished. Even after being on the waiting list, the likelihood is that you would first be referred to support groups or other forms of assistance because you've had a course of one-on-one therapy previously. It's not like going to the doctor where you can simply return the next week with another appointment if you find your symptoms still remain. The object of the CBT treatment I had is to ensure I can handle my problems myself with a strategy, but sometimes one needs easily-accessible support and advice on this. Finishing your course of therapy is incredibly anxiety-inducing, so having the knowledge that you could easily and quickly access your therapist again would do much to reduce the fear of being alone to cope again.

One idea I'm floating is that NHS Direct should be expanded to have a dedicated mental health department, providing 24/7 non-emergency information and advice for those seeking advice and support. More radically, I'd like to see online counselling sessions set up. These would allow either one-on-one or group counselling and therapy sessions to take place, letting people get support from the comfort of their own home. I'm not saying this is a replacement for therapy in person, but for those who feel happier getting advice from the comfort and convenience of their own home. This would also have the positive upside for some people that it could be anonymous - it could be conducted with blurred faces or purely through voice. Such anonymisation and private treatment from your own home could help some overcome the embarrassment of seeking treatment. And for the George Osborne's of this world, there's the upside that it could ease lengthy waiting lists whilst saving money. Online treatment is definitely something to consider. Any scheme should aim to integrate the excellent work of charities like Mind, Rethink Mental Illness, and the Mental Health Foundation, perhaps incorporating them both into the NHS and providing them with public funding. The employees and volunteers of these charities would be well-placed to man the phones in the aforementioned mental health support phone lines.

I know it's not exactly in keeping with the times, but there really is no way to make NHS mental health services better without a large increase in government funding. At the most basic level, more therapists and counsellors are desperately needed. Politicians are preoccupied with looking at things like operation waiting times, the number of nurses, and feedback for doctor surgeries; they need also to be looking very very seriously at the atrocious state of mental health services in the UK. That's not to say that the only way to solve the shortage is just ploughing money into a monopoly service. I'm very much in favour of Blair's public service choice reforms - if the state can provide funding for private practices to take on NHS patients and provide mental health services free at the source, then all is well and good.

2. Raising awareness and breaking the taboo
It's all well-and good to make mental health on the NHS fit-for-purpose, but there's no point if people are still too afraid of stigma to seek help, and if people still view mental health as a taboo. Many people don't understand mental health, some don't think it's an issue at all, and many of those who have problems either don't know they've got problems or refuse to recognise it. The sad truth is that if a potential future employer finds this article when deciding whether I'm a suitable candidate, it's possible that it would lose me a job offer. Who would want to employ someone who has self-confessed to mental health problems when you could employ Joe Average instead?

We need to be creating a culture where people can go to the doctor and say that they're having trouble coping with stress, or that they're repeatedly washing their hands, or that they have massive moodswings, or that they need help coping with bereavement, or that they're constantly anxious, etc. We need a culture where people don't think twice about seeking help with their problems. How you go about creating that culture is another matter entirely, and I don't claim to have the answer, only a few suggestions.

A good way to start would be to get politicians actually talking about mental health. It's so rarely spoken about by them that it's easy to forget the NHS provides these services at all. They're all busy talking about operation waiting times, the number of nurses, and hospital closures and mergers. But when was the last time you heard an MP rage against scant psychotherapy services or long waiting times for treatment? I suspect that some MPs are part of the taboo problem, so it's up to the enlightened and progressive MPs to start discussing it. From an electoral perspective, they can even win some constituency points along the way by taking the plight of some of their constituents - a working single Mum suffering from acute stress, or a man depending on anti-depressants - to Parliament and the local newspaper.

More than just MPs not being afraid to raise the issue, it needs a champion. Betty Ford - the late wife of former US President Gerald Ford, made waves by admitting her alcoholism and setting up the Betty Ford Clinic. Though there's still a way to go with making it socially acceptable to talk about alcohol problems, it's far more open than it used to be. I'd love to see some well-liked celebrity come out and share with the public his/her battle with mental illness and become a champion for it rather than just revealing their own personal woes in interviews with OK Magazine.

3. Fixing the causes
Research tells us that mental health is worse in more unequal societies. This argument is probably best laid out in The Spirit Level, which puts forward a compelling argument that a more equal society has myriad  positive social effects: longer lifespans, better health, lower crime, lower drug use, and the list goes on and on. I feel obliged to point out, in the interest of balance, that some are sceptical of the claims made in the Spirit Level, and the arguments against the text are laid out in The Spirit Level Delusion.

This, and various other more obvious factors are clearly factors in worsening mental health. Such things as economic insecurity; struggling to make ends meet; loneliness; and living in areas with high crime are all things which can lead someone into depression and result in them trying to cope in various ways.

Government already does a lot to alleviate poverty and reduce inequalities, but income inequality rose sharply in the 1980s and continued to rise afterwards, including under the previous Labour government. The Gini coefficient is a method of measuring equality of distribution of wealth. A value of 0 indicates total equality - everyone has  the same wealth, and a value of 1 indicates that all the wealth is in the hands of one person. The closer a country's gini coefficient gets to 1, the more unequal the wealth distribution of the nation is. The UK's gini coefficient has risen from being steady around 25 from 1960-80, to  over 35 by the 2000s. With government austerity and the financial problems - including the almost inevitable second recession - this inequality will continue to rise. (I assure you that the glass is indeed half empty.)

On less statistical grounds, there are more obvious factors which exacerbate mental health problems. We'll all have slightly different causes, but some common similar themes can be seen. Some will suffer due to a burdensome workload, others will put up with acute loneliness, other will struggle living in a high-crime area, others will not know how to cope with the loss of a loved one. These are all fairly obvious things which can make us all feel down, and for those of us who are prone to mental health problems, can cause real issues. Again the practicalities are unclear, but proper research needs to be done into the factors which bring on issues, and look at ways to solve them.

Unless we address the issue, things will only get worse. A number of news stories of tragic suicides of celebrities over the past few years are testament to the extent of the problem and proof positive that it needs to be tackled. It's not just an issue of ensuring people can live more comfortable lives; it's an issue of life and death. It's going on right under our noses, and we're ignoring it and brushing it under the carpet.

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