Alastair Campbell, Ruby Wax, Bob Geldof are amongst the signatories of a powerful open letter published this week. The letter argues that mental health services must receive equal funding to physical health, with lead instigator former minister Normal Lamb calling the disparity a 'historic injustice'.
Though the letter continuously repeats that the current funding crisis is 'not the fault of any particular government', it has been written now because the 'Parity of Esteem' between physical and mental health enshrined in law in 2012, and part of the government's own mental health strategy is simply not reaching cash-poor services. The reality of closures, job cuts, burnout and crises has only increased since 2012 even though, as the letter argues, there are strong economic as well as humanitarian arguments for the fairer dispersion of NHS funds.
Whilst this letter is to be lauded, much of the 'parity of esteem' ideology it rests upon is problematic, as it suggests that mental suffering is 'an illness like any other'. But is this really the case?
Mental suffering affects the core of one's self, one's thoughts, perceptions, energy levels, experience. Who suffers, for how long, and with what chance of recovery is heavily indexed to other things which define the self - early abuse, trauma and deprivation, social isolation, poverty and minority status, families which are critical and hostile. Similarly, the policies and ideals of the state have a direct effect on mental health. So, mental suffering increases following austerity measures appear to have an immediate drip down effect on things like antidepressant prescription and the number of people going to their GPs in anguish. The parity argument reinforces ideas of a simple causality, rooted in neopositivism, that just doesn't fit the evidence-base.
To then assign causality to a physical agent like brain chemistry is highly controversial. There is no robust evidence that mental suffering is caused solely by a particular pathology of brain chemistry . Rather, it is hopeless, unsafe, damaging and impoverished environments that can all contribute to damaging our mental health. These environments are directly linked to society, with contemporary ideas of what it means to be human and to succeed. If, for example, Department of Work and Pensions workers are conditioned to frame non-working as a 'psychological failure', making invisible the fact that there are no jobs, the individual is left with a feeling of lack - associated with understandable irritation, confusion and lack of energy - all too easily labelled and experienced as depression.
Mental suffering here is localised in the body but can also be understood in many cases as a form of dissent at an environment which makes thriving impossible. By labelling this illness, we shut down the message that the body is trying to transmit. Of course, this context-less narrative is one the government is likely to lap up. And, combined with this, the parity/equivalence/illness narrative is deeply unhelpful. For example, though any anti-stigma campaign will have some effect, there is consistent evidence that the public prefers psychosocial to biogenetic explanations of mental suffering, and will be less prejudiced if these more contextualised accounts are offering to them. Funding a campaign that argues mental suffering is like having a broken leg, as opposed to one which sees hearing voices, for example, as something that can be useful and provide insight, is thus a political act. A 'Bad Things Can Happen and Drive you Crazy' campaign has yet to be funded by government, despite its purported aim of following what the evidence-base tells us. This, perhaps, is because the government can be responsible for at least some of the bad things.
Mental suffering is on the agenda as never before, and thank god. But whilst those in the 'just like any other illness' camp are keen to take credit for this, the reasons are far more complicated. The rise in social media, the cult of the individual, and the rise of celebrity and misery memoirs, for example, are at least as probable reasons. The stories that do well in terms of book sales or internet hits tend to have some things in common. They provide a complex background leading up to the emergence of distress, one which has explanations in life history as much as biochemistry; these stories tend to construct a breakdown as a breakthrough leading to a different relation to the world, hope and the idea of a future.
There are - nearly always - lessons to be learnt from the suffering which can bear messages from the past, and provide nuggets of wisdom for future growth. In representing mental suffering, we must avoid stamping all these stories as 'just like any other illness' and thereby denying the complexity they carry with them. Let's demand equal funding, access to therapies and, yes, sometimes medications when suffering threatens to tear our minds and bodies apart. But let's do that insisting the suffering is no less real, no less deserving because it so often embodies something of what goes wrong with families, communities and society.Suggest a correction