The manifestos of the three largest parties collectively contain 75 references to mental health -- 70 more than the respective manifestos in 2010, excluding the indexes. Those that have read the recently released manifestos could be forgiven for remembering little of what was said, because despite extended paragraphs, there are few quantifiable pledges.
Theresa May had earlier this month promised 10,000 more mental health staff, but the Conservative manifesto made no such promise. It did, however, pledge to provide mental health training to teachers in every school, bring mental health awareness into the schools curriculum, and educate a million members of the public about mental health awareness.
These are positive commitments that will encourage those who are struggling to turn to others for support and to seek professional help when needed. As with other health conditions, early diagnosis and intervention are crucial for optimising outcomes and for preventing mental illness from becoming a long-term condition.
The problem is that if you are encouraging openness about mental health then you're likely to have more people seeking professional help. This is fine if we can ensure that there are adequate numbers of mental health professionals, but the Conservative manifesto makes no commitment to do so.
Although the Labour manifesto is light on commitments to mental health education, it promises that every primary and secondary school pupil will have access to counselling -- offering to set aside £90 million per to fund this. This recognises that those with mental health issues tend to experience their first issues during childhood and adolescence.
The Liberal Democrats tick the box for both mental health education and the access to therapy, promising to put mental health education on the schools curriculum and, crucially, to set a maximum waiting time for accessing mental health services in line with access to physical health services.
Each of the three manifestos refer to 'parity of esteem', but with their commitment to maximum waiting times, the Lib Dems are the only party with a proposal for bringing mental and physical health onto an equal footing.
It might be said that it's easiest for the Lib Dems to propose ambitious policy of the three parties because they are (according to the latest polls) the least likely to win the election, but the electorate could look to this as a policy to demand from whoever is in government next.
Social Determinants of Mental Health
Considering that each of the manifestos have sections devoted to mental health, relatively little is said about how broader social factors and policies affect mental health.
Recession and unemployment are associated with increased rates of mental illness and suicide, as are social inequalities, unhealthy lifestyles, and traumatic experiences such as those of many war veterans. Each of these involve chronic or acute stress that lay the conditions for mental illness, and each of them are influenced by government policymaking.
The Conservatives introduced their 'well-being index' in 2010, aiming to quantify a number of factors that relate to psychological wellbeing, but there is no mention of this, or anything like it, in any of the manifestos. This seems like a missed opportunity.
A good public health strategy is one that is settings-based, balancing sufficient services for those at heightened risk, with preventative, population-based efforts. A government that pollutes the air and hands out cigarettes should not be applauded for then providing good cancer treatment; nor should a government that puts sugar in our children's food be applauded for providing dental treatment. In the same way, a government that cultivates stress and conflict doesn't redeem itself by talking about mental health care.
As we look ahead to the election and beyond, we should seek a government prepared to bring services up to date to match our needs, and also one aligned with the protection of good mental health, which begins not in treatment rooms but in communities.