There is so much to celebrate about the Royals' latest campaign, 'Heads Together', in which Harry, William and Kate have been speaking out around the country about the importance of reducing the stigma that sadly still exists around mental health problems in the UK. More than this, along with their charity partners, they have worked hard to secure their place as Virgin London Marathon Charity of the Year, 2017, which will bring a huge boost to both awareness of their cause and the funds needed to achieve its ends. Yet whilst the advocacy of the Royals has to be a sign that at least they take mental health seriously, it's hard to be jumping for joy at the prospect of any substantial changes Heads Together will bring about more broadly. Because, as important as it is to work against stigma on a social level, this is only part of the story in improving the state of our mental health, only part even of challenging discrimination in itself. The inequity between mental and physical health services, the lack of political will to address historic underfunding and the well-evidenced link between poverty, economic inequality and poor mental health are all issues that need addressing too.
However lovely it may be to live in a society without stigmatising attitudes, this alone only goes so far. Nobody would expect that being surrounded by understanding, empathetic people in your daily life would in itself help anyone to recover from a physical health problem. It won't do for mental health either. Yes, stigma can present real barriers to progress - research by the charity Time To Change has showed that for 89% of people experiencing mental health problems, the stigma and discrimination they faced had a negative impact on their lives, sometimes being worse than that of the mental health problem itself. However, the absence of stigma alone isn't enough to give people the optimal chance of having good mental health, just as the absence of stigma won't cure your cancer - treatment will. What we really require is a range of effective treatment options that are well-resourced, expertly-delivered and accessible at a time when they are needed. Whatever the state of social attitudes, this is a long way from being the case and is essentially a result of a political disposition whereby mental health continues to be inadequately resourced. Likewise, institutional discrimination persists within the NHS where, despite legislation, we still do not see 'Parity of Esteem' with physical health.
As someone who has campaigned to change attitudes, worked to improve services within the NHS locally and been involved in political campaigns nationally, I've seen from many angles the huge challenges we face in improving the landscape of mental health services. Awareness-raising campaigns such as 'Heads Together' make me feel optimistic on one level, but give me a sense of dis-ease on another, a feeling that we are potentially storing up problems for the future if we fail to take a rounded approach which includes increased investment in services themselves. If we encourage people to talk about mental health - as they rightly should not be fearful of doing - what happens when they seek services they might need only to find that the waiting times are overly long and availability limited or non-existent? What about the lack of training in mental health that persists in primary care, which is usually the first point of contact with statutory services? By creating a climate of openness about mental health but failing to match the need that may present with appropriately-equipped services, we could be setting people up to expect support that isn't actually available. This along with the possibility of encountering misinformed attitudes within the health service could at worst undo the work of building the confidence people have in their mental health problems being real, worthy of support and nothing to be ashamed of.
I say this as someone who, when I finally realised I had a problem with suicidal thoughts, went to the GP and was told that I my symptoms were representative of 'attention-seeking behaviour'. I had to fight for over 6 years to access specialist eating disorders services despite nearly losing my life to my condition, like many others who didn't get the help they needed in the past and live with the consequences of that today. Whilst stigma in the workplace, school, wider society and the media certainly played a role in me not coming forward or accessing services in the first place, the fact is that when I did, the services weren't there as a result of the political prejudice that has played out in the historic underfunding of mental health. The discrimination I experienced within the NHS itself (which included the withholding of treatment for many years as I was I was deemed 'too unwell') fed directly into my self-stigmatisation and as a consequence, my eating disorder. When help was finally accessed, my treatment had limited success, the resources available for each patient being so limited.
What we can hope for from this campaign is that it leads to us viewing not only social discrimination but political discrimination and institutional biases within the NHS as unacceptable. Hopefully, we will no longer tolerate this disservice to the 1 in 4 people experiencing mental health problems during their lifetime, the future generations whose public health is at stake, the many highly-trained staff working in this field whose expertise is not being matched with the resources they need to do their jobs excellently. This is where the vicious cycle of underfunding mental health services can be broken, and with it the sense for far too many people that being diagnosed with a mental health problem is a catastrophe which comes with inordinate barriers to recovery.
However, my own hope for an end to discrimination on a political level under the present government is only a tenuous one. When I was invited to speak at the launch of the All Party Parliamentary Group's report 'Parity in Progress'? in the Houses of Parliament last year (which found that despite legislation, there is a long way to go in balancing the way mental health is treated in comparison to physical health politically), I was told that it was one of the first times that the health secretary Jeremy Hunt had talked about mental health specifically in public. This alone surprised me, but not as much as the embarrassment I felt (and sensed in that room of leading experts in the field of psychiatry and mental health) at his apparent lack of appreciation for the complexity and importance of this subject. Hopefully the work of the 'Heads Together' partner charities will go further than the apolitical Royals are able to in challenging our politicians, who do not match the demands of a population who more than ever recognise the need for prioritising mental health.
The movement for change must be met by more than warm words from those with the power to write legislation and apportion budgets. We need our politicians as well as the public to champion mental health at the highest level, with genuine commitment to the humanitarian as well as economic arguments for better services. Most importantly of all we need them to listen - not only to the perspectives of the privileged few - but to the voices of those with lived experience themselves, if we are to redress the inequalities and disempowerment brought about by those stigmatising attitudes we should want to change. Until then we can only hope that the time we have to wait for the political establishment and health service to catch up with public demand won't cost too many years of preventable misery, and too many lives we can't afford to lose.