Employment as a Health Outcome? It Just Won't Work

16/02/2016 12:36 | Updated 16 February 2016

The government have revealed plans to boost funding for mental health care in the UK by an additional £1 billion by 2020. Amongst other things, they're promising 24/7 community care for people in crisis, help for a million more people with mental health issues and a 10% reduction in the country's suicide rate. I'm not entirely cynical - this is a great step forward and feels like the first concrete move in the battle to get mental health seen on an equal footing with the physical health needs of the nation - but there's something bugging me, part of today's announcement that makes me feel distinctly uneasy.

The report, by the Mental Health Task Force and chaired by Mind's Paul Farmer, recommends that employment should be recognised as a "health outcome". I understand that this might seem like a sensible move - we all want people to recover from mental health issues and return to making a contribution to society. It's good for an individual's self-esteem and it's great for their communities - but mental health isn't as straightforward as that.

A couple of years ago my psychiatrist told me that despite everything pointing to a diagnosis of borderline personality disorder, I couldn't have the condition because I'd held down a job. Total ignorance of personality disorders aside - and also ignoring the fact that I was signed off from work long-term - I asked him whether the whole point of my treatment was to get me back to paying my taxes. I was told not to be so flippant, but the last few years have made me realise that I was too close to the truth for his comfort.

When I did return to being gainfully employed my care stopped. I was still struggling with chronically low mood, suicidal ideation and frequent concrete plans to end my own life, but I was back at work. I was once again functioning at a level where I could put on a mask to the outside world and pay my dues to society - and my local mental health team stopped caring. I went from having at least one appointment a week to one every three months. They honestly haven't got a clue how I'm coping and they don't seem to want to find out. I've raised how my lack of care is affecting my health with at least six health professionals but things have just got steadily worse.

And here's the problem with using employment status as a health outcome.

A lot of people with severe mental health issues are great at putting on that mask and pretending everything's fine. There used to be a phrase to describe us - high-functioning depressives, or high-functioning any other mental health diagnosis you care to include. I thought that was no longer used as it's so inaccurate - we're not functioning at all, we're just great at pretending we're OK and then coming home to collapse in a heap of emotional pain and exhaustion, wearily trying to summon up the energy to spend another night fighting our own particular demons.

But it looks like high-functioning is what the government wants. They want us all to pretend we're fine. The most important thing for our current administration is that everything looks OK and that there are enough statistics to back up their notion that they're the saviour of the mentally unwell. They don't care about what's really going on and just like my local community mental health team, don't want to look beneath the surface and address the real problem.

Even if you're fully behind this government and think I'm just a bitter, cynical old fool, there's a problem with this simple approach to such a complex problem. By judging the success of treatment on something as superficial as employment, the government are seriously hindering their target to reduce deaths by suicide. There's only so long you can pretend things are fine before you start to give way under the intolerable amounts of pressure you're under - and by this point you're highly trained in not asking for help. And that means that when you most need help you won't seek it out.

There's still a commonly held belief that a person with mental health issues is at their most vulnerable when they're really unwell - but one of the warning signs for suicidal behaviour is that a person can look like they've started to recover. They have more energy and are back to engaging with the world again - and they also have the energy required to carry out their plans of suicide.

I firmly believe that today's report is a landmark in how mental health is perceived in this country and for that I applaud it - but please don't think it means that the fight is over. Ignorance still lies at the heart of every level of society and until we challenge that, parity of esteem can never full be achieved. Getting people with mental health issues back into work is a great aim to have but as a health outcome is flawed and can be in direct conflict with the person-centre care we have a right to.

It all comes back to whether you see the UK as more than just an economy, if you're willing to see the personal stories of pain and of courage behind the statistics. For me, we're more than just an economy, we're a society. And with our current government, that's something we're at real risk of forgetting.