It's Good To Talk About Mental Health, But Let's Say Something New

14/05/2017 16:06 BST | Updated 14/05/2017 16:07 BST

The confetti of mental health articles, hashtags, celebrity disclosures and social media affirmations filling timelines and news cycles this week can mean only one thing - it's Mental Health Awareness Week.

To be fair, the issue now has such profile you could be forgiven for thinking this week no more or less exceptional than any of the preceding fifty-two. This year though, we have the added fervour created by an imminent general election; a piece of serendipitous timing that is sure to help crystallise soft outcomes like 'awareness' into hard manifesto pledges.

The Mental Health Foundation launched the week by publishing new research that suggests the prevalence of poor mental health is even worse than suspected - and is getting worse still - particularly among the young. Sure enough, the state of the nation's mental health has already inspired our politicians to variously promise to scrap the Mental Health Act, train and recruit 10,000 new mental health professionals, ring-fence mental health budgets, invest an extra £1billion in services, and roll out Mental Health First Aid training to school teachers across the country.

National coverage and political concern on this scale seemed to me unthinkable a few years ago. Today, I must confess to feeling more than a little wearied by it. Not because as an area of social policy and public debate, mental health is not worthy of concern and investment - of course it is. No, my problem is with the poverty of imagination in the public and (particularly) political conversation around the issue. The drive for parity of esteem between physical and mental health has allied itself to our social, cultural and political belief that the solution to our problems is always 'more money' and 'more specialists'. This has led the conversation to a place where it is dominated by the rather conservative themes of greater investment and more treatment.

Here's why this is unhelpful. First, as I've written elsewhere, underinvestment in services is not among the most important reasons for the state of our collective mental health. Second; as such - and without some effort to address the social determinants of poor mental health - demand for services will always outpace increased investment. This is because investment in the tired service designs and structures of the status quo does nothing but recycle these determinants by creating a transactional dependency on highly skilled and expensive experts attempting to 'treat' our way out of a public health issue.

There are a number of false equivalences between physical and mental health that I always struggled to reconcile in the campaigns for better mental health, but the most glaring example is in the policy response to what is no less than a public health crisis in young people's mental health.

Consider an equivalent crisis in physical health - childhood obesity. The conversation and policy response is led by lifestyle, social and political interventions that include reducing children's intake of sugar, taxation, incentivising corporate responsibility and investment in physical exercise at school. In other words, preventative measures targeted at the origins (aetiology) of obesity and its medical effects. Nobody would seriously suggest the best way to tackle childhood obesity is by increasing the number of gastric band surgeries we perform, and yet this is the flavour of our current thinking on mental health, where the response of patients, professionals, celebrities and politicians seems limited to demands for more treatment by more trained professionals in more specialist services. This outcome is of course necessary because we all need to start opening up more. When we do, we'll break the stigma surrounding mental health through our greater social and cultural awareness of the issue and more people will seek help. It's an odd circular logic that misreads what's happening at a population level and, frankly, won't make a dent in the issue.

In this climate it's interesting (and will surprise most people) to learn that the OECD reckons the UK has 'for some time been at the forefront of evolution and change in the organisation of mental health systems, and ways of delivering mental health care'. Ours are also the second-best resourced mental health services in the world after the Netherlands; the very best resourced if this investment is taken as a proportion of spending on health overall.

Whatever this says about the relative state of mental health beyond our shores, if we are going to be at the forefront of new thinking then it's time we actually started thinking in new ways - and this starts with a more honest and socially reframed appraisal of what is driving our current levels of distress.

Our society is increasingly making people distressed and unwell, and we badly need more thinking, discussion and awareness of the solutions to our public mental health crisis that lie beyond and before treatment.

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