The way we think about how we feel has undergone a remarkable change in the last decade. It once appeared weak to reveal our sadness, anxiety or fear. Today it is taken as a sign of strength and maturity to acknowledge our vulnerability.
Ruth Davidson, the Scottish Conservative leader, is the latest to win praise for speaking openly about her struggle with depression as a teenager. In a new book published last week, Yes she can: why women own the future, she disclosed how she hurt herself, cutting her arms and stomach, and how she now valued her mental health too much to contemplate ever leading the Conservative Party, a role for which she has often been tipped.
This is progress – of a sort. Ruth Davidson is the latest public figure to speak about her mental health and each one who does so helps lift the burden of anxiety and depression that blights millions of lives.
The advice has changed too. In place of “pull your socks up”, today you will as often hear an invitation to sit down and talk. It is the first step on the road to recovery. But getting people to take that step is a challenge.
This is not just about money and resources. In wealthy countries such as the UK it is estimated just one in five sufferers receives adequate care. Even if there was a mental health clinic on every street corner, it would still be necessary to get sufferers to recognise that they have a problem, need help and should seek treatment. How do we get people to talk?
One idea which has been introduced in New York, and is now exciting attention in Canada, Australia and New Zealand, is the friendship bench. It is a park bench with “a higher calling”, as one exponent put it – a special place where a person can go when they want someone to talk to.
The idea originated in Zimbabwe and is highlighted in a major report by an international group of experts to be presented at the World Innovation Summit for Health (WISH) in Doha in November (13-14), which I chair.
In the capital, Harare, friendship benches are located around the city for people struggling with what is known in the Shona language as kufungisisa (“thinking too much”). Grandmothers trained to listen and deliver problem-solving therapy provide support. A study published in 2016 in the Journal of the American Medical Association found that after six sessions on the bench, just 13 per cent of those treated were still depressed six months later compared with 50 per cent of those in the control group. A key advantage is that the benches avoid the stigma associated with visiting a mental health clinic.
In New York, the Fund for Public Health describes friendship benches as “non traditional public meeting spaces” which “have been proven to enhance community engagement, increase access to care, reduce symptoms of depression and anxiety and increase social cohesion.” Thrive NYC, New York’s mental health programme, is advertising for peer health workers at $30 an hour to deliver problem solving therapy from them and has so far helped over 11,000 individuals.
This is exactly the sort of innovative thinking we need if we are to meet the demand for mental health care in the coming decade.
In the UK the Royal Foundation established by Princes William and Harry and their wives announced this year that it was investing £2million in what might be seen as a technical version of the friendship bench - a digital start up to help lonely, isolated people find the right place to talk.
Both are examples of “stepped care”, providing an initial point of contact which can help many with moderate problems while leading others with greater needs to be referred for more intensive treatment.
It is good to talk – but first we must get people to do so.
Professor Lord Darzi, OM, is a surgeon and Director of the Institute of Global Health Innovation, Imperial College London.