In her latest annual report, the Chief Medical Officer, Prof Dame Sally Davies, shone a spotlight on mental illness in the UK. It was not pretty. Mental illness is the largest cause of disability in our community, causing the most sick days, while costing a huge 4.5% of GDP.
Yet three in four people receive no treatment for it at all. Nothing. Add to that, investment in mental health services has been falling since 2011. All this, while at the very desperate end of the spectrum, it costs £1.6 million for each working aged adult who commits suicide. And this figure does not factor in the terrible tragedies left behind in the aftermath of each suicide. It is perplexing to me that mental and physical health are not treated with equivalent esteem. None of this would be acceptable if we substituted the work "infection" for "mental health". It is only because of stigma and misinformation that such spectacular neglect is possible.
There are many things we should be doing to support people's mental health, such as dramatically reducing waiting times for help; supporting people to work even if not fully recovered; increasing mental health training for GPs; and media campaigns targeted at overcoming stigma in all its forms.
Close to my heart as a psychotherapist, I have been thinking about the scandalous lack of talking therapy available on the NHS. This has always struck me as odd, given our deep historical connections to talking therapies. You can visit Freud's house in Hampstead, and take a look at his psychoanalytic couch. But if you try and get some counselling or psychotherapy on the NHS, you will probably be waiting a very long time indeed. People in crisis are falling through the cracks everyday. Many people are sent off by over-stretched GPs desperately clutching at a prescription for antidepressants. How frightening it must be for patients to be abandoned to their own devices in this way: will the tablets work? Can I endure six weeks waiting for the medication to kick in? Will the medication numb my emotions?
But it is good to talk. And the overwhelming evidence is that talking therapy works. And works in ways that can be life transforming for many people. It doesn't matter much what the brand of counselling or therapy is. What seems to be most healing is the relationship that develops between client and practitioner, based on attunement towards the client, honesty and respect.
Increasing Access to Psychological Therapies (IAPT) is a great idea. But when people have to wait six months or more in crisis, this is not good enough. The focus with IAPT also is on cognitive behavioural therapy (correcting distortions in the thinking that leads to misery). This is a great approach for many people. However, some people do need to explore their issues much more deeply than IAPT would allow. They may need to get to what lies beneath their distorted thinking. So other approaches are also needed.
As part of our research programme at the University of Westminster, we set up free and rapid access 'humanistic' (1) talking therapy for men (Atlas), the results of which will be available towards the end of the year. It is heartbreaking to hear from the men in that programme, that if not for this one-off programme, they may have fallen through the cracks in the NHS. In fact, one man we talked to made a link to the high rates of male suicide, "...when my girlfriend is unhappy, she seems to have lots of other girlfriends that she talks to very regularly, like almost every day... And men don't have ... those same relationships, and also, and because of that you get to a point where I don't want to carry on doing this so you might as well commit suicide because there's nothing, nobody's going to help...." The despair this man talked about, the almost complete social isolation, and the yearning for a healing relationship is not unusual in my experience working with men.
And here lies the rub. We blame men for not getting help. But we don't talk about how we have first socialised men to be on their own, to keep their emotional vulnerability hidden. Subsequently, we get uncomfortable when we see men cry, or otherwise vulnerable. We may even mock men for it. I have seen partners say they are thinking of leaving their man who shows their softer emotions.
The more I think about it, the more I think that masculinity is actually something that exists outside of men. It exists in your eyes. Because you have all these expectations about how men will be. Perhaps you think they should be strong, sexy and silent? As a professional, you may dread seeing upset men walk through your door because of the discomfort it raises in you. Whatever your perspective, you have strong views about how you want men to be.
We have decided as a society not to provide people with the mental health help they need. We might as well have said that we will treat cancer, but not infections. But we have gone further with men. We are even more reluctant to give distressed men the help they need because of our particular investment in masculinity. Is it you who believes that boys will be boys? That there is nothing we can do to stop men committing suicide?
Have you ever thought that the problem with masculinity rests with you? It is not that men won't get help for vulnerability. Perhaps reluctant men are just being realistic about your response based on past experiences? They suspect they will be judged not only for their mental health, but on their masculinity. It is time to change.
If you are worried that you or a man you know is at risk of suicide, for non-judgmental help, call the CALM helpline 0800 58 58 58 or visit www.thecalmzone.net/help/helpline. Men and women can call the Samaritans on 08457 90 90 90 or email email@example.com for support.
(1)Humanistic talking therapy takes a non-medical, non-pathologising approach, treating the individual as unique, with a potential to grow, where the therapist-client relationship is important. - Rowan, J., What is Humanistic Psychotherapy? British Journal of Psychotherapy, 1992. 9(1).