A number of news pieces in recent weeks have discussed a new report which found that only 25% of people with mental health problems get the help that they need. Articles highlight both the frequency of such difficulties (a third of families having a member with mental health problems at any one time), the high financial cost of not treating such difficulties, and the effectiveness of treatments like cognitive-behavioural therapies (CBT) for those who do receive them.
Certainly it is extremely important to make support available when people are struggling. However, these news reports seem to miss something by regarding this purely as a health issue, and by focusing only upon treatment once mental health difficulties are present rather than also considering measures which may prevent such problems or increase resilience.
The fact that so many people suffer with issues such as depression and anxiety has implications far beyond the health service, and the focus on targeting funds only at treatment for existing mental health problems seems somewhat blinkered.
As a starting point, here is a list of other arenas which could usefully attend to statistics on mental health and shift policy and practice accordingly. In all of these areas a broader biopsychosocial understanding of the experience of mental health problems would be of value:
Many of the negative patterns of thinking about, and treating, ourselves when we are struggling are laid down in childhood and adolescence, and experiences such as bullying, alienation, abuse or neglect in youth certainly increase our vulnerability. For this reason we could put more resources into addressing problematic school cultures and into cultivating the kinds of emotional and social skills that we know to be helpful during the early years of life. It seems strange that we wait until people are really suffering before teaching them how to understand, and work with, painful emotions and difficult relationships.
The workplace and employment
Viewing mental health as a purely internal personal matter neglects the role that the world around us has on whether or not we find ourselves struggling. Situations of workplace bullying or harassment, and toxic cultures where everyone is expected to work long hours or where employees are not valued, are certainly implicated in suffering and could be usefully addressed by awareness raising and increased resources.
Additionally, the perception of mental health difficulties could be usefully addressed on an organisational level. Destigmatising mental health problems such that employees are able to say when they are struggling could help a great deal, as could allowing everyone a few ‘stitch’ days a year when they take time out to look after themselves (after the phrase ‘a stitch in time saves nine’).
Finally, many find that some kind of employment – whether of a more or less conventional type – acts as a buffer against mental health problems in various ways. It can provide an income, give a structure and routine to the day, enable some form of contact with others, and ideally provide a sense of meaning and purpose. As a culture we seem to have swung from a situation of encouraging those who are struggling not to work (in ways which often increases their isolation and sense of being unable to do so), to one of forcing people who have become used to not working back into work. Resources could be usefully put into finding a more balanced and supportive approach.
There could be greater recognition of the role of media in encouraging a certain way of viewing and treating ourselves, which many authors have linked to problems like anxiety and depression. Research consistently links limited beauty ideals to body image anxiety, but it goes further than that. Advertising, and much other media such as magazines and self-help books, often rely on encouraging people to think that there is something wrong with them that needs fixing (in order that they will buy a product). Makeover shows, reality TV, and popular contests like X-factor promote a limited idea of what it is to be a successful person, and arguably exacerbate a sense of failure among those who don’t meet the standard. The sense that we need to monitor ourselves and compare ourselves against others is opposite to the kind of compassionate and kind treatment that many regard as the key way of avoiding/combating problems like depression.
News articles often neglect to report the differences in rates of diagnosis of mental health problems. All of these suggest that those in more marginalised groups are more prone to such difficulties. Again, this suggests that access to individual counselling and therapy should not be the only approach to dealing with this problem. Attending to societal inequalities and injustices is vital, not just from a human rights perspective, but also from a mental health perspective.