Thanks to the work of Norman Lamb and other Liberal Democrat MPs, mental health has risen up the political agenda. For many years, NHS spending on mental health has lagged far behind that of other conditions and research into treatments for mental illness has also been disproportionately low. MIND recently estimated that local authorities in England spend, on average, only 1.36 per cent of their total public health budgets on mental health – even though such problems cost the country an estimated £100 billion a year.
The aspiration of policymakers now is to achieve ‘parity of esteem’ between mental and physical health, the subject of much debate in the health policy world.
Is it possible, however, that the very term ‘mental health’ is part of the problem? Is it the ‘mental health’ label that has caused conditions such as anxiety and depression to be relegated to the second tier of medicine? While such disorders are essentially biological or chemical in nature, they have not been treated like other medical conditions, possibly because of the unhelpful ‘mental health’ tag – with all its preconceptions and misconceptions. Why otherwise would healthcare spending on these conditions have been so low? Why hasn’t depression been taken as seriously as diabetes?
Taking the patient-centred approach, I think we should move towards abandoning the term ‘mental health’ altogether. If someone has depression, bi-polar disorder or post-traumatic stress, let’s just call it that. After all no one goes to the doctor saying I have a ‘physical health’ problem – why should people talk about having a ‘mental health’ problem?
The ‘mental health’ label has dogged sufferers for far too long and how better to get rid of the myopic stigma surrounding mental health than to jettison this outdated term altogether and lobby harder for each condition to be treated on its own merits?
For the past four years I have been editing Wellbeing, the newsletter for the Anxiety Alliance. Last year I was in dialogue with Peter Kinderman, Professor of Clinical Psychology at Liverpool University and his view is also that we categorise too many conditions under the ‘mental health’ banner. As he said in an article for BBC Health News in January 2013,
The forthcoming edition of an American psychiatric manual will increase the number of people in the general population diagnosed with a mental illness – but what they need is help and understanding, not labels and medication.
So, where we practically can, let’s just talk about health. After all, mind and body are part and parcel of the same thing.
In a follow-up article on mental health, I hope to look at what sort of policies might enhance our wellbeing. As with heart disease, where a lot of prevention work is already being done, there is little point in treating emotional disorders without looking at ways of reducing the risk factors associated with the theses conditions – however challenging that might be. And of course, this is where Nick Clegg’s recently announced Mental Health Taskforce comes in.
* Judy Abel is a Lib Dem member who has worked in health policy for several major health charities. (She is still working)
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27 Comments
It is worth saying that parity of esteem is necessary across the issue of inability to work etc among those with mental health conditions along with those with more “observable” “physical” conditions. It is at least arguable that most of the problem that led to benefit cuts is due to prejudice / failure to recognise mental health issues as a reason for not always being available for paid work. It has taken an amazing amount of hard work by our LDDA and other dedicated people in and outside the party to make our parliamentarians that they had been led up the garden path by the Tories in terms of demonising and punishing this large group of people. Norman Lamb and others are having to try to drag back much of the money already cut from benefits AND services supporting these people. Had there been more advance thought on this, we would probably as a Party have made more of a red line of this, ensuring that if the Tories wanted to chase the Mail, Express, Sun etc agendas they would do it alone. Yet another issue we need to publicly acknowledge. People want politicos who are prepared to admit to error, not people who perpetually rationalise away poor decision-making.
If certain words have become “part of the problem” – in a way that terms such as “spasticity” have in the past – it’s because they’ve been misused and misunderstood.
Wellbeing is a useful term and I like it – I also agree we need to mvoe towards more holistic care provision. But physical and mental health needs are very different, require different approaches and therapy/treatment should be delivered by people expert in their respective fields. Mental health is an entirely different discipline to physical health. I accept that we should be talking about general “health” and “wellbeing” wherever possible and when appropriate, but sometimes it is right to discuss “mental health” as something which is distinct and separate.
Atr the moment, I’m working on a project identifying the relationship between living with HIV and mental health. Yes, it’s an umbrella term, but it can be useful – and is no more likely to be used to label someone as terms like “schizophrenia”, “depressive”, etc.
The key, as Prof Kinderman says, is understanding. Understanding what mental health is will unlock new possibilities for those with mental ill-health (myself included).
Challenging stigma isn’t quite as simple as using new terminology. And I object to someone wishing to describe me according to my physical condition. I do not wish to explain to the world that I have bi-polar affective disorder. But if I say “I’m having some mental health difficulties”, without being overly specific, most people do understand.
It seems, however, that many do not know what mental health is, including the writer. She used “mental health” to describe a range of mental ill-health conditions. We have to describe what good mental health is to recognise what can affect it to lead to mental ill-health…
Definitions, definitions…personally: I am not bothered being ‘tagged’ under the mental illness label. There is however, a rather convincing argument by Dr. Tim Carpenter, “The Curse of the Strong” that depression in particular, is not psychological: ‘a state of mind’, it is a physical illness. An imbalance of chemicals (serotonin and noradrenalin) that descend into low levels very quickly, which can have extreme consequences to the depressed person: they break down.
Perhaps, if we classified each ‘mental illness’ by its diagnosis it would reduce the stigma: in my particular case, I have a depressive illness – I could the add the other illnesses that has been a result of the depression.
I would recommend the article ‘Depressive Illness –“The Curse of the Strong”’
You can find it here.
http://www.lanternsurgery.co.uk/website/H81672/files/Depressive_Illness_Curse_of_the_strong.pdf
To stop using mental health as a term is not smart. If you called it something else the problem would remain. People need educating the same way people were educated about homosexuality or HIV.
I saw Norman talk at a conference. His estimate of how many people are helped by CBT was a joke.
Another thing that annoys me is that CBT is sold as a panacea when in fact it only works for people with excessive ‘negative automatic thoughts’. The NHS should screen for this (very easy to do). Then only offer CBT for those people.
It also seems most people don’t understand statistics or research. Evidence-based research can’t work for therapy or other mental health interventions because mental wellbeing is so subjective. Research has shown that therapists hugely overestimate how many people they successfully treat.
The NHS measures CBT success based on an exit-questionnaire. Most people return to their original mental state within two years after treatment so you need to measure that.
I should be an advisor. I have research knowledge, common sense, personal experience and compassion.
Most people are missing the wood for the trees due to bad research or misinterpretation of the results.
Mike
Founder of MEN HEAL (MENtal HEALth support organisation for men)
http://menheal.org.uk
@menhealuk
totally agree with the sentiment of this article
The stigma (and self stigma) attached to “mental health” is immense. I prefer to talk about emotional ill health when I have to differentiate but that should be a rarity
@ Mike – I agree CBT is used now, seemingly, to be the answer to everything. Having gone through the motions, and currently re-going through the motions, I can attest that CBT can with certain individuals do more harm than good. In my case – self harm increased.
I’ve had a panic attack, been on CBT and recommended antidepressants twice, so I feel I can have an opinion on mental health, but I am worried that political correctness is making it difficult to talk about and this would be a further step down that line.
My mental health problems have hurt others and I should be allowed to say this without being accused of stigmatising it. We need to treat mental health seriously and we should not allow the debate to be hi-jacked by political activists focused on extreme political correctness.
Indeed, Reg – CBT can have its uses but it is far from the cure-all it is sometimes promoted as. What works for one does not necessarily work for another.
Health is something very personal – including mental health – and should be treated as such.
And Mike – thanks for the honest post above. I agree entirely with the substantive points you make.
One of the biggest organisations that could help towards restoring/improving mental health is the national health service.
I am not referring to NHS patients but NHS staff who are bullied by those in their line management structure. If you want to find workplace bullying, with all its negative impacts on esteem and general well being, you can, unfortunately, find no worse example than the health service.
Dear All, thank you very much for all your thoughtful feedback so far. I think all I was perhaps trying to say is that mental healthcare and research spending has been woefully inadequate for a reason and it seems to me it must be because the mind has not been taken as seriously as the body, which is, of course, illogical. I feel the physical/mental health divide may have had something to do with this. If mental health conditions were defined as psychological or neurological, for example – this is just an example – they would be more embraced by mainstream medicine and the mind/body divide would become less important – and the spending might also appear. Also, the Lib Dems often talk about the stigma associated with mental health conditions in their own literature, If there is stigma, then using different terminology, and thinking about things in a different way, might not be a bad idea.
On CBT, I spoke with a psychotherapist friend recently who also said CBT often didn’t really get to the root of things and wasn’t the panacea it is sometimes made out to be.
I should perhaps say that I suffered from anxiety about six years ago, It didn’t last that long, and was linked to a specific life event , but it got me editing Wellbeing to try to help others going through the same thing.
Thanks Judy. Sorry I didn’t quite get my tone right. I enjoy your posts and keep writing to us!
Best regards
Don’t worry Eddie. Thank you for your reply. And I’ll keep writing – I have a lot more articles in mind!
@ Judy – Thank you for the article: as far as I am concerned any discussion on mental illness is welcome
Thanks too for the encouragement Reg..
I am not sure whether the suggestion to abolish a specific label is very helpful at this point.
When I finally got to the point where I realised that the various things that weren’t working properly in my life anymore were a fairly good approximation typical symptoms of stress-induced depression, I have to say, I was glad for the label.
I am still glad to be able to talk about mental health where people are leaving it out – if you talk about ‘health’ generally, you are immediately derailing the discussion because people think of physical health. You may wish it weren’t so, but at this point in time, I find ‘mental health’ a term that’s useful to emphasise this aspect of health issues more generally. And I feel a bit distraught to hear that you want to do away with it, just at a point where I feel that the term ‘mental health’ is becoming more acceptable and people are starting to get used to it. And, in a way, it’s like saying that we should do away with racism by simply refusing to acknowledge that people perceive differences between races, or the idea that we can deal with sexism by simply trying to abolish the ‘male’ and ‘female’ labels altogether – even if, just as with mental health, you might question the very idea that you can have two distinct labels for categories which are a lot more complicated. Would be nice if you could deal with a debate in such an easy manner, but that’s not going to work, I think.
If we want to have parity of esteem, we need words for the things that we want to be equally handled. Perhaps once the difference is smaller, we can discuss whether we shouldn’t even use different terms any more. But not now, when we desperately need words to describe the awful chasm between the ways in which physical and mental health are treated. And just introducing a nicer euphemism is just going to muddy the water.
For example, I am only slowing getting to a point where people at least expect questions about ‘health and safety’ with respect to mental health. At my work place, there is a lot of health and safety stuff going on, and risk assessments and all that. But none of that includes mental health (e.g. when a new procedure is introduced, and people haven’t even asked whether this may cause stress for some people).
I want a term that’s easily understood (and finally less stigmatised, too) in order to have these conversations.
And that’s an opinion that comes very much from the frontline in these kinds of debates.
I should probably add that I find this suggestion rather superfluous also because I don’t find the term ‘mental health’ or even ‘mental illness’ in any way offensive. Yes, people say ‘you have gone mental’, but the useage of the adjective is different in this context (you don’t talk about mental illness in the same phrases) …. and really… as somebody who self-defines as having a mental health problem I don’t see it as an issue.
It’s evidently different if a term has become a serious term of abuse – ‘spastic’ comes to mind. It’s good to see that back of that term, but it wasn’t very sensible term to begin with, and more accurate words are available, where necessary.
I just don’t think that this is a similar problem.
And I’d prefer to have a fairly straightforward language for making mental health issues visible alongside physical health issues, rather than arguing about the exact language we might be allowed to use.
Thanks Maria. I was trying to look at ways we could achieve parity of esteem for treatment of physical and mental health problems, which there has not been in the past for some reason. I thought one way might have been to take a more holistic approach by breaking down the mind/body divide. Maybe I didn’t express that very clearly.
Judy – I understand what you are saying. Not least as somebody whose mental health problem has caused a number of physical problems, to a point where the distinction makes no sense.
What I am saying, though, is that on the frontline, in a workplace which is quite concerned with physical health and which at the same time often takes measures which seem actively designed to damage people’s mental health, we are very far from a point where this process can even start.
We first have to make them aware that mental health is something they need to care about. And I, for one, need words to do that.
I think the problem is here an ideal world in the future, where we might be able to think about health holistically (I love the idea), and the here and now, where we finally get some attention for mental health and have to do all we can to give it a high profile. I have fought, and I am fighting, to make this a topic we can finally talk about – and then you are telling me I shouldn’t be using a term that I feel is finally being liberated? I find that intensely frustrating.
Essentially, I think your post comes a generation too early.
What you suggest will be possible once people like me, at the coal face, have had a chance to use the term ‘mental health’ enough for people to understand that there is no difference between mental and physical health.
I think your article is full of the right intentions, but, at this point in time, makes a suggestion which would only hamper the development you seek to achieve.
Thank you for your thoughtful comments Maria. I do understand that the suggestion of not using a term which is finally being more widely accepted and understood could seem really counterproductive. I like the idea of being a generation too early with my post – I do sometimes get ahead of myself! Thank you very much and bye for now. Judy.
Maria, I see your point, but I think what Judy was driving at was not to do away with the term ‘mental health’ altogether but, wherever possible to use the specific term if a diagnosis has been made.. it becomes far more meaningful than a general term which can be heard as a dismissive. You might say ‘the car is broken down, its in the garage’ but it means so much more if you can say, ‘it needs a new clutch bearing’.
Seems to me though, that the history of the evolution of NHS revolves around the prioritising of treatments that involve money for drug companies, anything else is somehow not a treatment.
Great debate everyone! Everyone having an open and honest debate like this is definitely leading us in the right direction (at least I believe so) in regards to mental health. We might make mistakes by talking, but I have faith than open debate irons things out, as long as our agenda is a good one.
Thanks everyone
Mike
Peter: Some great points. Nice analogy about the car.
I spoke to an ex-soldier today who has bipolar disorder. He was evicted from his house due to the bedroom tax and is now living 20 miles away from his support group and friends! He had to be sectioned because of the distress caused.
Our society is getting so lost in legislation that people are not getting the help they need. A lot of fools acting like a robot following rules and regulations. The common sense and compassion has gone.
I was helping someone else who can’t leave their house.
Here’s the conversation:
Me: “My friend can’t come out the house due to severe anxiety issues, and he also had bipolar. How can you help him?”
GP: “He needs to come down to see us”
Me: “He can’t come and see you because he finds it highly traumatic to go out of the house”
GP: “No problem. Just tell him to come down to see us”
Me: “Yes, well that’s the problem. He finds going out the house highly traumatic”
GP: “He’ll have to come down and see us”
Me: “Can you come and see him at all?”
GP: “He needs to come down and see us”
Me: “Sorry, I think you aren’t understanding here. How many times can I repeat myself? HE CAN’T GO OUT THE HOUSE”
GP: “He needs to come and see us”.
WOW!
This is just one example of the stupid society we live in. Total unemotional automaton on the phone.
Fast forward two years… a psychiatrist finally saw him in his house after a LOT of hard work.
Psychiatrist a week ago to my friend: “Yeah, you’ll have to come down and see us”.
My friend starting drinking heavily again after a year of sobriety. I almost felt like joining him and I don’t even drink!!!!
Yes a great debate. Thanks Mike, Talking about things and sharing ideas can be really useful in moving things forwards. That’s why I would like to write a second piece about prevention – because growing a more compassionate society which puts wellbeing at the forefront of its thinking, will take initiatives across many policy areas from health to social care, education to the workplace.
“After all no one goes to the doctor saying I have a ‘physical health’ problem”
They might, however, say that they had a sexual health problem, or an orthopedic issue, or a gastroenterology problem or… There’re lots of broad terms which encompass a wide variety of different conditions, these terms do not prevent the individual conditions from being treated on their own merits.
Getting rid of the stigma associated with mental health is important, but getting rid of the term itself doesn’t seem like it would be at all helpful in achieving that goal.
Perhaps THE most important thing is to really listen to patients and ask them how they feel about the services they are receiving. This issue should be about compassion, caring, fresh ways of thinking and adequately funded healthcare and research. Whatever happens, this important and sensitive issue must not be turned into a political football. Patients’ wellbeing, dignity and individuality must be at the heart of all policy.
Yes, I agree that it’s been a positive thing to have had such an open discussion of mental health on Lib Dem Voice. Thank you Judy…and I’d be very interested in the piece on prevention which I imagine will be thought -provoking and somewhat challenging to how we think about mental well-being.
Thank you very much Andrew. I will probably try to write that before Christmas sometime. – if not, for early in the New Year. And, as with all exchanges of ideas, I have, learnt something too.