In recent months, the news about mental health support in the UK has been, with few exceptions, overwhelmingly negative. Whether it’s NHS shortfalls and a lack of beds, which impacted patients who later died1; children with mental health issues facing “unacceptable”2 waiting times to get help; or women who find it difficult to access mental health services during the particularly vulnerable time of pregnancy3, the overarching picture looks bleak.
We are arguably far more enlightened on the subject of mental illness than we were 15 years ago, and politicians have been trumpeting their commitment to spend more money on services, and bring about parity in treatment with physical health. Yet it seems we are still failing, far too often, to help those who need it most.
The reasons behind this are (perhaps unsurprisingly) many and complicated. It’s generally accepted that the NHS is underfunded, with a fall in the proportion of GDP spent on health services and cuts to social care placing huge pressure on the service. Add to this an ageing population and the burden of treating long-term illnesses, and there’s even more strain. So the NHS in general is struggling, and mental health services are facing their own particular challenges.
Firstly, with raised awareness has come an uptick in the demand for services, as more people seek help. Secondly, mental health issues are on the rise, especially amongst young people. Finally, there’s been a worrying fall in the number of mental health nurses around to look after people4.
We also have to consider the fact that no matter how far we’ve come in understanding mental illnesses – not looking at it as attention seeking, laziness, or something to be feared and locked away – there’s still an awful lot of misunderstanding and prejudice that can hinder treatment. People still tell hair-raising stories (even if they are very rare) of professionals making disparaging remarks or not taking them seriously.
Mental health problems can benefit hugely from early intervention. Take the example of someone who has started having panic attacks for the first time. They may well ring a ambulance or turn up at A&E, because the nature of panic attacks means that a large proportion of people who experience them will be certain there’s something physically wrong with them – such as a heart attack, or stroke. However, even if that person is absolutely certain they are going to die, they will probably be sent home without any treatment, because they aren’t in any ‘real’ danger.
This, of course, makes a certain amount of sense. Doctors have to prioritise the people who are actually facing a physical threat to their life. Yet it doesn’t help the person who is still convinced, each time they have a panic attack, that they are facing imminent death. This is a terrible state in which to have to wait for a GP appointment, and to potentially wait months more for therapy. Things become even harder if the usual medication prescribed in these cases doesn’t work for an individual, leaving them to battle the feeling of mortal danger all on their own.
The kind of delays which are highlighted often in the news could make the difference between this person experiencing panic attacks and then quickly recovering with the right support, or the anxiety becoming entrenched. Regularly experiencing panic attacks is mentally exhausting and upsetting, and leaves the body in a similar state to someone who’s been fleeing from a predator for days on end.
Without fast intervention, people can begin to self-medicate to relieve their symptoms. Some young people facing anxiety have started to abuse Internet-acquired Xanax5 and alcohol, complicating their illness and putting them in danger of addiction. The result is a vicious cycle, in which people are de-prioritised and face delays as health practitioners deal with the most difficult cases, and as a result become more difficult to treat themselves.
The commitment and hard work of the vast majority of those who work in UK mental health support is unquestionable, with many working huge amounts of overtime and facing stress and burnout themselves. There are simply too many people who need help, and not enough funds or resources to provide it. As Peter Kinderman, a clinical psychologist at the University of Liverpool, puts it: “The entire NHS is suffering and the mental health system is a large part of the NHS – and it’s suffering too. I think there’s been quite a profound change in the last 25 years, that people are now more willing to talk about their mental health, but we just don’t have the systems to respond to it.”
So what’s the solution? While we wouldn’t presume to have a panacea for this serious and complex issue, we do think there are ways to support mental health outside of simply allocating more money (which, ideally, would be the initial step). Firstly, although the demand for services has increased, we must continue to foster an open and honest atmosphere around mental health, so people feel able to discuss and seek help for their problems before they hit crisis point.
Secondly, we need to ensure that children – through schools and other societal programs, as well as reaching out to parents – get the best start possible, learning about self-care and being given the emotional tools they need to face the inevitable difficulties of life. Increased equality would help hugely in this, as poverty is a leading cause of chronic stress6, and discrimination is linked to stress and poor health7. Creating a more holistic education system, which values emotional wellbeing as well as academic achievement, and allows children the room to express themselves and follow their interests, could also help to protect their mental health.
Finally, people need to be aware of – and not made to feel ashamed of pursuing – the non-medical actions which can help them maintain their mental health. Self-care can feel like an ‘airy-fairy’ term, but small everyday actions can make all the difference to a vast amount of individuals. Like our physical health, small daily choices have a huge cumulative impact, and our physical and mental health are intimately connected. Empowering people to take actions which improve their own wellbeing could reduce costs to our overstrained healthcare system, and make our whole community healthier and happier.