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R ecently, I was in hospital overnight for an operation when the nurse on duty came in with some painkillers. “The doctors said I can take this, too,” I told her, revealing the small white tablet in my hand. When I explained it was an antipsychotic for my bipolar, her expression changed. I could only imagine what she was thinking – possibly something along the lines of “Oh no, is this one going to cause merry hell on the ward tonight?”
If I’d told her it was a chemotherapy drug or a dose of insulin, I wager she’d have been brimming with the milk of human kindness or, at the very least, nonplussed. Instead, her demeanour drummed home the fact that I not only have a lifelong illness and all the assorted complications that entails (from pharmaceutical through to financial and social), I also have a condition that seems to bring with it a constant feeling of being prejudiced against.
Charities campaign tirelessly for an end to mental health stigma. We’ve all seen the adverts (like those from Time to Change). Sometimes it feels that, on our behalf, they are making massive, confident strides, often catalysed by celebrities such as Stephen Fry revealing their personal struggles with mental illness (and, sadly, at times linked to catastrophic news like the suicide of someone like Robin Williams).
Politically, mental health has been on the agenda of various governments for at least 20 years with varying degrees of success. And during that time a few lone MPs have also stuck their heads above the parapet to champion this unfashionable ‘Cinderella’ subject including MPs Charles Walker and Kevan Jones who spoke out about their own mental health problems in 2012 (a 2008 MIND report revealed that of 650 MPs in the Commons, one in five admitted to having had a mental health issue at some point in their lives).
But despite this, the authors of a 2014 book, ‘Mental Health Policy for Nurses’, state that the ‘almost unanimous failure on the part of MPs to advocate for the mentally ill has seriously impeded the development of services and their availability and accessibility.’ And the fact is, almost nine out of ten people with mental health problems (87 per cent) say they still experience stigma and discrimination (according to the Stigma Shout survey by Time to Change).
As both someone with bipolar affective disorder and a journalist whose chief passion is mental health, this leaves me in a state of worried indignation. We still, it seems, have so far to go – when will radical, enduring change happen? With the General Election coming up in just two day’s time, this would seem like a prime opportunity for politicians to nail their mental health policy colours to the mast. The question is, will anyone commit?
Someone who has been on my radar for a while is Nick Clegg, the deputy prime minister and LibDem leader who, for people like me, is something of a posterboy for this subject. He has made no secret of his desire to bring treatment for mental health problems out of the shadows and in line with physical health, making this a legal responsibility through the Health and Social Care Act 2012.
“Some people politely call it a ‘Cinderella service.’ I think it’s worse than that – it’s almost an institutional form of cruelty”
Mental health has been a personal crusade of his for many years. His interest was born out of a meeting a family in his constituency whose daughter with an eating disorder was being desperately let down by the organisation (or lack of) of mental health services.
“Some people politely call it a ‘Cinderella service,” he told me as we sat in his office in Whitehall. “I think it’s worse than that – it’s almost an institutional form of cruelty, the way in which people are left in a state of great vulnerability and fragility to fend for themselves in a way that would be deemed completely unacceptable if it was a physical health problem.”
This schism between how physical health and mental health problems are perceived is a constant battle for people like me (the ‘if you can’t see it, it’s not there’ attitude to ill-health still prevails).
When we met, I suggested to Clegg that we are, in some respects, where cancer patients were in the 1950s (a friend once told me she didn’t even know her father had died of bowel cancer in the 1950s until she got it herself 40 years later and her mum then saw fit to tell her. “It was so taboo that everyone kept quiet about it,” she told me).
“That’s a really interesting parallel,” he said with seemingly genuine interest. “That’s a really interesting way of looking at it. I hadn’t thought of it before.” In a world of wily politicians, Clegg comes across as someone who has been genuinely touched by his mental health encounters (which is perhaps why he is so generous when, during the interview, I come to the blood-draining realisation that I my recorder isn’t on and he makes sure his own copy is sent to me by his press officer…).
At a Mental Health Conference in January, Clegg unveiled a number of pledges for the LibDems in Government, including treatment within two weeks of referral for people experiencing first-time psychosis, access to talking therapies within six weeks (18 weeks at an ‘absolute maximum’) for anxious or depressed people (“the same as if you were waiting for an operation on your hip,” says Clegg) and, most ambitiously, an ambition for ‘zero suicides’ (modelled on a programme in Detroit, USA).
And in February, one of the LibDem’s five priorities for the next five years was revealed as ‘Quality health care for all’, including ‘ending stigma around mental health and putting it on an equal footing with physical [health]’.
When we met, the other political parties hadn’t pledged much in relation to mental health. And, with just two days to go, it’s been mentioned to varying degrees (the Conservatives pledge to improve access to mental health treatments and the Green Party says mental health will be made a greater priority).
Clegg, of course, still feels that his are the safest political hands when it comes to mental health provision (“It’s certainly something I’ve pioneered in this coalition government,” he said. “I’m not going to pretend to you that the Conservative or Labour Party have tried to block it, but I don’t think the changes would have happened without us.”)
Sadly, talk is cheap and funds are scarce. Although mental health problems account for 23 per cent of the burden of disease in the UK, spending on mental health services consumes only 11 per cent of the NHS budget.
And according to the King’s Fund, although the focus on parity of esteem between mental and physical health is ‘highly welcome’ and some specific achievements have been made in recent years (including the Improved Access to Psychological Therapies (IAPT) programme), they say that ‘the increased attention now being placed on mental health has come late in the parliament, and there remains a gap between rhetoric and reality.’ Sufficient funding is needed, workforce shortages need to be addressed and investment in training and education is vital.
In all likelihood we will, yet again, have a hung parliament, of which Clegg’s LibDems may not even be a part. Right now it is just too close to call.
And British political history is replete with stories of parties that came to power with impressive pledges, only to u-turn once the dust settled. What’s to say that the green shoots of mental health change that he’s nurtured so carefully aren’t going to get trampled underfoot by whoever is in government next?
“I like to think we’ve got enough momentum going now that it’s not really possible for any future government to turn the clock back.”
Clegg – whose party pledges to put an extra £3.5 billion pounds into mental health – told me the problem is now too big for any government of any flavour to ignore. “We are starting to reach a point of no return,” he said. “I like to think we’ve got enough momentum going now that it’s not really possible for any future government to turn the clock back. The scale of it is such that it would seem to me to be incomprehensible why any future government, regardless of what political composition, would not keep up with the changes we have embarked upon. It’s something that affects one in four of your citizens. What more evidence do you need? It’s a national duty.”
And what if he is asked to form a government with one of the bigger parties? He sais he is “notoriously and constantly reminded” of the one thing he couldn’t deliver on, namely the abolition of university fees, but he added, “I take what we put on the front page of our manifesto this time very seriously”, including putting mental health provision in line with physical health. It’s unambiguously, openly and overtly one of the priorities for the Liberal Democrats going into this general election.”
WHAT NEEDS TO BE DONE? Of course I am bound to say this, but as a service-user, I think even more should be done. Clegg tells me that, in addition to his election mental health pledge, we could do with blurring some of the “wholly artificial distinctions” between children and adults, residential and community, mental and physical” and to start treating people like people rather than “units that cross these entirely arbitrary boundaries” (something that has started to be addressed by the Department of Health’s recently-launched Crisis Care Concordat). I completely agree.
Children, adolescents and ’emerging’ adults It’s these artificial boundaries that mean that, on turning 18, children stop getting the same mental health provision they needed when they were 17 years and 364 days old because the criteria for illness changes. I believe that these young ’emerging’ adults (aged 18-29) are increasingly heading for mental health crisis because, currently, the threshold for treatment is higher for adult services than for CAMHS (Child and Adolescent Mental Health Services). This means a young person may previously have received help but won’t under AMHS (Adult Mental Health Services). More needs to be done for this age group, as well as for children and teens. The number of youngsters being referred to mental health services has doubled [1200 under-18s waiting for a first appointment in 2010 compared to 2500 in December 2014].
Single parent support As a single parent with mental health issues, I also think that single parents need to be given more support to prevent them feeling isolated and to help foster good mental health in their children (a 2007 study found that single mums are significantly more likely to have a moderate to severe mental disability than partnered mothers). Earlier this year, Gingerbread announced its ‘Single Parents Decide’ pre-election campaign to highlight problems to politicians. Mental illness and the poverty it so often engenders should be on the political radar.
Mental health first aid This is an Australian import and relative new-comer to the UK – mental health first aid, where people are taught about the warning signs of mental illness and what to do about it whether in work, school or social arenas. “Whether it’s mental health in the justice system, the jobs market or in schools, you need to make sure that people are identified much earlier and then referred to help much earlier than is the case at the moment,” says Clegg. Mental health first aid may help to achieve this by helping everyone to understand that mental illness can affect people in a plethora of environments and that it’s the responsibility of all of us to tackling our own prejudices and use our energy to help people instead.
Very much in line with the Liberal tradition, compassion, says Clegg, is key: “If you want to be a compassionate society you have to be an open one and not try and resolve people’s problems in the closet. You don’t help people by trying to sweep their problems under the carpet, which has been the attitude towards mental health problems for a long period of time.”
Just a few days before the General Election, I feel reluctant to nail my colours to the political mast because, quite frankly, for so many reasons I am still undecided. Not only that but, having trained as a news reporter, I like what I write to be balanced and impartial (“Bury the ‘I’”, my journalism lecturer John Foscolo drummed into us trainee reporters, discouraging us from making ourselves the news).
However, my gut feeling is that of all the politicians, Clegg appears to be perhaps the safest pair of hands to leave mental health policy in. None of the others have said anything to instil confidence so far.
But whoever ends up in power in May, Clegg is realistic about how much commitment this area is going to need: “Sorting this out is like turning around a tanker,” he says. “It won’t be one government, it won’t be one parliament. But if I can play a small role in effect trying to kick-start a cultural change then I hope I’ll look back on it as being one of the things I’m most proud of.”
- A version of this article also appears in the May issue of Psychologies magazine