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12 January 2017

Leader: The NHS and the black dog

Mental health is beginning to get the political attention it deserves, but proper funding is vital.

By New Statesman

“I don’t like to stand by the side of a ship and look down into the water,” Winston Churchill once confessed to his doctor Lord Moran. “A second’s action would end everything. A few drops of desperation.”

The great wartime leader suffered throughout his life from depression – the “black dog”, as he called it – sometimes spending months in abject despair. Yet, for his early biographers, this depression was unspeakable. How could the prime minister who faced the threat of the Nazis with implacable resolve have been unable to control his own mind?

We know now that mental illness can happen to anyone. It is not a sign of weakness or a shameful secret. No one, whether rich, powerful, creative or successful, is immune.

In the 2010 book Downing Street Blues, the psychiatrist Jonathan Davidson collects evidence that many of Britain’s leading politicians suffered mental disorders. Benjamin Disraeli spent part of the 1820s in what his first biographer called “clouds of despondency” so deep that he seldom left the house. William Pitt the Elder complained of “gout in the brain”. In 1931, Harold Macmillan was admitted to a sanatorium after suffering a breakdown. Gladstone had 15 depressive episodes, writing in his diary in 1838 of his “inward trouble”.

These stories are a reminder of the frequency of mental health problems: one in four Britons will be affected each year, according to the charity Mind, with depression and anxiety the most common. Some 80,000 children and young people suffer from severe depression. There has been one
suicide in prison every three days in the past six months.

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Science has been slow to understand the human brain. In the early 19th century, “lunatics” were locked up in asylums. In the early 20th century, some were “treated” with lobotomies. Now, there are better, albeit imperfect, options. Anti­depressants have improved the quality of life of millions; cognitive behavioural therapy can benefit those with debilitating anxiety.

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Yet there are few quick fixes in psychiatry, and this presents a challenge for an overstretched NHS trying to allocate limited resources. Long waiting lists can result in people waiting months for a counselling appointment. Those without strong support from their friends or family can end up trying to cope alone. For men – many of whom feel that stoicism is expected of them – the problem is particularly acute. The highest rate of suicide is among males aged between 45 and 49.

In recent years, more politicians have spoken publicly about their mental health struggles. In 2012, the Tory MP Charles Walker revealed in the House of Commons that he had lived with obsessive-compulsive disorder for 30 years. He was, he said, a “practising fruitcake” who had to do everything four times, from washing his hands to entering a room. His Labour colleague Kevan Jones spoke of his depression and voiced the common fear “that somehow if you admit fault or frailty you are going to be looked upon in a disparaging way”. The Liberal Democrat MP Norman Lamb did much during the coalition to push mental health to the top of the agenda. His interventions were driven by personal experience: his son Archie suffers from OCD.

Although rhetoric often outpaces action, mental health is beginning to get the political attention it deserves. Theresa May’s speech on 9 January was welcome, as was her announcement of better training for schools to identify pupils who are struggling. It is right to tighten employment law so those who take time off for mental health issues are not penalised – although more consideration should be given to those in casual or insecure work, who will not benefit from this. (A wider review by Lord Stevenson and Paul Farmer, the chief executive of the charity Mind, is promised.)

However, proper funding is vital. There is now “parity of esteem” – where mental health funding is supposed to rise in line with overall NHS budgets – but the King’s Fund think tank found in October that 40 per cent of the 58 mental health trusts in England had their budgets cut in 2015-16.

The government suggested this week that mental health issues cost Britain £105bn a year. Better funding makes economic, as well as moral, sense. As the politicians named above show, it is possible to live a fulfilling life in spite of mental health problems. As Winston Churchill wrote in 1911 of his black dog: “He seems quite away from me now – it is such a relief. All the colours come back into the picture.” The same can be true for millions of others.

This article appears in the 11 Jan 2017 issue of the New Statesman, Putin's revenge