“Prime Minister pledges a revolution in mental health treatment”, the official press release reads. Specialist care for mothers! Increased funding for emergency services! A bold take on the “taboo of poor mental health”! Positive steps from Prime Minister Theresa May, right?
Except they’re not positive steps from May. In fact, they’re not from May at all – the press release in question, confidently calling for a revolution in mental healthcare, was written nearly exactly one year ago today, when David Cameron was still at the helm.
It’s striking to see the similarities between Cameron’s statement — 11th January, 2016 — and Theresa May’s – 9th January, 2017 – which arrived shortly after a speech in which she outlined the comprehensive changes she claims the Conservative government are intending to implement around mental healthcare.
In 2012, the coalition government pledged to give mental healthcare “parity of esteem” with physical healthcare. But since then, only half of mental health trusts had received any increase in budgets, with just 25% believing they’d be given further promised increases.
Children and adolescents, a demographic May focused on in her speech, were significantly impacted during this time — according to freedom of information requests from mental health charity YoungMinds, 75% of mental health trusts froze or cut their budgets between 2013/14 and 2014/15, and over one in five local authorities had frozen or cut their Child and Adolescent Mental Health Services budgets every year since 2010. The NSPCC found that one in five children are denied mental health treatment because they’re not deemed ill enough. Cameron’s promises, it seems, were empty.
Though the language they’ve used to deliver their policies are similar, there are marked differences in the way the two premiers have attempted to tackle mental ill-health. May’s focus is firmly on preventative state intervention – working with schools and employers at the onset of illness.
Cameron’s Big Society solution, on the other hand, sought to put the onus of problem solving onto communities themselves. In theory, he claimed, this would be empowering. But in reality what it meant was that responsibility for dealing with mental illness was often placed on charities who themselves had experienced severe cuts in governmental funding. Exclusion and isolation from communities, something mentally ill people frequently experience, alongside the slashing of state-funded intervention, meant that many people went without support and without access to services altogether.
May’s rejection of this strategy is interesting, but there are several problems with her vision of a “shared society”. Her version of state intervention, for one thing, focuses on prevention – all very well, of course, until you consider the vast numbers of people who are already undergoing or are in desperate need of treatment.
And without the extra funding that mental health services need, what good are any of these promises? Since Cameron’s “parity of esteem” pledge, the gap in funding between physical and mental healthcare has actually increased. Jeremy Hunt may have claimed on the Today programme that the NHS is not in a state of crisis, but anyone who has spent time on a psychiatric ward, or even tried to get a timely referral to NHS therapy services, will know that there are serious structural problems. The system as a whole is desperately underfunded, and strategies, plans and promises that don’t take this into consideration are flawed from the start.
The language of May’s speech also betrays a misunderstanding of the structural realities of mental healthcare. The takeaway point of the speech — the need to tackle stigma — is an important element of mental health discourse at the moment, so it’s a natural, and rather soundbite friendly, point to focus on. And tackling stigma is important — the 2016 British Social Attitudes study from NatCen found that 44% of people would be “uncomfortable” working with somebody who had experienced psychosis; 82% said they wouldn’t feel comfortable “having someone with depression look after their children”; 64% said they would “feel uncomfortable having someone with depression marry into their family”. Stigma is about more than just name-calling — it has a real impact on people’s lives.
But “tackling stigma” is also a convenient way to avoid talking about some of the more inconvenient truths about both mental illness itself and the way that it’s treated. May herself admitted that the NHS was currently providing “inadequate treatment”, and at the start of her speech focused on groups that experienced significant discrimination elsewhere including working class people and people of colour. But she failed to acknowledge that these very groups are most likely to have been impacted by the austerity policies of David Cameron’s government.
Austerity measures have had a significant impact on these marginalised groups, not only financially but also in terms of their mental health. Trying to pretend that mental health is not also a political issue, that it’s not connected to things like racism, disability or class, is to fundamentally misunderstand the issue, and is certainly no way to tackle it effectively or in the long term. May has not even outlined or suggested increased funding, so it’s unclear how her so-called “preventative measures” are to be implemented.
While it’s good news that a world leader is talking about mental health in such blunt terms, it urgently needs backing up with action to stop the continued erosion of frontline services. Borrowing words from left-wing discourse may be a handy way to pay lip service for what is a significant, devastating and often fatal crisis in mental healthcare. But social justice buzzwords can’t disguise the fact that that the mentally ill are being let down by a government who has so far failed to commit a penny of extra funding to the health service.
Emily Reynolds is a freelance journalist based in Berlin who writes about mental health. Her first book “A Beginner’s Guide To Losing Your Mind”, is out in February 2017.