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9 September 2021

Why we can’t treat our way out of the mental health crisis

More doctors providing more pills isn’t the answer.

By Rachel Kelly

For years now, like other mental health advocates, I have been arguing that the NHS needs more resources to deal with the nation’s burgeoning mental health crisis. But a recent conversation with Keith Leslie, the chair at Samaritans, has made me rethink. “The NHS will never, ever be able to solve the mental health crisis,” he said. “We need to think about mental health in a new way.”

Leslie is someone to whom we should be listening. The government is hampered in its attempt to track the psychological wellbeing of the country. An obvious starting point, you might imagine, is looking at how many people talk to a GP about mood disorders. But it is hard to see a GP right now, so we are rather in the dark about actual demand for mental health services.

By contrast, Samaritans has daily real-time data for the number of people calling its phone lines. At about 10,000 calls and emails a day, this was around 10 per cent higher in June 2021 than it was at the same time last year.

The reality is that many thousands of people need urgent mental health support at any given time, especially young people. Estimates from the Centre for Mental Health in October 2020 suggest that up to ten million people – ten million – will need either new or additional mental health support. The NHS cannot cope with this level of demand, and never will.

While no one can deny the vital role of professionally provided treatment in addressing serious mental health conditions, we need – urgently – to focus on other routes to wellbeing that can complement and sit alongside clinical support.

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[See also: Boris Johnson is exploiting the public’s misunderstanding of National Insurance]

Let’s rewind. For the past decade, we have tried to treat our way out of the increasing number of people affected by mental health problems. There has been a rise in the use of antidepressants, as well as in the numbers of people talking to a therapist, which are the NHS’s main approaches to treating psychological disorders. In England, 1.6 million referrals were made for talking therapies such as cognitive behavioural therapy (CBT) in 2018-19. This is compared with 1.44 million in 2017-18, an 11.4 per cent rise.

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Meanwhile, more than 20 million antidepressants were prescribed between October and December 2020, compared with 19.3 million during the same three months in the previous year, according to the NHS Business Services Authority. Roughly six million people now take the drugs.

Yet despite the increased number of drug prescriptions and therapy sessions, our nation still faces profound mental health challenges. The number of suicides in the UK is around 6,000 a year, which is roughly stable, though Leslie is expecting that to increase in the aftermath of the recession that is likely to follow the pandemic. 19 million adults report high levels of anxiety, according to the Office for National Statistics in June 2020.

Surely the answer then is more money for the NHS for medical help? Leslie disagreed. “GPs have around eight minutes to treat someone, so all they can do is prescribe a pill or suggest talking therapies. But even if you had more resources, this approach would not solve our mental health crisis. This is because we are treating mental health as a medical problem, when in fact it is far more of a social challenge.”

This view is a long way from how we thought of mental illness in the 1970s. The perception then was that a few unfortunate people had something wrong with their brain chemistry. The answer was to lock them away and give them pills. Mental illness was for doctors to deal with.

Almost no one believes that now. The new paradigm is that we all have mental health, just as we all have physical health, and we affect each other’s wellbeing. Our day-to-day mental fitness depends hugely on our environment and immediate experiences.

This new understanding naturally points to different answers to our problems. Leslie suggests a two-pronged approach – and neither is about supplying more medical help. The first applies to all of us; the second is more targeted.

Take the first, more universal approach. Here the aim is for all of us to do a better job at supporting one another. To create a more sympathetic environment for anyone who is struggling, especially in the workplace but also in schools, chiefly through peer support.

The government would have an enormous role to play in fostering these more compassionate conditions in schools, where it provides funding and where it has started to focus on students’ wellbeing. But this is not just about central government. Parents, employers and community organisations could all play a bigger part in prioritising and supporting the mental health of everyone.

In these more private spheres of the home, workplace and neighbourhoods, the government’s role could be to provide benchmarks and expectations of the forms this peer support might take. It could share what “best in class” mental health support might look like, based on rigorous, evidence-based standards.

Employers are especially important, and key among them are line managers. “It’s very basic stuff,” said Leslie. “Line managers need training, they need to learn how to spot signs that someone is in trouble and how to support them, and these discussions need to be very routine.” Parents also need training to help them understand their children’s psychological needs. So, indeed, do many of us adults. Taken together, this approach would create a more sympathetic environment in which all of us could share our mental health experiences and get the support we need.

[See also: The government has failed to deliver on mental health] 

The second approach is to provide much more targeted relief for specific communities who are vulnerable, such as minorities. Michael Marmot’s research has focused on how much harder Covid has been for the wellbeing of the economically disadvantaged. Solutions are much harder to deliver to these groups, who suffer disproportionately from poor mental health.

“This is about the long haul,” said Leslie. “It is about getting access to and the trust of these people in need, who do not see themselves as similar to those who may be trying to help them.”

The government must play a role here in helping the disadvantaged. If mental wellbeing is about whole-person flourishing rather than just the avoidance of mental ill health, then we need to recognise that all areas of policy and social life are relevant: not just healthcare but the arts, transport, food, education, homes, green spaces, work and welfare, social care and more.

A two-pronged approach, then, but one with a glimmer of hope. We may be able to harness some of the social capital that has emerged out of the Covid period.

The pandemic has brought a revival of neighbourly activities and solidarity. People have reconnected with their concern for one another. There have been innumerable stories of support that sprang up spontaneously, from those armies of cheerful volunteers at the vaccination centres, to young people delivering supplies to the doorsteps of the elderly.

The last word goes to Leslie. While demand is up for Samaritans, so too are the number of volunteers. As he says, let us not waste a good crisis. Covid has created much willingness to think the unthinkable. Nowhere is this truer than in the mental health sphere.

Rachel Kelly is a writer and mental health advocate. Her latest book is “Singing in the Rain: An Inspirational Workbook”, published by Short Books.

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