I have been meaning to blog for ages. I recently went to a very interesting conference in Copenhagen and spent three days discussing personality disorder, which is one of my primary clinical and research interests. Unfortunately, I’ve been incredibly busy and it’s had to fall to the bottom half of the to-do list. I thought I would make an extra effort today, however, since it is World Mental Health Day.
This seems an apt time to consider some of the issues which persist in mental health. There is the very concept of ‘mental illness’ of course, the battles between the pro- and anti-diagnosis camps, the bickering over effective treatments; all stuff that often goes on in the ivory towers that some of us inhabit. I have always believed that there are two main issues which really affect people with mental health problems and their families: stigma and funding.
i think we’re often quite proud of the way we have come to acknowledge mental health issues in this country, and, to some degree, rightly so. But often success is only lauded because it comes in a sea of perceived failure. So when MPs talk about their mental health problems in Parliament I am pleased, but the very fact that it is such a big deal suggests we still have a long way to go before we truly have an open discussion about the prevalence and impact of mental health problems.
On Monday, the Sun ran this front page:
‘1200 killed by mental patients’. Now the term ‘mental’ went out of use many years ago amongst those us who have some compassion and humanity. News International publications are not, if you will indulge me, known for either their compassion or their humanity. Despite the story admitting that most people who have committed serious violence in the context of a mental illness, the headline will do nothing to eradicate the image of the knife-wielding patient (an image that persists, as we recently saw of the Hallowe’en costumes being sold by Asda and Tesco).
So what are the real figures, the contextual ones? Well, here are a few:
– 1.2 million people in the UK use adult mental health services
– 95% of all murders are committed by people who have NO mental health problem (remember Harold Shipman, who killed hundreds of people?)
– Half of all violent crimes are committed by people under the influence of alcohol
– Around a fifth are committed by those who are under the influence of drugs
– People with severe mental health problems are 10x as likely to be the victims of violence as they are to be the perpetrators
– They are also more likely to harm themselves than anyone else: 90% of people who kill themselves have mental health problems
Given that 15 million people in the UK will have a mental health problem at some point in their lives, and that substances are implicated in the vast majority of all violent crime, this witch-hunt against those who are often very unwell is appalling. But let’s take a look at some more stats:
– Mental health services in the UK have had funding cut by £150m since the Coalition government came to power
– 2000 psychiatric beds have been cut in the last two years. No one, not even the Sun, got angry about that. But I know psychiatrists, good psychiatrists, who openly admit that they are discharging people from hospital when they are still unwell just because of pressure on beds. I have worked on wards where there are three people to a bed and you just hope to God that no one has a relapse whilst they’re on leave, because the chances of finding a bed anywhere in three boroughs is so slim.
– Mental health NHS trusts (which are distinct from physical health, as a general rule) have lost up to 20% of their staff since the cuts came into force. These cuts affect everything from secretarial support to the number of social workers and psychologists available to see those who need such intervention.
– Some of the areas most significantly cut: crisis resolution, early intervention, home treatment teams. In short, the very people who take care of those in crisis; the very people who can intervene if they see that risk is escalating. But they can’t, can they; not when they have caseloads of 60 or 80 people. As someone who works in community mental health services, I tell you this: it is impossible to look after that many people who present a moderate risk to themselves or others and to do it well. As the cuts take hold, services have increased their thresholds and increasingly, only take those deemed to be at high risk. 80 high-risk people cannot be managed by fewer than 2 professionals, and even then they will need intervention from other members of the team.
The fact is this: mental health services are buckling under the strain. Staff are overworked and under-resourced; many are simply burning out. It doesn’t take much intuition to realise that in a job which requires you to deal with people who often have complex needs, this is unsustainable. Newspapers could do a terrific job, if they could be bothered, of putting mental health on the agenda in a positive way. They could get angry about those people who are being denied services they need, not because we don’t want to provide them, but because we simply haven’t the resources to do so. They could make services better for the one in four of us who will have mental health problems – your brother, you best friend, your partner, your mum, your neighbour, your child. They could, if they wanted to. But, like so many others, they simply add fuel to this ghastly fire which means that those with mental illness are further stigmatised, further dehumanised and increasingly seen as the ‘other’.