Here is a copy of the debate in today’s Observer between me and psychotherapist Oliver James, arguing for and against major employers providing onsite psychiatric support for their staff.
Alastair Campbell – I was really pleased to see the headline proclaiming “MPs to get mental health clinic in parliament amid rise in depression and anxiety”. I know the general view of MPs is negative but the vast bulk work hard and under real pressure, so it would be surprising if there was not a considerable number of parliamentarians and staff who would benefit from on-site psychiatric support.
If one in four of us require help for a mental health problem, why should MPs be different? In fact all that the authorities have agreed to is a £25,000-a-year programme of support. Not much, but a step in the right direction. Parliament is a major employer, and in my view every major employer should provide mental health support services for its staff. It is good for the employer, and in the long run will save them resources, and good for staff. Parliament and MPs should be taking a lead in this, whereas in truth often they lag behind, and as so few MPs have spoken out about mental illness, the stigma tends to get reinforced.
Oliver James – While I respect your campaign to de-stigmatise mental illness and we might agree that the present government needs its head examined regarding its policies, there are three problems with this plan:
(1) Will it actually make more employees seek help? I know of a major commercial law firm which (like most large corporations) makes psychiatric support freely available to its overworked and affluenza-stricken denizens. The employees avoid it because it would risk the loss of their promotion prospects.
(2) I am less sanguine about psychiatry than you. Psychiatrists mostly offer pills and other sticking plasters, like cognitive behavioural therapy (CBT). For the commonest problems, depression and anxiety, neither really work. The major part of the effect of antidepressants is placebo; the patient might as well swallow coloured chalk. Meta-analyses show that 18 months after undergoing CBT, there is no difference between people who had it and those who did not.
(3) Most fundamentally, to which I would love to hear your answer, how likely is it that this measure is going to change the fact that we have twice as much mental illness in the UK (23%) as compared with mainland western Europe (11.5%)? We need to deal with the underlying causes of mental illness, not tinker with the symptoms.
AC On (1), that is because of the stigma, which is why we have to break it down so that people feel as comfortableake sure talking about mental health as they do physical health. I did a talk at the Bank of England this week and was really impressed they had a resident psychiatrist and I spoke to people who had benefited from her presence, including senior people.
On (2), I have benefited both from the expertise of psychiatrists and from medication.
On (3), good point, but again I think this is because we do not treat mental ill health with the seriousness we should, and again because of the stigma. A small clinic in Westminster won’t change much, but changed attitudes by MPs will, and this might help. There was a report this week from the Royal College of Psychiatrists and Royal College of General Practitioners, which said 16% of the burden of disease in our country comes from cancer, 16% from cardiovascular problems, and 23% from mental disorder. Yet cancer and heart care are taken way more seriously than mental illness.
OJ If the medics have done the business for you, great. But the evidence suggests you are very much the exception. I suppose I do concede a small part of the stigma could be reduced by the wheeze. However, my core point is that the Human Genome Project is rapidly proving that genes play little part in causing mental illness: the huge differences in prevalence between different countries strongly suggests politico-economic and cultural factors are vital.
There is now also overwhelming evidence that our electro-chemical thermostatic settings result from care during the first six years of our lives and from prenatal factors, putting us at more or less risk. This vulnerability is exacerbated in later life by high economic inequality, excessive materialism and excessive stress on individuality at the expense of collectivism. We need a total rethink of what our society is for – is it the profits of a tiny few or the wellbeing of the majority? The status quo is not only ecologically unsustainable, but emotionally too. A few corporate shrinks is nowhere near enough, a distraction from the real issues.
AC You are absolutely right that the focus of society should be the wellbeing of the majority, and right too that relentless focus on materialism has not delivered happiness. That is exactly why there should be greater emphasis on mental wellbeing, from cradle to grave, and why we should recognise that we all have physical health, some days good, some days less so, and given the mind is the most complicated part of our being, it is the same for our mental health. I agree a few corporate shrinks is not enough and that a change of attitude is called for. But ultimately parliament has to provide leadership, and in this small step it is doing so. I just hope the bigger steps follow – a reversal in the cuts to mental health services, proper investment in school sport, and above all equality of understanding, services and treatment between physical and mental health. And by the way, the medics haven’t cured me, they just helped from time to time.
OJ Okey dokey, maybe we are not so far apart. Except that I would advocate very fundamental structural changes, not just attitudes. For instance, politicians must grasp the nettle of the importance of early years. Before three, for their brains to flourish, kids need responsive care from someone who knows them well, preferably at home, preferably from a parent or relative. Who is prepared to stand up and say this and put paying for it ahead of things like a new Trident missile system?
My argument is that we should follow the Austrian model and effectively pay parents to stay at home (often sharing the care). Equally, Thatcherism created massive job insecurity, higher pay for a few with static pay for the majority, and much more atavistic workplaces, with some of the longest working hours in Europe. These are major causes of our higher mental illness prevalence. Addressing these things, the causes, seems a much higher priority than putting shrinks into corporations (or for that matter, schools, which would be the logical next step). I accept that you are trying to live in the world of the possible and you may say that I’m a dreamer. But I’m not the only one.
Alastair Campbell is an ambassador for the Time to Change campaign. His ebook, The Happy Depressive, is now available in paperback (Random House, £4.99).
Oliver James is the author of Office Politics – How to Thrive in a World of Lying, Backstabbing and Dirty Tricks, which is now available in hardback (Vermilion £20)