With apologies to Angela Merkel – I had intended to keep my praise of her as lead blog over the weekend – I feel I have to say something about the current furore raging about the ‘mental patient Halloween costumes’ being sold by Asda, Tesco and on Amazon. Thanks in large part to social media, Asda and Tesco have done the decent thing and withdrawn them. I suspect Amazon will be a tougher target – ‘we don’t give a shit about much apart from making money’ appears to drive them – but we will get there.
I have been busy on twitter and on the airwaves trying to explain why this matters, and will be talking to Jeremy Vine on Radio 2 at lunchtime. The mentally ill have enough to deal with without the brutalising stigma that still surrounds mental illness. That is why the Time to Change campaign exists, to break down the barriers and the taboo and to fight for better services and understanding. I know people who are mentally ill who say they can cope with the symptoms of their illness. What they cannot bear is the fact they feel they cannot talk to anyone, not even their family, let alone their boss, because of their fear of the reaction. That is stigma. Imagine if cancer victims or asthmatics or diabetics felt the same? Mental illness is an illness. Just because you cannot see it does not make it real. And stigmatising it takes us back to the dark ages.
Here is the piece I have done for The Fabian Review on mental illness, which was published this week, before the Asda-Tesco-Amazon storm blew up.
Mental health is still treated completely differently from physical health. To ensure mental health sits at the heart of the whole person agenda, politicians must lead the way in helping to destroy taboos, and underpin changing attitudes by law.
When I think about what the world would look like if mental health were considered of equal value to physical health,
I imagine something radically different to what we have now.
I imagine professionals using a recovery-based approach to caring for people with mental health problems, rather than just medicating them and leaving them without proper support or care.
I imagine an end to the postcode lottery of good care, and cultures of restraint replaced by cultures of respect and dignity.
I imagine a time when people are as comfortable talking about their mental health as they are about their physical health. When there is no taboo in asking for help and people are confident in knowing how to look after their own mental health.
I imagine a time when the rights and services that exist for physical health conditions also exist for mental health and we give actual meaning to the legislative reality of parity between the two.
I imagine a time when power is given back to patients, so that they are at the heart of the decision-making process about their care and professionals are responsive to their needs. While this can be a tricky issue when people are in a crisis, that doesn’t mean these issues can be avoided. All too often, rights, choice and control go out the window. It doesn’t have to be like that. It shouldn’t be like that.
I imagine a time when your definition of crisis counts. That the plans you have co-written, along with those who are helping you, determine the care you get. A time when these plans are built with you – not against you.
I imagine a time when doctors and nurses uphold their duty and care and undertake the assessment and monitoring of people’s physical health needs, along with recognising and responding to mental health needs. A time when the benefits of peer support are obvious and accepted as of equal value to those of healthcare professionals. A time where people are no more scared to admit to a mental health crisis of the past on their CV than they are a successful fight against cancer.
I imagine a time when we look after the most vulnerable people in our midst, rather than isolating them and leaving them to languish.
I imagine a time when the model of social recovery is the standard, rather than the exception – building in employment support, clinical services, social care, community relationships and carers.
I imagine a time when we are beyond talk of integrating just health and social care services. A time when siloed responses by government agencies in planning services across health, justice, social care, social security and employment are eradicated.
All of these things are at the very heart of ‘parity of esteem’ – as enshrined in legislation for the very first time in British history in the Mental Health (Discrimination) Act 2013. The legislation is a good step. But if ever we needed an example of the passing of the law being the start, not the end, of the road to progress, this is it. Because for all the progress made, the scale of the challenge – not just in terms of service but also of attitudes – cannot be overestimated
We are a significant way off from the vision I describe. Charities such as Mind and Rethink Mental Illness, and dynamic partnerships like Time To Change, have long been calling for shifts in attitudes, practice and outcomes. Yet as a society, even in the face of gross examples of care and shocking outcomes, we still put up with things that should never be tolerated – in society, in our communities, in our NHS.
The most obvious way to explain what is brutally wrong with our current approach is that despite recent legislation, we treat mental health completely differently from the way we treat physical health. And now with Andy Burnham’s whole person care vision we have an opportunity to change that and achieve the 1948 World Health Organisation definition of health: “a state of complete physical, mental and social well-being”.
Currently, there are huge waiting times for talking therapies, with no right to access this kind of care, due to technical restrictions with how the National Institute for Health and Care Excellence (NICE) evaluates what it can mandate. The NHS constitution commits to putting mental health on a par with physical health but has a get out of jail free card with regard to those who are being cared for under the Mental Health Act.
There is a lack of crisis and emergency care, at a time when the demands are growing not diminishing. If you show up with a mental healthcare crisis, you are not guaranteed access to care and treatment.
Research into causes, treatment and medication for mental illness are grossly behind the times. Drugs aren’t properly evaluated and there is a stranglehold on the amount of investment in mental health research. When talking about people with mental health problems, the use of poor language continues within the press and politics.
We rarely read or hear about schizophrenia unless it is to peddle the myth that the mentally ill are likely to be violent, when in truth they are more likely to be victims of violence than perpetrators. To read some of our papers you would think a good chunk of violent crime is committed by the mentally ill. In fact, fewer than 5 per cent of crimes are committed by people with severe mental illness.
Stigma has a serious impact on the quality of services for people with mental health problems. Too few feel able to complain. Worst of all are inequalities in rates of premature death. Why do we just accept, as we seem to do, that people with severe mental illness are at risk of dying up to 20 years before the general population? This disparity is absolutely unacceptable. The brutal findings of the independent Schizophrenia Commission, established by Rethink Mental Illness, found that people with severe mental illness are woefully in need of basic levels of physical care and support, despite being at higher risk of preventable illnesses such as diabetes. This is purely in response to the use of anti-psychotics. Yet doctors repeatedly fail to undertake and monitor the most basic of physical needs, such as taking blood pressure, reviewing medication and weighing people.
The crisis care campaign from Mind showed that services are under-resourced, understaffed and overstretched. The reality of the situation is quite stark – four in 10 trusts are failing to meet Department of Health guidance on staff levels. Too often people are turned away. Their calls go unanswered. They are told they are not ill enough to qualify for help. Too few people have care plans, despite being mandated by care regulators.
Mental health has always been a Cinderella service and now it is at further risk. People are asking, what are mental health bodies for? All of this is happening a time when funding for mental health is failing. Faced with the pressure of sweeping reforms to public services, the fear is that without immediate attention things will get much worse before they get better.
The good news is that with a truly integrated, personcentred service, things can and will change, with effort and attention. We used to have an enormous taboo about speaking about cancer. This idea now seems outdated – swept away – and these days no one would ever say that treating cancer was not a priority. You would never ask why someone got cancer. You would never ask why someone has asthma or diabetes. You wouldn’t say, ‘What have you got to be cancerous about?’ ‘You shouldn’t be having trouble breathing.’ You wouldn’t leave someone with cancer or lung failure alone to fend for themselves.
Greater openness led to greater political support for tackling cancer. We need to take the same approach to mental illness. We are already seeing – amidst all of the talk of cuts and austerity – that services for people who are experiencing mental illness are being cut.
Where is the outcry that would greet a similar approach to cancer or children’s services?
If someone goes to accident and emergency with a broken leg, the hospital is obliged to treat them with courtesy, dignity and responsiveness. If you are faced with the horror of news that you have cancer, the system has to respond within a minimum period of time. But if you are going through a mental health crisis there is no guarantee whatsoever that you will be helped.
Things are improving, but far too slowly for those who are suffering, neglected, isolated and without support or care. One day we will look back and wonder – did we really believe that depression was a lifestyle choice? Did we really believe that if you have been diagnosed with schizophrenia you are likely to be violent? Did we really find it acceptable that if you have had a bout of mental illness, you must under no circumstances tell your employer?
Some day we will look back on all of this and despair that we waited so long to right such fundamental wrongs. Change only comes if people make it happen. So where do we begin?
First, with the acceptance that mental health matters to all of us. The way we behave in wider society sets the tone – and government and politicians have a key role to play in helping to destroy taboos and break down barriers. But changing attitudes must be underpinned by law, creating equivalent rights for mental healthcare in the same way as for physical healthcare. People should feel they can be open about their problems.
We need to invest in care, or at the very least, stop cutting services which were always underfunded and straining at the seams. Mental health budgets have reduced in real terms and cuts are having a very real impact. Suicide rates are very worrisome, compulsory treatment is on the rise and the police are systematically detaining people with mental health problems – who have committed no crimes – rather than having to do this only under exceptional circumstances. The rate of prescriptions of anti-depressants and anti-psychotics continue to rise.
We have to turn the tide. We have to ensure that reforms to health, social care, welfare and public health work for mental health, instead of waiting for our current problems to get worse. Public health professionals urgently need mental health training. GPs must fulfil their basic duty of care.
The most important thing we can do is keep breaking down barriers in talking about these issues. We must continue to work to end stigma and discrimination – not just with employers, friends, and in our communities, but within the very culture of the NHS.
Politics also has a massive role to play in this. Last year in parliament, for the first time in history we heard four MPs speaking out about their own experiences. They received an overwhelmingly positive response from the public but there is so much more work the political class can do. We can wait no longer. The time to change is now.