Why we need to radically rethink our approach to mental health

When I first wrote about my own struggles with severe depression in 2014, the topic was rarely covered in the media. Now, mental health is constantly in the news.

The stories revolve around two main themes. The first is the feeling that we are facing a mental health crisis; the second is that the NHS needs more resources to meet demand.

Take the first theme first. Earlier this month, a YouGov survey for Rethink Mental Illness found the country’s mental health had “failed to bounce back from the pandemic”. The research found that the mental health of around three in ten adults has deteriorated since the start of the year.

A second survey, recently published by the UK Council for Psychotherapy (UKCP), told a similar story: we are a nation struggling for well-being. Its survey found that nearly one in two adults believed the cost of living crisis was affecting their mental health.

Meanwhile, estimates from the Center for Mental Health in October 2020 suggest that up to 10 million people – 10 million! – will need new or additional mental health support.

The second theme, played out almost daily in the media, is that the NHS needs more resources to meet demand. Here is Adam Jones, director of policy and public affairs for the UKCP: “I think what concerns us is the fact that there is already an all-time high in demand for mental health services. We also know that there are record rates of prescribing antidepressants…We are concerned that current capacity is already insufficient.

Mark Winstanley, managing director of Rethink Mental Illness, tells a similar story. “The government must seize the opportunity to turn the tide on mental health,” he says, and protect the most vulnerable, “by investing in the NHS and social care services to help them respond to the increase in demand”.

For years, as a mental health advocate, and even an ambassador for Rethink Mental Illness, I have made similar arguments. No one can deny the vital role of professionally delivered treatment in addressing serious mental health issues, and the need for funds to do so. But we are going to have to radically rethink our broader approach to mental well-being. What if, given the level of demand, the NHS would never be able to solve the mental health crisis?

Keith Leslie, president of Samaritans, believes we need to think about mental health in a new way. He says: “The NHS can never, ever solve the mental health crisis.”

Surely I said in a recent conversation with him, the answer is more money for the NHS – for more medical aid? Leslie disagrees. “GPs have approximately eight minutes [on average] to treat someone, then all they can do is prescribe a pill or suggest talk therapies. But even if you had more resources, this approach would not solve our mental health crisis. This is because we treat mental health as a medical issue, when in fact it is much more of a social challenge.

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

Hardly anyone believes him now. The new paradigm is that we all have mental health, just as we all have physical health, and we influence each other’s well-being. Our day-to-day mental health depends heavily on our environment and our immediate experiences.

This new understanding naturally leads to different answers to our problems. Leslie suggests a two-pronged approach, and none of the answers relate to providing additional medical help. The first applies to all of us; the second is more targeted.

Take the first, more universal approach. The goal here is for us all to do a better job of supporting each other and feeling more connected to each other. Creating a more sympathetic environment for anyone in difficulty, particularly in the workplace, but also at home and at school, primarily through peer support.

While we could all play a role in more private spheres, the government would have a huge role to play in fostering these more compassionate conditions in schools, where it provides funding and where it has begun to focus on well-being students.

Employers are particularly important, and the main ones are line managers. “It’s a very basic thing,” says Leslie. “Line managers need training, they need to learn to spot the signs that someone is having trouble and how to support them, and those discussions need to be very routine.”

Parents also need training and understanding to help them understand the psychological needs of their children. This is indeed the case with many of us adults. Together, this first approach would create a more sympathetic environment where we can all share our mental health experiences and get the support we need.

Here I have several dogs in the fight. For some time I’ve been writing about ways to take care of our own emotional well-being, adopting strategies from nutrition to poetry that can make us feel more supported and connected.

My latest book is called Youll Never Walk Alone: ​​Poems for LifeHighs and lows. To paraphrase the poet Paul Celan, a poem is like a handshake: it creates bonds between us. Or as Scott Fitzgerald wrote of literature: “You discover that your desires are universal desires, that you are not alone and isolated from anyone. You belong.”

In the book, I explain and share the poems that have helped me (and those in my workshops) to understand and allow our feelings, whether desperate or joyful – to feel that we all have a poem for keep us company.

I’ve organized my selections according to the season they more or less ‘belong’ to: we all have seasons in mind, from winter and gloomy to springy and hopeful.

So whatever the seasons of your mind, poetry can help you understand your emotions and feel less alone at three in the morning, when there’s no one else to talk to and the support from the NHS is largely unavailable.

A second approach to our mental health crisis is to provide much more targeted assistance to specific communities and minorities who are vulnerable. Sir Michael Marmot’s recent research has focused on how much harder Covid has been on the well-being of economically disadvantaged people. Solutions are much harder to come by for these groups, all of whom suffer disproportionately from poor mental health.

“It’s about the long term,” says Leslie. “It’s about gaining access and gaining the trust of those people in need, who don’t see themselves as similar to those who may be trying to help them.”

The government here must play a role in helping the underprivileged. If mental health is about the flourishing of the whole person rather than just the avoidance of poor mental health, we must recognize that all areas of politics and social life are relevant: not just health care, but the arts, transport, food, education, housing, green spaces, work and well-being, social assistance and more.

A two-pronged approach, then, but with a glimmer of hope. Yes, we are facing enormous psychological problems. Yes, the NHS and a medical approach is the answer for some. And yes, some communities will always need additional government assistance. But the fact that mental health is now so prominent in the news means that we are also talking about it in ways that were unthinkable just a few years ago. And the next step will be to accept that some of us can and should be part of the solution.

Rachel Kelly’s new book Youll Never Walk Alone: ​​Poems for LifeHighs and lows is published by Yellow Kite; more details here.


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