We need to talk about breaking the mental health taboo
By Harry Phibbs
St Clements Hospital in Mile End, in the east end of London, is a Victorian building which was a mental health hospital until it closed in 2005. It is now a derelict site.
But I understand that some of the former patients are still to be found there forlornly camping in the grounds or hanging around the entrance. They think of it as home. That sums up the abject failure that can occur of the ‘care in the community’ policy.
Mental illness is the great taboo for many of us, politicians especially. They are embarrassed to talk about it. Yet some of the greatest politicians had mental disorders. Abraham Lincoln suffered from depression. The psychiatrist Anthony Storr argued that Churchill’s affliction with Bipolar Disorder was key to his greatness.
At any given time one in six people have a diagnosable mental health. Mental patients are typically less able to exercise the power of choice to get the treatement they need. For obvious reasons a psychiatrist is less accountable in this regard that doctors dealing with physical ailments.
Only 10% of prisoners have no mental disorder. The UK has one of the highest rates of self-harm in Europe (400 cases per 100,000 people a year). The annual cost of schizophrenia, just one mental illness, to the taxpayer was estimated, five years ago, to be £6.7 billion a year.
The aim of the ‘care in the community’ initiative started half a century ago was noble. Where possible it is better for individuals to lead independent lives rather than be confined to institutions. there will certainly have been many beneficiaries of the policy as well as many victims.
But shoving people out into the ‘community’ (which can be resistant to embracing them) before they are ready and with a lack of genuine care is sometimes pursued for financial reasons but proves a huge false economy.
The Centre for Social Justice, a think tank established by Iain Duncan Smith, is seeking to break the taboo with an important report on the subject.
Perhaps in these straightened times one of the factors which might persuade politicians to pay attention is the cost.
The report says: ‘Mental illness accounts for over 20 per cent of the total burden of disease in the UK, more than cardiovascular disease or cancer. The NHS spends 13.8 per cent of its annual budget on mental health services. The wider economic cost of mental health problems is around £105 billion.’
Yet in many ways the report is optimistic that these problems can be defeated. It talks about ‘completing the revolution’ to make a success of the policy rather than reversing it.
‘We need to ensure that community-based voluntary sector services work as effectively as possible,’ it says. ‘The role of civil society and communities in promoting good mental health tends to be neglected but is essential for ‘completing the revolution’ which began with the closure of the asylums and the movement of treatment into the community.’
Yet instead the emphasis is on ‘risk averse’ doctors who are too quick to prescribe drugs.
One of the big costs of mental illness is welfare benefits. But because someone is mad need not mean they are incapable of working.
‘Employment can greatly improve wellbeing,’ says the report, ‘primary care and other mental health services have a vital role in helping people become work-ready, even if that journey may be a long one.
Yet less than one-third of mental illness is reduced by treatment. NHS mental health providers have to be better integrated with a full range of other agencies (from the public, private or voluntary sectors) given the complex social, physical and psychological needs of people with mental ill-health.’
Family breakdown can be both a ’cause and effect of poor mental health’. So helping couples to stay together should be acknowledged as a priority for mental health policy. Yet at present this area is neglected.
A new settlement is needed where those with mental illness who can cope with being part of society are accepted as being able to make a contribution. But those who can’t cope should be excluded for their sake and ours.
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