otrbristol | 6th March 2016

“It’s time to talk about our collective mental health”

For those that missed it, 4th February was Time to Talk Day, an effort to get people talking about mental health in everyday settings and ways in order to break down the stigma that undeniably still surrounds mental ill health.

It’s not often though you get much analysis about what and where this stigma originates. Campaigns that seek to challenge it exclusively pursue a logic that by talking more openly about mental health, we normalise the subject and thus reduce discriminatory attitudes. The problem here is that the language of mental health is (and should be much more) contested, and the root driver of stigma is actually structural – not individual – in nature. I’m reluctant to knock such a well-intentioned and important cause, but there really is a problem because sixty years of campaigning appears to have made very little difference to social attitudes on mental health.

In my view, the feelings of shame, personal failure and weakness that surround the stigmata of mental illness – and that work to prevent us reaching out for help – are woven into our socio-economic order. They are meant to be there. They are fundamental to maintaining and reproducing the status quo. If we don’t recognise this, our campaigning is at best ineffective; at worst an active agent in recycling stigma by obscuring what ought to be our real focus – the condition of human wellbeing effected at a population level by our social and economic arrangements.

The government’s recent Five Year Forward View for Mental Health describes the predictable impact years of chronic underinvestment in research and services has had on the quality and amount of care available to people. My own service, Off the Record (Bristol), bears witness to this daily, and I count myself among those calling for greater resource and better design across the mental health system. But I hear almost nothing from any direction on the reasons why demand for services is rising exponentially. Funnily enough given my day job, I don’t actually believe this rising demand has much to do with the absence of those same services.

Epidemiologists Richard Wilson and Kate Pickett established the “Pernicious effects that inequality has on societies: eroding trust, increasing anxiety and illness, (and) encouraging excessive consumption”. In fact, widening inequality has been the defining feature of the last thirty years. For a generation we have organised ourselves around neoliberal values that laud competitiveness and self-reliance, individualism, the pursuit of ‘happiness’ and a consumerist materialism that privileges consuming and possessing life over participation in it. Neoliberalism also purports to meritocracy – if we work hard enough and play by the rules, we can surely be successful and happy. But the reality is social mobility is now something from another era. There is no meritocracy.

Though these are undoubtedly broad brush strokes, it’s not difficult to see how socio-economic values like these – when allied to real world nepotism – combine to create a perfect storm of psychological and emotional suffering at a population level – particularly among the young. From the perspective of neoliberal values, mental ill health is evidence something fundamental is wrong with us; it represents a failure of strength, of effort, of being able to be happy and thus live a normal life. It’s why powerful feelings of shame and worthlessness surround and compound individual suffering in a way they don’t with physical health conditions.

This is why language is so important. When anti-stigma campaigns work to normalise mental health they almost always attempt to achieve this aim using a language that mirrors physical health. Mental health ‘disorders’ are presented as illnesses like any other; one in four of us will suffer from a diagnosable problem, they say. It’s an understandable approach, and there’s a value to individuals having – and owning – a label with which to make sense of what and how they feel. But in going down this road these campaigns actively obscure the systemic bases of stigma and suffering. Worse, categorising and commodifying mental health in this way is actually a very neoliberal way of approaching the issue, and works to recycle the same harmful values from which stigma emerges by separating individual suffering from social context. In recent years a whole happiness industry has been launched to help us learn how to do it better – you don’t get more neoliberal than that!

So I’d like to propose we start a different campaign. The cost of mental ill health to the economy is estimated by the Five Year Forward report to be £105 billion a year – roughly the cost of the entire NHS. We might start by asking what this kind of epidemiological prevalence says about our society and economy. Why it is that in a supposedly advanced and materially flush society, one in four of us will suffer a mental health problem? My sense is a campaign that asks these kinds of questions might shine a light on the real reason mental ill health remains so stigmatised.