“It’s different now” – how changing attitudes to mental health bring new challenges for the NHS.

Mental illness has a very long continuum of experience that runs from mental well-being, through being troubled, severely depressed, to having a severe and enduring mental illness. The factors involved are genetic, chemical, biological and social, and as with any other set of diseases we are learning about its causes and improving its treatment every day.

Today I want to talk about how our society interacts with mental well-being.

I grew up in in Woolwich, South London during the 1950s and early 60s. The country was going through a long-term period of post war economic growth and whilst we children played on (often very exciting) bomb sites, things were generally OK. Times were safe. We were pretty secure.

Let’s be clear. There were problems with this. Even at the time, and moreso in my teens, I recognised that much of this safety was based on severe limitations and prescriptions about what was ‘normal’ and ‘correct’ behaviour. I grew up in a homogenous society – there were few differences of any kind. Community was very strong and that felt good BUT it also felt repressive. It is simply not believable that none of my all male secondary school fellow students were gay, but I never saw the issue arise. Of course, it must have been there but in my childhood there was very little awareness of there being ‘other’.

Of itself this ‘safety’ raised problems of mental health. Later in my life issues of separation and attachment would take what psychoanalysts call ‘work’ to get through. But if I had had to choose between growing up in security or insecurity I would have chosen the former.

As a child in Woolwich, if you behaved badly, the threat was, “You’ll get sent to Bexley”. From a young age I knew that the Bexley (where you get sent) was not a pretty suburban town across the border in Kent (which it was and still is), no it was a very large mental hospital. Being sent to a mental hospital was the threat used to scare us out of misbehaving – not that you’ll get sent to Brixton (then the nearest prison) but to a mental hospital!

Mental illness was scary. But mental health treatment was even scarier.

Looking back now I know that this fear was a continuation of centuries of fear about mental ill health (and its treatment). There was mental ill health in my family, but what there was, was very normalised Some close relatives suffered from ‘nerves’  but pre-Valium there seemed to be no treatment. As children we were just told to be quiet if we were around when it was happening.

Later on, at the age of 18 and at university I read Erving Goffman’s analyses of total institutions – especially mental hospitals. This painted a very scary picture of being completely at the mercy of the doctors and nurses. If they got hold of you – you were really got hold of.  And I gloried in the rebellion of Ken Kesey’s One Flew Over the Cuckoo’s Nest. This painted a picture of refusal that fitted with my personal late 60s experience as a student and of left wing politics. Bexley could apparently be beaten. (But it was very scary).

I’ve outlined this history of my first two decades because of its differences from today. It’s different in two ways. For decades, and especially over the last few years, mental health and illness has become much more a topic of everyday discussion. IPSOS/MORI recently published results from a survey showing that the public now consider mental health to be the second most important disease after cancer.

The experience of moving from mental well-being to being troubled is now discussed much more often. Some of this discussion is about mental illness – some of it about losing our equilibrium and becoming anxious. It’s true to say that in 2018 we as a society find it much easier to talk about the day-to-day experience of mental ill health.

Of course it’s not true of every part of our culture. Some locations, some groups,  probably find it as hard to talk about as my family did in the 1950s, but generally, as with most cultural liberalisations, this is a welcome one-way street to tolerance.

The other social difference over the last 60 years is the decrease in people’s security. I know of course that there were parts of our society that did not share the sense of security that I grew up with. (Woolwich was not a wealthy part of London and contained considerable poverty, including the ‘worst street in south London’ –Rope Yard Rails next to the Arsenal.) I hope I have made it clear that I don’t see the world I grew up in with its limitations and repression as being uniformly good, but it was a lot more secure.

Economically my mum and dad had the jobs they wanted when they wanted them and my future was always going to be within a labour market from which I would be able to pick and choose. Our council housing was secure and there really was orange juice for me and milk at school.  In so far as the future would be different from the past it was only going to get better. (And by and large it did).

Growing up in the first couple of decades of the 21st century is different. For example for many there is now a much more interesting world with the possibilities offered by social media replacing those of black and white television. For some people these opportunities are much greater than for my generation. And for others the present and the future is much more uncertain.

Last week the children’s commissioner published statistics about vulnerable children gleaned from a wide range of public sources. These identified large numbers of children with a single vulnerability (for example 920,000 experiencing some sort of mental illness) and smaller numbers with multiple vulnerabilities (103,000 children living with adults who not only experience domestic violence, but are also dependent on drugs and alcohol and have mental health issues).

There are large numbers of children growing up with a very wide range of insecurities – all of which create possible problems for their future mental health well-being. They are growing up into a society which has normalised a lot more insecurity in many aspects of people’s lives,.

It is difficult to believe that this does not have an impact upon mental health and that the demand for care is therefore growing. Simon Stevens says that the long awaited figures on children and young people’s mental health, due this year, are “bound to show that the level of undiagnosed mental health problems and distress among young people is much higher than has officially previously been recorded.”

The wider social relations of our society are involved in that increase.

Going backwards is – thank goodness – not a solution. But being aware of the implications of how we are going forward must be.

None of this makes mental well-being any easier and therefore has direct impact on mental health and mental health services. I’ll be looking at what that means tomorrow.

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