The case for change

Despite the current flourishing of new ideas and initiatives in mental health, and despite a growing public conversation and movement against stigma, most people agree that our response to mental health is not working. While there have been promising successes in specific areas such as early intervention in psychosis, the overall picture is bleak. Everywhere we turn we hear depressing statistics and stories. Perhaps most starkly, the World Health Organisation predicts that by 2030 mental health problems (particularly depression) will be the leading cause of mortality and morbidity globally.

 

And when we look at the UK, we see a range of deeply systemic and long standing problems, all of which predate the Covid 19 pandemic. For example, the estimated 26% (or 11.5 million adults) who regularly take antidepressants or drugs to control anxiety. Or the fact that the economic and social cost of mental ill health in England is more than our public spending on education (it has increased from £105 billion in 2009/10 to almost £119 billion a year). Or the news that rates of black British people subject to restrictive interventions – including physical, chemical and mechanical restraints – leapt from 52.1 per 100,000 people in 2016-17 to 106.2 in 2021-22 (compared to a much smaller increase for people from white backgrounds). Or the endemic workforce shortages that have seen little growth in numbers since 2009, at the same time that demand for services has been rising inexorably. 

 

Since 2016 there has been a 21% increase in the number of people who are in contact with mental health services (1.4 million in 2019 vs 1.1 million in 2016). During 2021 mental health services in England received a record 4.3 million referrals. As the British Medical Association recently pointed out, workforce shortages “are affecting staff workload, wellbeing, morale and the ability for staff to provide good quality of care.” 

 

And of course patients suffer, with an estimated 1.2 million people in England on waiting lists for community mental health services, and 43% of adults saying long waits for treatment have made their mental health worse. Alarmingly, research published in 2022 from the charity Young Minds on almost 14,000 young people found a quarter (26%) had tried to take their own life as a result of having to wait for help.

 

All of this is clear evidence that the current system is not working.

 

Too many people across the UK are struggling with their mental health but are not getting the help they need when and where they need it. They are trying desperately to access mental health services that have responded to rising demand by restricting entry to only those with the most complex mental illness. The result is frustration, despair and worsening ill health as they wait and hope for months and even years for something or someone to help. Mental health services are often highly medicalised and not designed to deal more holistically with the social and economic factors that affect someone’s mental health.

 

Through the Living Well programme, we came across many stories of people experiencing poverty, worrying about money, caring for others whilst balancing their own mental health needs, living with the aftermath of adverse childhood experiences, feeling socially isolated, being victims of crime and not having their basic needs met. Struggles with ‘mental health’ are often struggles to work through adversity and its effects. How hard it is to feel mentally healthy in an age when the protective factors for good mental health - such as strong relationships, economic security and good housing - seem so threadbare.

 

Despite this, there is an over reliance on clinical interventions in secondary care and a lack of holistic help and support for mental health in the community that could prevent many problems getting worse. Holistic help and support for mental health looks at the whole person, and combines medical and social perspectives.