To Solve Britain’s Mental Health Crisis, We Must Fundamentally Change Society

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British society is wailing about the growing crisis of mental health while also refusing to make the changes solving the crisis would require. An addiction to reducing the social security bill – while promoting longer working hours, more insecure employment, greater casualisation on the one hand and greater specialisation on the other – means working yourself out of the hole mental health difficulties have put you in is not an option.

Progressive movements have struggled to find a footing when discussing mental health difficulties, distress and trauma, often, at best, focusing on calls for greater funding for mental health services. There is a fantasy that the combination of correct treatments and tweaks to society will somehow eradicate mental health difficulties once and for all – that one day, somehow, everyone who lives with mental health difficulties will wake up “normal”.

Most people grasp in an airy, abstract fashion that it would be good to be nicer to those who live with the effects of mental health difficulties, distress and trauma, but are unwilling to do much beyond this. 

Society sets people with mental health difficulties up to fail.

The 21st century has not delivered the safety and security “the end of history” promised. New Labour saw those who live with mental health difficulties as a reserve workforce parked on benefits, ready to be activated in the years of economic expansion. Governments from 2010 onwards have seen those who live with mental health difficulties as a shifty bunch of shirkers needing the moral corrective of benefits sanctions if out of work and low expectations for life if within it. The overwhelming focus has been on propping up the mental health of those not yet too unwell while reducing the options and support for those already unlucky enough to find themselves beyond the reach of small interventions and limited care.   

Mental health difficulties produce inequality when the additional problems they generate are ignored. In 2013, the charity Rethink Mental Illness worked out that people with more severe mental health difficulties die an average of 20 years younger than those without them. The tendency of mental health to lock people into a downward spiral of unmet need and diminishing life opportunities is so well recognised it even has a name: the social drift hypothesis. Put simply: if you get ill, you will often end up closer and closer to society’s margins.

“Get an education, get a job, get a family, get a house” is simply a grinder for mincing those who live with mental health difficulties when the means of entry to any of these life stages demand huge amounts from the individual. 

Care in the community asks the community to change.

In his book Closing the Asylum: The Mental Patient in Modern Society, about the months preceding the Labour landslide of 1997, Peter Barham remarks: 

“Public tolerance and sympathy for the mentally ill is genuine but lacks solidity, and provides a very shaky foundation on which to generate support for programmes that declare an interest in securing a better deal for former mental patients in social life, attending to their rights, and transforming their social relationships. And, inevitably, the insolidities of public feeling and perception are likely to be sorely tested by ill winds bringing news of tragic incidents.”

Barham was writing at a time where public, and especially tabloid, fears were heightened by the perceived new arrival of people with mental health difficulties in “the community”, by the process of deinstitutionalisation commonly referred to as “care in the community”.  While often held up in lazy rhetoric as the ultimate in Thatcherite callousness, community care was very simply the policy decision to treat and support people in their own homes, rather than filing them away like uncomfortable footnotes to progress, in huge institutions at the edges of towns and cities. 

Many, including people who live with mental health difficulties themselves, refuse to recognise mental health as disability. The social model of disability understands disability as the problems caused to individuals by the ways that society is constructed to serve the interests of people who do not have impairments. The social model of disability calls for an end to institutionalisation and for the focus to be on providing the care and assistance to disabled people that they choose, to do the things they wish to do. The focus of discussion around mental health still tends to lie on either fixing the individual or preventing individuals becoming unwell rather than focusing on people’s lives as they are lived right here, right now.

People without impairments don’t want society to change.

British society is often reluctant to make changes to its fundamental assumptions about how the world works. The UK has reached the point where a kind of atavistic conservatism rejects out-of-hand any suggestion that change must be made. Indeed, the current post-Brexit pandemic culture wars are nothing less than the rejection of demands for equality and equity from those the structures of society have actively harmed. In the same way people may resent the changes required to an old stately home to make it accessible to wheelchairs, so too are people reluctant to let go of the privileges of hanging on to the idea that those with mental health difficulties are somehow just messing up. “If I can survive this difficult world and prosper, I do not want others to have it made easier.” “My working life suits me, why would I alter it so others might have a chance of achieving what I achieve?”  

It is common in policy circles to talk about the social determinants of health – insecure housing, poverty or low educational achievement – as if these things were like floods or hailstorms, not the result of social organisation and government decisions. 

Where do we fit in?

The idea that people who live with mental health difficulties are a category of people discriminated against postdates most big ideologies. There are no good old days to return to. Someone who experiences mental health difficulties that mean they have additional challenges in day to day life with their thoughts, their cognition, their perception or their emotions would have struggled to find a place in society at any point in history which progressives recognise as being a better version of the society in which we live now.

Now, as Peter Barham says: “Generally demoralised and reduced to poverty, people with long-term mental health disabilities lead lean existences amidst the continuing ruination of the buildings, services and other connective tissues that formed the old welfare state.”  

The question to focus on is: where do those who live with mental health difficulties fit into society? To ask for more support or care is not weakness. To demand opportunity is not special pleading. No person should become poor because of their mental health. No person should be excluded from what they could do for want of the support they might need to remove the barriers to doing it. People who live with mental health difficulties shouldn’t feel like they have to negotiate re-entry into society: they should never feel excluded from it or live under the threat that this will happen. Political demands must focus on changing the position of those who experience mental health difficulties within society. Just asking for a little more treatment here, a little less hatred there won’t cut it. 

Mark Brown writes, broadcasts and does things in and about mental health. He presents ‘Mentally Interesting’ with Seaneen Molloy for BBC Sounds.