Tackling depression.
Richard Layard and the Mental Health Policy group have today published their report on depression. Its main conclusion is that there needs to be a major extension in what are often referred to as "talking therapies", the likes of cognitive behavioural therapy, or in some cases just simply to talking to someone about how the person feels. It estimates that for this to happen in every part of the country, 10,000 more therapists will need to be trained by 2013.
The first point should be that such a major report is welcome. Statistics show that 1 in 4 people during their lifetime will experience a form of mental illness. It of course does not just affect that one person; it can lead to the breakdown of families, the inability to the work, and the effects which one sufferer can inflict on those around him or her. Depression and mental illness is shown to be rising, although whether this is down to better diagnosis, drugs companies coming up with increasing numbers of supposed disorders or to the effects of consumer society could be argued about for hours. What is certain is that mental illness makes people prisoners in their own bodies, affects aspirations, inhibits expectations and can be far more destructive than physical illness can be.
The second is that the actuality of the government supporting this and recognising that mental health is such a problem is unlikely. The fact of the matter is that mental illness just isn't, well, sexy enough. It also can't be treated with a panacea, and there is no sign of any "wonder" drugs that so perk up the tabloids being around the corner. The initial effect of the the emergence of the SSRI class of drugs, of Prozac, that depression could be kept under control just by popping a pill has long since passed, and with it so has the safety of the drugs, especially Seroxat (Paxil). The side-effects, especially the immense difficulty which emerges when people attempt to come off them, have in some cases left the drugs with few people other than the drugs companies continuing to be rapturous about their worth. When it comes down to it, the danger of women losing her life to breast cancer is always going to be the story which leads the newspapers, not that of someone committing suicide, unless they happen to be famous. While the NHS faces huge bills for drugs which are little better than the current ones available, but which have been built up by the media to work "miracles", such as Herceptin, the first services that face the chop in the resultant cutbacks are often those which treat mental illness. Obsolete's local NHS trusts first move to trim its deficit was to cut the cognitive behavioural therapy groups. Even worse, most mental health trusts are already the runts of the litter when it comes to getting funds in the first place.
What needs to happen is a sea change in the attitude towards mental illness, by the media, health professionals, the government, and the public at large. The reaction to when the Sun led its first edition a couple of years back with "BONKERS BRUNO LOCKED UP", has not changed its policies in regarding mental illness more carefully. The likes of Pete in Big Brother, who suffers from Tourettes syndrome, are still alliteratively referred to as "Potty Pete". A Sun leader referred to them as a "house full of loons" and "nuts in may". Doctors, fed up with having to listen to many of those complaining of mental ill-health, have little option other than to prescribe an SSRI and fob them off. Sadly, it isn't their fault. Referrals to psychiatrists, unless the case is urgent, takes longer. Places on CBT groups are even rarer. Perhaps more dangerous though is the sad way in which mental ill-health may well be the last real taboo in British society. Brits have often had problems relating their emotions, and that hasn't changed in the decades since the 60s. Talking to each other, much as we do it about other things, still doesn't extend as much to about how we actually feel. It can be difficult trusting people enough to let them into your mind, but we often feel better for it afterwards. It's through this however that the problems themselves can often be nipped in the bud. We should be quicker to lend an ear, but we should also learn to recognise when things may well be getting serious. There is nothing that substitutes talking to a trained professional. The availability of such rightly needs to be extended quickly.
Mental illness is nothing to be ashamed of, although those who do suffer often suffer alone. While there will remain no cure-all, and the likes of Polly Toynbee, who is quick to jump on a passing bandwagon, in this case CBT, should be more careful about how much they talk it up, it can be lived with in almost all cases. As well as talking therapies there needs to be more mental hospitals which can handle in-patients in secure accommodation. Those who are severely mental ill are at the moment increasingly locked up in prison, unable to get the treatment they desperately need. The Guardian should also be careful of dismissing the rise of the consumer society and the link with depression, especially in the way it casually quotes a poet and philosopher talking of their own experiences as evidence that depression is not a modern problem. The concept of wage slavery, the problem in modern society of alienation, and the increasing lack of empathy are all precursors to depression and mental ill-health. What now needs to happen though is for a political consensus to emerge; Cameron, with his recent speech on happiness should sign up to the the Policy Group's conclusions. Whatever political party is in power, those who come down with mental illness, or who are born with it through no fault of their own should be able to rely on the services being there to help them. The policy group's recommendations should be just the first step.
The first point should be that such a major report is welcome. Statistics show that 1 in 4 people during their lifetime will experience a form of mental illness. It of course does not just affect that one person; it can lead to the breakdown of families, the inability to the work, and the effects which one sufferer can inflict on those around him or her. Depression and mental illness is shown to be rising, although whether this is down to better diagnosis, drugs companies coming up with increasing numbers of supposed disorders or to the effects of consumer society could be argued about for hours. What is certain is that mental illness makes people prisoners in their own bodies, affects aspirations, inhibits expectations and can be far more destructive than physical illness can be.
The second is that the actuality of the government supporting this and recognising that mental health is such a problem is unlikely. The fact of the matter is that mental illness just isn't, well, sexy enough. It also can't be treated with a panacea, and there is no sign of any "wonder" drugs that so perk up the tabloids being around the corner. The initial effect of the the emergence of the SSRI class of drugs, of Prozac, that depression could be kept under control just by popping a pill has long since passed, and with it so has the safety of the drugs, especially Seroxat (Paxil). The side-effects, especially the immense difficulty which emerges when people attempt to come off them, have in some cases left the drugs with few people other than the drugs companies continuing to be rapturous about their worth. When it comes down to it, the danger of women losing her life to breast cancer is always going to be the story which leads the newspapers, not that of someone committing suicide, unless they happen to be famous. While the NHS faces huge bills for drugs which are little better than the current ones available, but which have been built up by the media to work "miracles", such as Herceptin, the first services that face the chop in the resultant cutbacks are often those which treat mental illness. Obsolete's local NHS trusts first move to trim its deficit was to cut the cognitive behavioural therapy groups. Even worse, most mental health trusts are already the runts of the litter when it comes to getting funds in the first place.
What needs to happen is a sea change in the attitude towards mental illness, by the media, health professionals, the government, and the public at large. The reaction to when the Sun led its first edition a couple of years back with "BONKERS BRUNO LOCKED UP", has not changed its policies in regarding mental illness more carefully. The likes of Pete in Big Brother, who suffers from Tourettes syndrome, are still alliteratively referred to as "Potty Pete". A Sun leader referred to them as a "house full of loons" and "nuts in may". Doctors, fed up with having to listen to many of those complaining of mental ill-health, have little option other than to prescribe an SSRI and fob them off. Sadly, it isn't their fault. Referrals to psychiatrists, unless the case is urgent, takes longer. Places on CBT groups are even rarer. Perhaps more dangerous though is the sad way in which mental ill-health may well be the last real taboo in British society. Brits have often had problems relating their emotions, and that hasn't changed in the decades since the 60s. Talking to each other, much as we do it about other things, still doesn't extend as much to about how we actually feel. It can be difficult trusting people enough to let them into your mind, but we often feel better for it afterwards. It's through this however that the problems themselves can often be nipped in the bud. We should be quicker to lend an ear, but we should also learn to recognise when things may well be getting serious. There is nothing that substitutes talking to a trained professional. The availability of such rightly needs to be extended quickly.
Mental illness is nothing to be ashamed of, although those who do suffer often suffer alone. While there will remain no cure-all, and the likes of Polly Toynbee, who is quick to jump on a passing bandwagon, in this case CBT, should be more careful about how much they talk it up, it can be lived with in almost all cases. As well as talking therapies there needs to be more mental hospitals which can handle in-patients in secure accommodation. Those who are severely mental ill are at the moment increasingly locked up in prison, unable to get the treatment they desperately need. The Guardian should also be careful of dismissing the rise of the consumer society and the link with depression, especially in the way it casually quotes a poet and philosopher talking of their own experiences as evidence that depression is not a modern problem. The concept of wage slavery, the problem in modern society of alienation, and the increasing lack of empathy are all precursors to depression and mental ill-health. What now needs to happen though is for a political consensus to emerge; Cameron, with his recent speech on happiness should sign up to the the Policy Group's conclusions. Whatever political party is in power, those who come down with mental illness, or who are born with it through no fault of their own should be able to rely on the services being there to help them. The policy group's recommendations should be just the first step.
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Mmm. One issue that you don't raise is how mental illness is defined. Of course, depression and schizophrenia can be very serious things, but there is also a tendency amongst psychiatry to medicalise anything which is 'abnormal'. C4 showed an interesting prog on Sunday about hearing voices, in which it was argued that most of the time this is actually a natural phenomenon - and yet it can get people locked up. Incidentally, on the supposed need for more mental hospitals, the psyche survivor movement has long argued that institutionalising people is oppressive and doesn't help the person. While I wouldn't go completely down that route, bringing back all the asylums is not I think the way to go.
Posted by
Redaspie |
Tuesday, June 20, 2006 10:15:00 AM
Good points. I also didn't mention the recent plans by the government that could have resulted in those with personality disorders being locked-up, which were vigorously opposed.
About the asylums, I obviously don't believe we should go back to the bad old days, but there is an obvious need for more mental health beds. There are too many people with mental health problems in prison who simply shouldn't be there; it doesn't help them, it doesn't help the others around them and it doesn't protect the public at large, as prison does not help those who need both more constant and personalised care. About being institutionalised, the mental health act should also be reviewed. The consequences of being locked up for six months on the say so of two doctors is I think out of date, and should be changed.
Posted by
. |
Tuesday, June 20, 2006 2:08:00 PM
Absolutely! There is an element of social control in the way psychiatry as a profession has responded to people who behave 'abnormally'. I have become sceptical of institutionalisation and institutions generally recently after reading online accounts of people who were locked up due to schizophrenia, severe autism or some such, who claim they were *tortured* by staff systematically. And these were apparently in quite respectable places
Posted by
Redaspie |
Tuesday, June 20, 2006 9:24:00 PM
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Anonymous |
Wednesday, July 12, 2006 2:36:00 PM