Abstract
Mental illness is a subject that makes many people uncomfortable. Mental health campaigner
“Round the bend …” is just one of the many insults that can be thrown to suggest someone may not be of sound mind. It has an interesting history. When the old asylums were built, the imperative on planners was to put them out of sight of the bulk of “normal” people, so they could be out of mind too. Round the bend …
There has been progress. You don’t hear the insults quite so often. And when I opened a new psychiatric hospital in Blackpool, The Harbour, it was on a busy main road and the first thing you see on arrival is a cafe to the left of the entrance, open to all, proudly saying they are part of the community.
We saw progress, too, in the response to a campaign I launched this autumn with former mental health minister Norman Lamb and former cabinet minister Andrew Mitchell, Equality4MentalHealth. It is a very time-specific campaign, aimed at pressing the government to do more for mental health in the spending review, but part of the broader campaign is to fight for better services and understanding. We are making more progress on the latter than the former. The fact that within a few hours the prime minister, the health secretary and the education secretary all welcomed the campaign was a sign at least that the issue is higher up the agenda than it used to be. But my worry as the taboo and the stigma erode is that it makes more people open up about mental health problems, seek out services and support, and find they are not there.
In the House of Commons, British Prime Minister David Cameron said he was determined to end a situation in which mental health was seen as the Cinderella service. But we have some way to go, and here is where the overlap of stigma and taboo has a dreadful effect. Imagine commissioners sitting down to plan spending and decide allocations when cuts have to be made. Let’s say there is a choice to be made. Do we cut cancer care, children’s services, accident and emergency departments, or mental health provision? I think we know the easiest target of those four, the one that will be greeted with the least local and political outcry. As a result mental health services are being pared back piecemeal all around the country.
Stigmas around mental health mean people can be uncomfortable speaking about it
Credit: Cultura RM/Alamy
The cancer comparison gives me hope, however. I remember as a child my mother telling me that one of our neighbours had cancer, but I was not to tell anyone. Remember what we used to call it? “The Big C.” That too was a taboo, and led to stigma and misunderstanding. But it has largely gone and the impact has been positive, which has made it easier to raise funds for research, and made it harder for politicians to resist the pressure to provide the resources needed to deliver improved levels of care.
The key to breaking down any taboo is openness. Without it fear and mythology thrive. Here’s an example. Fed a diet of headlines about “psycho killers”, many believe mentally ill people may turn violent. In fact they are more likely to be victims of violence than perpetrators.
Lack of understanding leads to a lack of support and you will find it in the most surprising of places. At a talk I did recently, as often happens at the end, a small gaggle of people hung back waiting to have a more private conversation. I call them “the whisperers”. They will try to get me on my own and they whisper “thanks for talking about mental health …” and then they tell a story of themselves or a family member struggling with mental illness. And I whisper back “why are we whispering?” The answer is because of the stigma and the taboo. It is the Big C of our times … put it in a box in the corner, and leave it there … like we used to do with people when we put them “round the bend”.
At this recent talk, one of the whisperers told me she was a nurse working in the National Health Service. She had regular bouts of depression. A single mum with two school-age daughters, she said that when depression struck she asked her older daughter to call the hospital to say Mum couldn’t come in today because her little sister was ill. And then the mother would call in the little girl to say she had to stay off school. Why? Because other hospital staff had children at the same school and she was worried her daughter would be seen when they were dropping off or picking up their own kids.
Now if that kind of thing is happening among NHS personnel, we can only imagine the lack of understanding elsewhere. The nurse told me she was genuinely worried that if she admitted to having a mental health problem she would certainly be putting her future promotion prospects at risk, and she might be putting her job at risk. So instead she felt forced to bring up her daughters to believe it was OK to tell lies about their mum’s illness. And so, generation to generation, the stigma and the taboo continue.
Change only comes if you fight for it. Whether the great historic campaigns to get women the vote, to end discrimination against gays and lesbians, or win the fight for racial equality, or something more prosaic like ending smoking in public places, all have involved taking accepted attitudes and wisdoms and breaking them down over time.
I see the stigma and the taboos in mental health in the same light. The change is coming, and a tipping point will follow and then we will look back and ask: “Did we really tolerate an NHS that discriminated against the mentally ill, by not having the same approach to waiting times as for physical illness? Did we really tolerate and accept a situation that meant those with mental illness had on average a life expectancy 20 years less than the average? Was there really a time when a nurse of all people felt she could not be open with her employer about the simple fact that she had occasional bouts of depression?”
That is why this is so important. How can anyone get the treatment they need when they are scared or ashamed to admit to the illness? And how can we call ourselves a truly civilised country until that taboo has gone?
