A disturbing view of mental illness

‘It affects our capacity to learn, to communicate, and to form and sustain relationships…. It also influences our ability to cope with change, transition and life events….[it] may be central to all health and wellbeing…and influences how we think and feel, about ourselves and others.’ (1)

According to Making It Happen, published by the UK Department of Health in August 2001, mental health holds the key to a fulfilled life. ‘Everyone has mental health needs’, says the report, ‘whether or not they have a diagnosis of mental illness’. And because mental health is important for everybody, ‘the need for mental health promotion is universal’ (2).

So what is mental health promotion all about – and why is it such a big issue now?

Making It Happen was produced for the Department of Health by mentality (3), a UK-based charity dedicated to promoting mental health. The report’s aim is to ensure the effective delivery of the mental health promotion standard of the UK government’s National Service Framework for Mental Health (4) – which says that health and social services should: ‘promote mental health for all, working with individuals and communities’, and ‘combat discrimination against individuals and groups with mental health problems, and promote their social inclusion’ (5).

But what seems to be most attractive to the government and mental health bodies is that, finally, ‘public mental health’ will be put on the agenda – and this ‘broader view’ of mental health will be used to justify intervention in an individual’s life, at all stages and in a variety of settings.

‘”Public mental health” takes a broader view of mental health and provides a framework for looking at how to create a mentally healthy society’, says the report. ‘This involves looking beyond prevention, to the relationship between mental wellbeing and physical health, and the relationship between mental health and behavioural problems, violence, child abuse, drug and alcohol abuse, health in the workplace and risk-taking behaviour such as smoking and unsafe sex.’ (6)

The report describes mental health promotion interventions in home/early years, schools, workplaces, prisons, local authorities, and mental health services (7). And realising the full breadth of mental health promotion’s possibilities will require the cooperation of ‘the voluntary sector, private sector and in primary care, transport, housing, social services, education, the workplace and occupational health’ (8).

Such a huge undertaking is justified by the authors for the ‘substantial benefits’ it will deliver, including: improving physical health and wellbeing; preventing or reducing the risk of some mental health problems; assisting recovery from mental health problems; improving mental health services and the quality of life for people experiencing mental health problems; strengthening the capacity of communities to support social inclusion; increasing the ‘mental health literacy’ of individuals, organisations and communities; and improving health at work, increasing productivity and reducing sickness absence (9).

But what about those with mental health problems? Behind its desire to intervene in just about everybody’s lives – whether affected by mental illness or not – and to educate us about mental and physical wellbeing, drug and alcohol abuse, the dangers of smoking, and not taking sickies from work, the mental health promoters seem to have forgotten those who are actually affected by mental illness.

In the above list, only three of the seven ‘substantial benefits’ of mental health promotion mention mental health problems. And when the report does discuss how mental health promotion can help prevent some mental illnesses, the list of disorders (anxiety, depression and substance abuse) excludes two of the most important mental illnesses: schizophrenia and bipolar affective disorder (manic depression) (10).

Indeed, Making It Happen is somewhat ambivalent about whether it is even a good idea to eliminate mental illness completely. The report incorporates some ‘different perspectives’, including the idea that mental illness ‘can also enrich people’s lives’ (11), and the user/survivor movement’s concerns about ‘the goal of interventions [being] to eliminate all disorders of the mind’ (12).

The report says that promoting mental health will mean ‘openly talking about the mental health needs of the whole community’, thereby challenging ‘the myth that people can be neatly divided into those who do, or do not, have mental health problems’ (13). From this worldview, we are all mentally ill and in need of some therapy and advice. Indeed, throughout the report, the only times those suffering from mental illness seem to appear is as a stage army – used to lecture the rest of us about our prejudices, lifestyles and social norms.

It is not surprising that concern for the truly mentally ill takes a back seat in Making It Happen. The prominence of mental health issues in New Labour’s health strategy has little to do with a genuine concern for those with mental health problems – as you can see from the government’s proposed compulsory community treatment orders and the detention of the ‘personality disordered’ who have committed no offence.

Rather, the rising prominence of mental health comes from a re-evaluation of the rest of us. Today, people are increasingly seen as fragile individuals, as victims of life and of other people, likely to display symptoms of mental distress, and in need of help. But constantly reminding us that we are vulnerable – from cradle to grave and from home to the workplace – is more likely to make us feel atomised and insecure than it is to make us mentally healthy and confident, as the report promises.

In the bizarre world of Making It Happen, people with serious mental illnesses are expected to celebrate aspects of their problems – while the rest of us will experience interventions in every aspect of our lives in the interest of creating a ‘mentally healthy’ society that will challenge our prejudices and help us face up to our frailties. In truth, this kind of mental health promotion will benefit neither the mentally ill nor the mentally well.

Read on:

spiked-issues: Mental health

(1) Making It Happen: A guide to delivering mental health promotion, Department of Health, 2001, p28

(2) Making It Happen: A guide to delivering mental health promotion, Department of Health, 2001, p28

(3) See the mentality website

(4) National Service Framework for Mental Health: Modern Standards and Service Models, Department of Health, 1999

(5) National Service Framework for Mental Health: Modern Standards and Service Models, Department of Health, 1999, p14

(6) Making It Happen: A guide to delivering mental health promotion, Department of Health, 2001, p16

(7) Making It Happen: A guide to delivering mental health promotion, Department of Health, 2001, p33-67

(8) Making It Happen: A guide to delivering mental health promotion, Department of Health, 2001, p15

(9) Making It Happen: A guide to delivering mental health promotion, Department of Health, 2001, p33

(10) Making It Happen: A guide to delivering mental health promotion, Department of Health, 2001, p34

(11) Making It Happen: A guide to delivering mental health promotion, Department of Health, 2001, p29

(12) Making It Happen: A guide to delivering mental health promotion, Department of Health, 2001, p34

(13) Making It Happen: A guide to delivering mental health promotion, Department of Health, 2001, p35