We need more friends and fewer shrinks
The medicalisation of social problems is straining mental-health services.
Last month, a row broke out between the UK Conservative government and the Labour opposition over the level of funding for mental-health services in England. According to Labour MPs who made freedom-of-information requests to NHS commissioning bodies, the figures suggest that, on average, mental-health budgets fell in 2015-16. These figures are disputed by the Department of Health, which claims that mental health is a priority for the current government, as evidenced by the way it has given mental and physical health conditions equal priority in law and has overseen an increase in mental-health spending of £0.4 billion this year.
Regardless of who is correct – the old adage ‘lies, damn lies and statistics’ springs to mind – most of those working on the front line argue that services are severely stretched. Stephen Dalton, chief executive of the Mental Health Network, said that ‘while some mental-health services have seen modest investment, most report they are at a standstill and others have seen a reduction in spending’. Sophie Corlett, from the mental-health charity Mind, said mental-health services have always been underfunded; however, demand is now rising, and, as a result, ‘services in many parts of the country are struggling to cope and people are not getting the help they need’.
Such claims are not without foundation. There is often a severe shortage of hospital beds for those requiring psychiatric in-patient treatment, and it is not unheard of for patients to be transferred over 100 miles to the nearest available bed. Professionals frequently tell me that they are having to treat patients, who should be in hospital, in the community, because there are no beds available. It has been estimated that between 20 and 30 per cent of police time now involves mental-health work, from detaining people for assessment under Section 136 of the Mental Health Act to returning those who have gone AWOL from hospital. Many mental-health professionals are doing an extremely good job in very difficult circumstances, so I would echo calls for more investment in mental-health services. However, this investment needs to be targeted, and if it is to be successful there needs to be a cultural shift in how we view and intervene in mental distress.
Dr Phil Moore, chairman of Mental Health Commissioners Network, has said that commissioners are considering alternative ways of funding mental-health provision, including using the voluntary sector and more community schemes. It is certainly the case that there are some very good voluntary and community groups working with people with mental-health problems, and they often have a more therapeutic relationship with patients than statutory workers do. In addition, the idea of communities organically responding to local need is one I find appealing. The problem is that the dominance of a therapeutic culture, operating within what the sociologist Kate Brown has termed a ‘vulnerability zeitgeist’, means that many of these groups are likely to encourage individuals and communities to view their problems and anxieties through a psychiatric or psychological framework. In addition, as their funding becomes ‘mental health’-dependent, it becomes increasingly difficult for community groups to respond to and work alongside the organically identified needs of the community. Structural and economic problems such as unemployment, and the pressures it can cause, often get rearticulated in terms of mental health – as something that is due to the individual cognitive deficits of the unemployed.
In such a scenario, we not only blur the line between those who require professional intervention and those for whom such intervention is unnecessary and unhelpful – we also redirect much-needed resources away from services struggling to provide care for the seriously ill. This is not to say that people are not struggling to cope today. However, the solutions to the problems we face, whether they are of a material, political, social or existential nature, will not be found by reinterpreting them through the prism of a professional therapeutic relationship.
There is also the danger that in order to continue to receive funding the extent of the problem will be exaggerated, with a wide range of human experiences becoming redefined as mental-health problems, and those cases identified presented spuriously as ‘the tip of the iceberg’. As I have argued previously on spiked, such ‘advocacy research’ can adversely affect social policy, as funds get allocated not according to need, but to those with the best media campaigns.
The other point that needs emphasising is the way that many of those who campaign for more mental-health provision actually play a part in cultivating a sense of vulnerability and anxiety within the population. For example, the increasing use of ‘trigger warnings’ to alert people to anything that may disturb them is based on the belief that people are so fragile that they are unable to cope with ideas or views they dislike. Likewise, the call for women-only train carriages is based on notions of female vulnerability and dangerous masculinity, a view similar in sentiment to the Victorian idea of the fragile female, adrift in a sea of predatory males. The current process for lobbying for more funding seems to involve cultivating a sense of estrangement, vulnerability and anxiety, further exaggerating the dangers people face and encouraging more people to see the solution within a therapeutic framework. It is a circular and unhelpful process.
The answer to the current problem is simple, even if, in the current climate, achieving it is not. We need more friends and fewer professionals. While, currently, mental-health bodies tend to demean the former and extol the latter, if people’s individual problems were tackled at the social level, then professionals could focus on helping those who really need it. Meanwhile, the rest of us could be left alone to articulate our own problems and develop strategies to overcome them.
Ken McLaughlin is a senior lecturer in social work at Manchester Metropolitan University, England. His most recent book, Surviving Identity: Vulnerability and the Psychology of Recognition, is published by Routledge. (Buy this book from Amazon (UK).)