It is now more than four and a half years since David Cameron became “the first Prime Minister ever to make a speech devoted solely to the subject of mental health.” The quotation marks come from the Downing Street briefing that day, in January 2016, and that was the main news – the fact of the speech. He was talking about mental health and urging us all to do the same in “less hushed tones,” with “less whispering; more frank and open discussion.”
“We need to take away that shame, that embarrassment,” Cameron said. “Let people know that they’re not in this alone, that when the clouds descend, they don’t have to suffer silently.”
As warm words go, they were excellent. Hot, even.
Theresa May talked about mental health too. Indeed, inadequate mental health provision was one of the “burning injustices” she highlighted from the steps of Downing Street after the Brexit whirlwind which destroyed Cameron led to her succeeding him six months after he made that speech.
Then she too was gone, and with her any real hope of the fresh urgency on mental health and mental illness that is needed, now more than ever, because of the Covid catastrophe. In this department, Boris Johnson doesn’t even bother to talk the talk, let alone walk the walk.
His governing mind, Dominic Cummings, fancies himself as a super-forecaster. I don’t, but let me make this forecast with 100 percent confidence: the mental ill health consequences arising from Covid-19 will be serious, and costly, both financially and in terms of human life. And the government is nowhere near prepared for what is coming.
The Royal College of Psychiatrists has warned that Covid-inspired mental illness will be “the second pandemic.” It is not hard to see why. Think of the mental health consequences for NHS staff and care workers, many denied proper protective equipment, who were dealing with Covid at the height of the pandemic; the low-paid key workers who have kept our infrastructure going; families unable to say farewell, console or bury loved ones; parents who were trying to teach, work full-time and pretend everything was all right; children removed from their friends and trapped for months in their homes, the school year wiped out along with the exams they studied for, now trying to make up for lost time; students told it’s safe to go to university, then told they have to stay indoors and do everything online, and that they might not be home for Christmas; people old and young having to learn to fear strangers; the rise in anxiety across generations, matched by a rise in isolation for so many.
There is worse to come, not just because we appear to be lurching without real leadership or clarity towards another form of lockdown, but because of the broader economic consequences of Covid. Britain faces Europe’s deepest recession even without the additional hit from what is now going to be at best a bad Brexit deal, at worse no deal.
During the financial crisis, I remember then Labour MP Alan Milburn telling me how train journeys to and from his North East constituency were regularly disrupted by a suicide on the line. Not for nothing is a sustained period of economic pain called a depression. But any realistic assessment tells you what is coming down the tracks now could be even worse.
I accept that both Johnson and his health secretary, Matt Hancock, have a lot on their plates right now. But Mr Hancock is Secretary of State for Health and Social Care, not just for Covid, and if mental health was a big enough issue for Cameron and May to say it was a priority, surely Johnson and Hancock should too. If they won’t listen to the Royal College of Psychiatrists, perhaps they’ll listen to the respected Brain and Mind Centre at the University of Sydney, which has warned Australians that suicide rates could rise by up to 50 per cent in the wake of the economic impacts of COVID-19. This for a country far less hard hit than the UK has been.
So here is a question. How many meetings did Hancock have with mental health organisations during the first three months of the pandemic, as it wrought its havoc with the services they run, and the minds of the people they seek to help? The answer is zero.
Hancock was not always so shy of this subject. In October 2018, a couple of months after Mrs May appointed him health secretary, he chaired a Global Ministerial Mental Health Summit in London. Prince William and his wife Kate attended. Mrs May gave it her blessing with a reception for ministers and experts who came from all over the world to swap ideas and expertise. I just looked back at her speech that day, World Mental Health Day.
“I have made parity of care a priority for our long-term plan for the NHS,” she said. “We can end the stigma that has forced too many to suffer in silence. We can prevent the tragedy of suicide taking too many lives. And we can give the mental wellbeing of our children the priority that it so profoundly deserves.”
The words were excellent, easily as warm as David Cameron’s, and so much more impressive than the actions which have followed.
Hancock promised real equality between mental and physical health, but, two years on, we are a long way from that. He asked me to speak at the summit and said some nice things about the work I had done to try to destigmatise mental illness. “It’s great we are talking about this more,” he said. Well, yes, maybe. But I for one am sick of talking about it. We are only still having to talk about it because there is so much we’re still not doing to deal with the problems we’re all talking about.
Thanks to all the talking, we managed to get “parity” between physical and mental health written into the NHS Constitution. But talking has to be a precursor to doing, and since the talking inside government has virtually stopped under Johnson, I worry the doing is getting pushed further and further down the agenda.
Even before Covid, suicide was the biggest killer of young men in Britain, and the most recently published suicide rate was at its highest for two decades. It seems inevitable that as we emerge from this crisis, we will do so accompanied by a tsunami of psychological and psychiatric distress.
Of course, this is not just about ministers. Government must shape and fund services that the health service and voluntary sector deliver. Employers need to do more to support the mental well-being of staff, and we as individuals can and should do more to look after our own mental health, which is a big part of what my new book on depression, Living Better, is about. But I really worry that if we are as badly prepared for the mental health consequences of the “second pandemic” as we were for the physical consequences of the first, and the government is as slow to get a grip on it, a lot of suffering, pain and suicide lie ahead.
In the hundreds of messages I’ve received about the book there is a common theme beyond the shared experience of illness and the relief of greater openness. It is how far we have to go before we get anywhere near erasing the stigma and taboo that still cling to mental ill health, or having the services we need to meet demand.
One of the most striking emails came from a woman called Vanessa Wheeler, 51, of south London who is bipolar and had several long spells in hospital, especially in her 20s. She then trained as a discrimination lawyer, not least because she came across so much of it herself, including in the NHS.
“Without exception any health worker with a mental health problem that I advised went to another trust to get treatment,” she wrote. “This is because of the stigma. Stigma kills. If someone had diabetes or cancer they would not even think of going outside their own trust for treatment because there is no stigma.”
She reminds me of the case of the bipolar psychiatrist Daksha Emson, who killed her three-month-old daughter and then herself in October 2003. The independent inquiry which followed concluded she was a victim of stigma within the NHS. Emson, 34, had exactly the same fear as the nurse I mention above, namely that her illness would not remain confidential. The inquiry panel, headed by Lionel Joyce, a manic depressive who chaired an NHS trust, accused the NHS of being “complicit through neglect”, saying that the care it gave staff was “indefensible”.
“It’s nearly twenty years since her death,” says Vanessa, “but not enough has changed within the medical profession. They need to change and society will follow.”
I later read the recommendations made by the Emson inquiry. Several are unmet. The same goes for the long promised, though more recent, reforms of the Mental Health Act. More than half those being treated in hospital for mental health problems are sectioned under the Act, which means being held against your will with little or no say over what happens to you. In 2018 an independent review of the Mental Health Act made over 150 recommendations for reforming this discriminatory and outdated legislation. More than 18 months later we’re still waiting.
Whether you look at the Global Summit Declaration from Prime Minister May’s time, or the NHS Taskforce Report under Prime Minister Cameron, the analysis of what was needed was often spot on. But we are making far more progress on stigma than we are on services. Indeed, I sometimes worry we may be making things worse; making people feel they can and should he open about mental health conditions, only to find they can’t get treatment, and end up feeling even worse. We have had some big spending pledges, but the money often seems to go on other things. With the Covid crisis so costly, the fear of even more being shipped out of mental health budgets is real.
Four years ago, when Cameron made that speech, he said there should be a two-week maximum waiting time for someone with psychosis. So let’s talk parity. Having had psychosis back in the mid-80s, I can tell you what the physical equivalent of a psychotic attack is – you’ve gone through the windscreen of your car in a multiple motorway pile up, and you’re lying on the tarmac, broken bones galore, not sure if you’re going to see the day out.
Would the police, fire and ambulance service tell the car crash victim to wait two weeks to see someone? I don’t think so. It shows how far we are from genuine parity between physical and mental health.
I did think both Cameron and May genuinely wanted to see better services, even if I was far from convinced they were ready to will the means to deliver them. But for Johnson, it doesn’t even seem to be on his radar.
As in so much under Johnson’s leadership, I fear we are going backwards, and, without overstating it one bit, people will die prematurely as a result, often at their own hands. Many of the deaths would be avoidable if we had a Prime Minister and a government prepared to take mental health and mental illness as seriously as his predecessors said it would be taken.
“Living Better” is out now in hardback, ebook and on Audible, published by John Murray Books