Mental health is about everybody

I want to agree with the Guardian’s Suzanne Moore in her recent article The lesson of Prince Harry’s grief? We need mental health services for all. And mostly I do. But I think she’s missed the most important thing about mental health.

The context of this article is in the headline. It Prince Harry’s recent interview in which he talked frankly about how he failed to deal with the grief caused by his mother’s death for a decade or more. He was bottling it all up with a stiff upper lip, with dire consequences for his life. He then sought help, and now feels able to talk about it. I applaud Prince Harry’s intervention. It is part of a general process of talking about mental health to make it less of a taboo topic. He is doing this in the best possible way: by sharing his experiences and not ramming any particular view down our throats. Mental health is one of the critical issues of our time and we need to talk about it more, and we need to be able to share more. But, alas, keeping the topic repressed for so long has left its legacy of muddled attitudes – even among the most liberal minded.

Ms Moore starts with a condemnation of the Royal Family’s lack of emotional intelligence at the time of Princess Diana’s death. In particular she feels that her two sons should not have been made to walk behind the coffin. She noticed that almost nobody showed personal warmth towards the pair during the service – so keen were they to show proper dignity and decorum. I think she’s only half right there. Some open warmth towards the boys during the service by their near relatives would certainly have been in order. But dignity and decorum have a useful purpose too. That long walk behind the coffin was not wrong in itself – it just needed to be balanced by something more intimate and informal.

Still, that isn’t the main problem I have with the article. This came as I read this:

Harry has rightly been praised for talking personally and thus destigmatising mental health issues. This is no doubt excellent. The normalising of mental health problems, which it is estimated will affect a quarter of us at one time or another, is necessary, but so too is funding. Mental health services are in a very poor state and it is almost impossible to get help. Many people in Harry’s situation would not get access to counselling and would be offered antidepressants and possibly a short course of cognitive behavioural therapy, as this is considered most cost-effective. In acute cases, people in a state of severe breakdown are now forced to go to hospitals far from their homes because there are no beds to be found nearby. This is a real crisis, and it is more visible by the day on our streets.

Yes, mental health services are neglected and need to be given a higher priority. But this will not work unless we start to think about mental health differently. Ms Moore’s article perpetuates the idea that dealing with mental health is about dealing with mental illness – depression, anxiety and so forth, and that this illnesses only affect a minority of us (even if it is as high as one in four). But mental health “problems” affect everybody. If you don’t suffer from depression and anxiety in some form regularly you are not healthy at all. It is how you manage it that is the thing – and it is something we all need to learn. And as we learn how to manage our emotions and anxieties better – and learn how to help our friends, relatives and neighbours, then fewer people will be left with the unmanageable symptoms that we call “mental illness”. And when we do suffer from those symptoms, society as a whole will be better able to deal with it.

And here’s the thing: the real problem is pretending that everything is OK when it is not – and this comes through from Prince Harry’s interview. We all know that a bit of anguish is normal. We also know, intuitively, that continually talking about our own emotions is self-indulgent and can undermine relationships with others. We also know that seeking professional help is a drastic step that you only take after other avenues have been exhausted – and is as likely to be a method for avoiding deeper issues as it is for confronting them. So it is the most natural thing in the world to weather our own problems, and then to assume that we are coping with them rather than bottling them up. But equally thinking that all you need to do when you feel down is to pop a pill to make you happy, then you are in even more trouble.

It is actually very hard. So the temptation is to try make the whole thing the exclusive domain of experts, whom we consult as required. And by trying to divert Prince Harry’s intervention into a call for more funding for experts, Ms Moore falls straight into this trap. But mental health isn’t just for experts, it is for everybody. We all need to be able to sense issues in those around us, and have an idea of what is going to help – and, of course, learn how to be more honest with ourselves, and have ideas about how we handle our own problems, beyond externalising it to a professional.

Which is why the first response to the issues raised by Prince Harry is not to rush out and boost mental health services – it is to tackle school curriculums. Above all it is at school that we learn excessive stiff upper lip (incidentally I feel strongly that stiff upper lips have their place – but that is another story). Great advances have been made here, but often in spite of government initiatives instead of because of them. The government’s recent recognition of personal, social and health education (PSHE ) is a welcome change from the bizarre antics of the previous Education Secretary Michael Gove – who dismissed such stuff as a distraction form proper academic education. This incidentally recognises something very important – that there is a strong social dimension to managing mental health.

Mental health is a positive and it is for everybody. By talking about it only when it goes wrong, and talking about the negative, we can make things worse, not better. That is what I take away from Prince Harry’s welcome intervention.

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No health without mental health. The genius of Nick Clegg and the Lib Dems.

2015-03-15 10.36.55What is the point of Britain’s Liberal Democrats? Most Lib Dems would point to the party’s liberal values. And yet these are shared by members of other parties. The same can be said for the party’s attachment to the political centre. Others will talk of community politics – but it is plain that many modern Lib Dems, including its leader Nick Clegg, aren’t really interested in this political strategy beyond a few local campaigns. Many outside the party would simply suggest that there is no point to the Lib Dems. The party is destined to be just a footnote in British politics.

But attending the party’s Spring conference in Liverpool in the run up to May’s General Election, the penny at last dropped. The party is the grit in the oyster of British politics, from which great pearls are produced. It is a serious political party that aspires to govern, not just to protest and complain. It stops Britain’s two main parties, the Conservatives and Labour, from having that ground entirely to themselves. And so it can introduce new ideas to a debate that would otherwise be contrived and stale, confined to a few carefully selected issues, based on focus groups and private polling.

What has given me this insight? It is the party’s campaign on mental health. It is pure genius from a party that looked beaten and irrelevant. The party is demanding “parity of esteem” between mental and physical health, and is in the process of securing serious extra resources for mental health support. It is trying to persuade politicians and the public to talk about the issue more. It is an idea whose time has come.

Consider three things. First is that mental health has an important bearing on just about every aspect of public policy – starting with the NHS, but quickly moving on to crime, employment, social services and onwards – and even defence when we consider the state of veterans returning from active service. And yet almost nowhere is it being adequately addressed. It sums up the dysfunctional element of public service provision better than any other single problem. The failure to handle mental health properly causes untold misery and a huge waste of public resources.

Second: it touches people personally. Most of us will know of people who have had serious mental health problems – depression, anxiety, eating disorders, and so on. And increasingly we are aware  that we ourselves are vulnerable, given the stresses of modern life. And people are readier and readier to talk about it.

And third: it’s hard. The reason why dealing with mental health is done so badly is because there are few quick fixes. it goes to the very heart of the centralised and functionalised way in which we organise our state (and much else), our tendency to standardise and dehumanise in the name of efficiency, and our reluctance to consider broader philosophical questions about how we manage ourselves. If politicians and the public now want to take the issue seriously, it is just the beginning of a long, long journey. And yet it is one that could transform the state and the way we live our lives. As an idea, it has huge potential.

This is not a particularly new idea for the Lib Dems. Mr Clegg claims to have brought the matter to Prime Ministers’ Questions very early in his leadership – to the bafflement of mainstream politicians. The policy initiative No Health Without Mental Health, which kicked matters off, came very early in the Coalition government, with Mr Clegg’s imprimatur clearly on it.  But it is only recently that it has shot to serious prominence, promoted by the Lib Dem Care Minister, Norman Lamb. Mr Clegg has made it central to the party’s overall policy presentation, giving it a mjor place in his last two conference speeches.

The interesting thing about this is that there is nothing uniquely Lib Dem in the insight that mental health is central to public policy. The first prominent person to promote the idea was Richard Layard, the Labour peer and a close adviser to to Tony Blair. His efforts saw the promotion of talking therapies, like Cognitive Behavioural Therapy (CBT). Lord Layard’s journey is an interesting one. It started with the idea that the promotion of happiness and wellbeing should be the primary aim of public policy, in place of monetary income – he is an economist. Now promotion of mental health is his big idea. This is a journey that I too have followed. But Labour were unwilling to take on the wider policy implications. It is all very well rolling out yet another highly centralised initiative on CBT, but rethinking mental health education and provision from top to bottom would challenge too many vested interests. It wasn’t an issue that the public were bringing up in the polls and focus groups, after all.

For the Conservatives, David Cameron took the first steps on the journey, by taking on the idea of wellbeing as a direct policy goal, But he hasn’t followed the idea through. But, it must of course be recognised,  he and his Tory colleagues could see enough merit in the idea to allow the Lib Dems to run with it in coalition. That is part of its genius. Its implications may be radical, but everybody can agree that something needs to be done.

Nick Clegg deserves enormous credit for promoting mental health. While the right obsesses about Europe, sovereignty and human rights, and the left with the demon of neoliberalism and the failures of capitalism, the Lib Dems have found an issue that is concrete, and yet whose implications are profound. It moves us on from the stale old debates.This is disruptive political innovation at its best – something that a mainstream third party is well-placed to do.

Whether or not it helps improve the party’s fortunes in a difficult General Election, it has given the party a meaningful mission in British politics. A political pearl indeed.

 

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