“Mental health culture has gone too far, says Mel Stride” said a headline in the Daily Telegraph two weeks ago. In the article below it the Secretary of State for Work and Pensions outlined his view that a significant factor in the post-pandemic increase in people not at work due to mental ill health was that many were “convincing themselves they have some kind of serious mental health condition as opposed to the normal anxieties of life”.
The interview did not mention that later that day the Department was going to announce the sharpest rise in poverty in 30 years, including an extraordinary 7.4 million people who struggle to source sufficient food – an increase of 50% over the previous year.
By co-incidence or design the record poverty figures gained little media attention, but the mental health comments continue to fuel much commentary[1].
72% of foodbank guests report mental health issues[2]
People like “Lucy” rarely feature in newspaper opinion columns – and certainly don’t get to write them. I met Lucy, whose name I have changed to protect her identity, in a spacious glass-fronted church vestibule which was set out as a welcoming café. Lucy had just had a conversation with one of the Trussell Trust foodbank volunteers and now she was waiting, coffee in hand, for her and her disabled mum’s 3-day supply of food. She told me a little about her mental health problems but that was not the focus of our conversation (we spent much too long talking about my recent birthday and her calling me old) – but it was part of her story. An unsurprising part of her story given the huge stresses and difficulties she dealt with every day. These were magnified by a large amount of unjustified guilt about needing to use the foodbank as well as shame about what she saw as not being able to cope. From the outside I saw her coping magnificently.
Lucy is unique and wonderful – but I have met a lot of Lucys in church halls around the country. Coping with difficult circumstances, mental health issues and shame is an all-too-common thread. But just as importantly there is a thread of humour, mutual support, and finding the energy to carry on.
Poverty, hunger and poor mental health are linked
Let’s start with the obvious: poverty and mental health issues are linked. Children from the poorest fifth of households by the age of 11 are four times more likely to have a serious mental health condition that the wealthiest. Adults in the most deprived areas have a 50% greater chance of depression than those in non-deprived areas, and suicide rates amongst the middle aged in those same deprived areas are more than double those in the least deprived. I could go on quoting study after study but put simply, if there are more people in Lucy’s position struggling to make ends meet, there will inevitably be more problems with mental health.[3]
As the Secretary of State spoke about “mental health culture” – referring to a rise of 150,000 people out of work due to mental illness – he knew that his department was about to announce that more than 1 in 10 of the British population were living in families which were unsure that they would have enough to eat, an increase of 2.5 million in a single year. Given these numbers, it is a testament to people’s resilience, rather than an out of control “mental health culture”, that the number held back by mental health issues is not greater.
Shifting responsibility onto those who are suffering
However, I fear what the Minister said was not a carefully considered position but instead it was just defensive politics. The economic inactivity numbers are not good, and the poverty numbers were about to be atrocious, so half-baked thoughts about a “mental health culture”, that play well in the Daily Telegraph were most likely a useful way of getting out of a hole.
However, by equating mental health issues with not being able to cope with the normal anxieties of life the Minister both diminishes the level of suffering being experienced and asserts that the situations people find themselves in are normal and cope-able with. It is a self-serving assertion that shifts responsibility firmly away from government or society more broadly and onto the shoulders of those who are doing the suffering. These assertions also have the advantage of being impossible to conclusively prove or disprove.
Reinforcing blame and shame
The thing that most angered me about Mel Stride’s statement was not that it played into inaccurate prejudices that the public have about people struggling with mental health problems (which it absolutely does). What angered me most was that it played into the unjustified prejudices that people who have mental health problems often have about themselves.
I will never forget speaking with a man in Glasgow who had been sanctioned – had his benefits removed – for 9 months. He began his story of hunger, followed by homelessness and understandable long-term mental health issues with the phrase “I was a bit stupid”. What he had done to be sanctioned was not attend an interview because, as a tribunal later confirmed, he hadn’t been told about it – yet just like Lucy, he still he instinctively found fault in himself.
Giving mental health a context
When I meet people like Lucy, who are experiencing real and understandable mental distress, I feel that the way that we talk about mental health leads us to inadvertently strip away important context. We rightly want to relieve any person’s distress with whatever tools we have – including medical treatment. But that process also encourages us to see the person as ill, and not see the ordinary person who has been damaged by difficult circumstances.
It is truly perverse that while someone like Lucy will have no difficulty getting regular antidepressant pills, it is a distant pipedream that her damaging context might be improved by enabling her to source decent food, shelter, and support for her disabled mum.
Yes, Lucy may need treatment but that cannot deal with the key injustice at the heart of this situation – it simply makes it more liveable with. Good and important in the short term but anesthetising us all to the underlying injustices in the long term.
The mental health culture has not gone far enough
I agree with Mel Stride that it is good we are more open about mental health problems. While the Minister’s objection was that we have gone too far, mine is that it has not gone far enough.
Rising mental ill health is a problem that has steadily increased across the population for over 30 years, focused on the young and the least well off, but touching all parts of society. The primary response however has been to deal with sick individuals, without systematically linking this to people’s circumstances or reflecting more broadly on why our society has become a mentally less healthy place.
Very recently, social psychologist Jonathan Haidt has produced a book highlighting the role of the mobile phone in mental health which has been met with enthusiasm. The more detailed arguments have been less welcome – that phones are a potent conduit for social pressures that have been increasing for some time. Social pressures that become more prevalent throughout society as poverty and especially inequality increases. This helps explain the society wide increases in mental illness beginning before the invention of the mobile phone that have been focussed on the least well off. The problem is too complex to do justice to here – but the tabloid scapegoat of mobile phones is not credible.
A good mental health culture that went far enough would be one that recognises that society-wide increases in mental distress are conveying important information. Information that tells us about how changes in society are experienced by people and how we can make our communities mentally safer and more nurturing places to be.
What next?
Poverty causes mental distress, and the more there is, the more mental illness ensues. It can be tackled if there is political will to do so. The Let’s End Poverty campaign is seeking to put poverty at the heart of the next general election campaign, where it needs to be if the next government – whoever wins power – is to make the transformative changes that are needed to reduce poverty and inequality in the UK.
But lots of what is next is to continue what churches are already doing so well. Lucy was at the foodbank because she needed food – but what she gets is much more. People listen to her story and share jokes. They tell her she is valuable; she is doing well; she is not a failure – in short, they treat her as the loved image of God she is. I truly believe that is where God is to be found at work, and it is happening in church halls up and down the country.
[1] My favourite of this genre was the sensitively titled “Generation Feeble has confused mental health for a pity party” but more nuanced and moderate articles were also penned.
[2] Trussell Trust (2021) “State of Hunger” p26
[3] On the BBC Question Time programme when this was discussed, newspaper columnist Rod Liddle asserted that the link was in fact inverted and that poverty reduced mental health issues. Within a society that is simply untrue e.g. it is Hull that bears the highest burden of mental health issues in the UK, and not Kensington. Presumably in good (if selectively researched) faith Liddle justified his claim by comparing different nations across the world. Differences in health care systems, and more importantly the understanding of mental health, does mean that less well-off nations often report lower levels of mental illness than richer nations. This is an interesting observation and should make us think about what we should learn from other nations – but even in those poorer nations the least well-off people bear the highest burden of mental ill health.
