Rhiannon Corcoran is Professor of Psychology and Co-Director for Health and Wellbeing at the Heseltine Institute for Public Policy and Practice.
In January 2014, Nick Clegg and Norman Lamb endorsed the last substantive policy statement around mental health and wellbeing in the UK: “Closing the gap: priorities for essential change in mental health”.
More recently there has been a noticeable absence of statements by the main UK parties in relation to mental health and wellbeing. Presumably this is because there has not been full recognition of the importance of this matter. In reality, a failure to effectively address our mental health and wellbeing crises has severe economic implications for the country and with them comes political suicide.
There are elements in “Closing the gap” that warrant praise, perhaps the most significant learning to come out of it in terms of priorities for essential change in mental health, is the importance of addressing the right priorities.
Promises
Amongst the promises made in January 2014 was an initiative to set up a new national Mental Health Intelligence Network to gather information around mental health and wellbeing and what affects them.
This is a laudable initiative led by specialist organisations and instantiated in developments such as the recently launched What Works Wellbeing Centre. But real understanding requires nuanced understanding that cannot emerge solely from prevalence statistics of contested concepts brought to us courtesy of an accessible Mental Health Dashboard.
Sure, mental health and wellbeing needs to be measured at national, regional and community level but, lest we forget, communities are made up of individuals who, when times are hard, can be overwhelmed by experiences, worries and difficulties that can quickly escalate into low wellbeing and/or mental ill-health when personal or social circumstances facilitate a downward spiral.
Detailed enquiry
A proper understanding of our mental health and wellbeing crises therefore requires rigorous detailed enquiry positioned alongside accessible ‘big data’. Yet, nowhere in “Closing the gap” is there any mention of support to develop this fundamental, nuanced level of understanding gathered via investigation into the human experiences of crises.
Looking up from the bottom one cannot lose sight of the fact that the ‘state of the nation’ promises recorded in last year’s policy rest upon real personal suffering.
No amount of data crunching or enhanced access to impoverished, over-burdened services to ‘close the gap’ between mental health and physical health provision will prevent the individual suffering of so many.
Without understanding, developed from rigorous, open-minded scrutiny, we will never improve the lot of those of us who languish in austerity, unable to support or sustain the necessary participation in publicly-minded community that provides a tonic. Nor will we ever improve the lot of those of us who cannot stop worrying about the perceived or real shortfalls in our selves.
Languishing Vs depression
The nub of the issue is that in order to make effective policy, our policy-makers need to inform themselves of the key matters of knowledge that make mental health and wellbeing issues understandable. One such matter is that different societal and psychological processes underpin and sustain low wellbeing or ‘languishing’ and mental ill-health.
Languishing is not the same as depression and they are therefore unlikely to be addressed effectively by the same measures and policies. It’s an easy mistake to make – if you don’t know. But ignorance in policymaking, in an area where the human cost is so high, is difficult to forgive.
It’s a tough call in austere times – right? But long- term, convergent, informed thinking is more cost effective than any short-term ‘fire-fighting’ approach. The shortfall in joined-up thinking is nowhere more clear than in this promise: “More people with mental health problems will live in homes that support recovery.”
While it would be very foolish to argue that decent, secure housing is not an important issue, recent mental wellbeing research suggests that an equally critical issue lies at the level of existing neighbourhoods not the specialised housing estate. Indeed by promoting this ‘specialised’ approach, some policy ambitions around stigma reduction will almost certainly be undone.
Sobering change
The critical importance of wider place-related issues to mental health and wellbeing is brought out by some of the sobering changes seen during the austere three-year period between 2009 and 2012 recorded in the data of the North West Mental Wellbeing Surveys:
- the number of people who talk to their neighbours ‘on most days’ fell from 51.9% to 33.6%
- the number of people who ‘never’ talk to their neighbours rose from 2.6% to 4.7%
- the number of people who meet with friends and family who they don’t live with ‘on most days’ fell from 53.9% to 41.2%
- a 12.7% fall in the number of people who felt ‘very strongly’ that they belonged to their immediate neighbourhood during this period
More compelling still are the results of a recent evidence synthesis drawing on prospective data from 3.4 million participants in the USA. This research places loneliness right up there alongside obesity and smoking as a major public health concern by showing that it is related to a 30% increase likelihood of premature death. Why, in the light of these and other findings that stress the negative consequences of loneness and social isolation, is there so little recognition of it in health policy?
Community trends
The failure to address such negative community trends will almost certainly jeopardise the promotion and sustainability of good mental health. So what informed policy measures could address these issues?
In the absence of significant commitments from party leaders, here is my manifesto for taking informed steps towards better mental health:
- Mental health intelligence networks would be complemented with Wellbeing Community Companion Networks to begin to address the damaging social isolation associated with languishing
- Place Directorates, like in Bristol, should be set up so that policy makers in previous ‘silos’ can meet to advance the place-related policy culture. Here, integrated, resilient local policies that focus on people and community can emerge in the re-thinking and re-building of places to support community cohesion
- Mental Health Research Consortia would be set up to focus on the social and psychological determinants of mental ill-health. These collectives would be tasked to produce the nuanced research linking particular experiences to better-specified ‘distressing’ mental states. Only research directed at this level can meaningfully inform psychological treatments and social prescription into the future
- A strong, connected network of life-span mental health peer support groups should be funded by Government and organised by MH charities such as Mind and Rethink. These democratic services can facilitate personal and sustainable recovery like no others can.
Only policies like these built on understanding not just measurement can address the real priorities to secure a better future for the people of our nation.
