One in four…
…it begins, that first cliché like the first heavy drop of rain that signals an imminent downpour.
The downpour of clichés is a report, A future vision for mental health published this month by a coalition of bodies with vested interests in the expansion of State funding for mental health.
The vision that the coalition (which calls itself the Future Vision Coalition, geddit?) sets out comprises four principles, each of which is shaky and poorly thought out.
1. Government money
Mental health and well-being is everybody’s business. It affects every family in Britain and it can only be improved if coordinated, assertive action is taken across Whitehall and at all levels of government.
First, this slyly conflates mental health and something called well-being. The vision is that mental health is not just about people who are mentally ill — oh, no. It’s also about people who are just not feeling great — people who are unhappy, cross, bored, worried…that kind of thing. The goal of this is to expand the market for mental health services greatly, expanding at the same time the importance of the bodies making up the Future Vision Coalition.
Then it demands that all levels of government must pay for the greatly expanded importance of the bodies making up the Future Vision Coalition, ignoring what the rest of us have known for some time now — that the government is broke, that it long ago ran out of tax revenues to spend on schemes like this one, resorting instead to uncontrolled borrowing, and that now even the uncontrolled borrowing is about to hit the wall.
2. Treatment for all, ill or not
Good mental health holds the key to a better quality of life in Britain. We need to promote positive mental health, prevent mental ill health and intervene early when people become unwell.
It’s not enough to expand mental health to include ‘well-being’. What about people who are perfectly well — happy, contented people who are rarely if ever cross, bored, worried or anything like that? Surely they can’t be left out.
No, this second principle extends mental health services to inlucde not just people who are mentally ill, and not just people who are not feeling too great at the moment, but everyone who might one day not feel too great or become ill.
People should get as much support to gain a good quality of life and fulfil their potential from mental health services as they expect to receive from physical healthcare services. Mental health care should offer hope and support for people to recover and live their lives on their own terms.
You might think that people who have an illness need treatment so that they can recover. But it’s not as simple as that. According to this third principle, people also need something called ‘support’.
Again, the concept of support expands the scope of mental health services beyond actual mental health issues and treatment, expanding the importance of the bodies making up the Future Vision Coalition.
We need a new relationship between mental health services and those who use them. Service users, carers and communities should be offered an active role in shaping the support available to them.
This fourth principle is the only subtle thing in the whole report. The idea is that the level of mental health services should be determined by people who are addicted to the ‘support’ that those services provide.
This will ensure that the apparent need for mental health services, and the apparent importance of the bodies making up the Future Vision Coalition, will increase without limit in years to come.
The report is full of the political doublespeak that you would expect from an exercise of this sort. Here are just a few examples.
We believe that every citizen has a right to good mental health.
Drivel like this makes it sound like ‘good mental health’ is something that can be handed out like sweets. The purpose of the statement is to make you think that it can be handed out, and that it should be handed out. In reality, becoming mentally ill is quite rare, and recovering from mental illness is not always easy, so that talking about it in terms of citizens’ rights is simply foolish.
Up to a quarter of children experience emotional or conduct problems, problems which could often be prevented and which are seldom well-managed. As a result, many of these children go on to experience mental distress as adults.
More utter nonsense. Is this telling us that fewer than a quarter of all children are ever unhappy or badly behaved? Is it really true that there is such a thing as “mental distress” in adults that is “as a result of” being unhappy or badly behaved as a child?
We believe that mental health care should be radically redefined to focus on supporting people to make their lives better on their own terms.
The implication here is that people who become mentally ill should be allowed to remain ill, and dependent on the State for ‘support’. The present focus on trying to make people better, it says, is wrong. The reason it’s wrong is because anyone who gets better leaves the system and is no longer dependent on it. The purpose of this report is to make a system that captures and retains as many people as possible.
Everyone needs some kind of support for their mental well-being at some point in their lives; key moments for support may occur at parenthood, infancy, bereavement, or when an individual’s home or livelihood is threatened.
This clearly attempts to draw everyone experiencing ordinary life events into the mental health system. Perhaps in future there will be outreach workers at bus stops in case people who miss the bus need support for their mental well-being as a result.
Our vision of recovery is one that respects every individual’s wishes and feelings, and which supports them to make their lives better as they see fit. The recovery approach should not be an excuse for withdrawing support when people begin to ‘get better’. In contrast, it means offering ongoing assistance to support people to attain their own goals in life, however long that takes.
This approach to recovery redefines the word ‘recovery’ to allow it to include people who remain in the mental health system receiving support indefinitely. According to this view, people who are no better can be said to have ‘recovered’, and people who are much better need never be discharged. It all serves to increase the size of the market.
This report makes daft proposals that would allow uncontrolled expansion of State services under the banner of mental health, most of which would not address mental health issues at all.
If the proposals were ever implemented, people with real mental illness would find themselves sidelined in an NHS trying to provide universal social care for every one of life’s rough edges.
Instead of uncontrolled expansion, what’s needed is a set of mechanisms to manage and focus mental health services where they can be useful and effective.
1. Instead of involving “all levels of government” together with all the bodies that make up the Future Vision Coalition, government mental health policy should be defined exclusively within the Department of Health (only ever mentioned in passing in this report) so that there can be proper accountability to Parliament for it.
In particular, other bodies that receive direct or indirect public funding should be explicitly excluded from political campaigning of the kind seen in this report, on the grounds that they have a vested interest in increasing public expenditure without limit in their areas of activity.
2. Instead of including along with people who are mentally ill, people with only ‘mental distress’, and people who are neither ill nor distressed, but who might be one day, the NHS urgently needs a definition of mental illness in terms of impairment.
In the same way as the NHS does not provide hospital care for a cold, it should not provide mental health care for a worry.
Ideally, this should happen before the publication of DSM-V in the US defines more kinds of mental illness than there ever were before.
3. The health care system should not provide support.
For example, if you break your leg and need to get to hospital, the NHS does not provide a doctor to take you there. A separate ambulance service takes you there. Travel is not health care.
In the same way, support is not health care. Keeping support separate will prevent support from diluting real health care for people who have real illness.
4. Users of mental health services should have no more say than anyone else in the planning of those services. Like point 1, this is an issue of vested interest.
Our healthcare system belongs to us all, not just to those people whom it makes into dependants.
The worst thing about this report is what it tells us about the bodies making up the Future Vision Coalition. They have put their names to this third-rate exercise in political propaganda, lost credibility as a result, and gained…what? Do they dream of State funding, of honours lists? Whatever grubby vision they were following, it can have had little to do with mental health.