Deborah Orr: Our descent into mental illness

This situation has been creeping up on us in Britain during a time of unprecedented plenty
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The Independent Online

We are all going bonkers. Or so you would imagine, when you listen to the way people talk about each other. Their ex-boyfriend is "nuts". Their best friend is totally "out there". The guy next-door-but-one is a "complete loony". The woman on the bus has "lost her marbles". You don't have to be mad to work here, but it helps.

It's not just casual and colloquial insults that pepper our everyday language. We have learnt how to take mental disorder a little more seriously too. We are well-versed in the language of behavioural difficulties, psychosis, depression, personality disorder, addiction, self-harm, obsessive-compulsion. We understand what it means when someone has had a breakdown.

Sometimes, on the streets of London, the signs of madness are physical and immediate. There was the naked man, in the cold winter night, jogging purposefully along the inner-city roadside, oblivious to the worried and tentative shouts of concerned passers-by, or even to the screaming sirens of the police van when it arrived. Or the naked woman, shaven-headed, shod in plimsolls, striding down Charing Cross road, and clutching a large canvas shoulder-bag. The crowd divided as she shouldered through it, leaving double-taking shoppers, glassy-eyed in their consumer trances, in her wake.

Yet all the noise around mental health doesn't really help. Despite the massive leap in lay-people's knowledge about mental health, even those who have suffered problems themselves will quickly revert to using an accusation of mental instability as essential proof of their rectitude and the other party's inexcusable folly. Further, when confronted with severe mental health difficulties in a loved one, many people still become fearful of what their suddenly unpredictable relative may be capable of.

Perhaps the most unpredictable thing of all is that this situation has been creeping up on us in Britain during a time of unprecedented plenty. The Salvation Army, in a report it commissioned from the Henley Centre think-tank, called our increasing disfunctionality "the paradox of prosperity". We are affluent and privileged. On paper at least, we want for nothing. But amid the plenty, our minds are uneasy and troubled. Our things don't make us happy. But maybe the feeling that without quite enough things we're worthless can make us more than just unhappy.

It is not, proportionally, the most privileged among us who display the most intractable mental health difficulties, although such problems can and do strike anyone. These problems blight disproportionately the poorest, the least educated, the chronically ill, some ethnic minorities, and people within the criminal justice system (who sometimes end up there because there is nowhere else to put them). Single mothers, asylum-seekers and members of the armed forces are also particularly vulnerable.

In the past our culture's mounting statistics on mental conditions from depression to autism has been put down to better diagnosis, or even the possibility that now we have mastered the business of pure survival, we can move on to deal with less pressing human difficulties. In recent years, it has been suggested that people approach their GPs primed with the knowledge of what they must say to get the pills that are available.

But it becomes increasingly apparent that we really are becoming less healthy, mentally. Mental health problems, says a recent report from the Institute for Public Policy Research (IPPR), account for an increasing proportion of ill-health. In the 1990s, the largest group claiming incapacity benefit had back pain. This year, the largest group of claimants have depression, and the World Health Organisation estimates that by 2020 "depression will be the biggest cause of disability and the second biggest contributor to illness after coronary heart disease in the developed world".

Most worryingly, such problems seem to affect disproportionately the young. In 2004, says the IPPR report, the Nuffield Foundation suggested that, over the course of the past 30 years, behavioural problems have doubled and emotional problems have increased by 70 per cent. Which is pretty much the same as most teachers will, and do, say.

In fact, all those problems that frighten Middle England so - the reports of antisocial behaviour, of " lack of respect", of violence, and of delinquency - can be viewed more clearly when armed with the knowledge that mental health problems are widespread, and that they affect the young particularly badly. The IPPR suggests that poor mental health is one of the " biggest social issues in the UK today", and I see no reason to question this assessment.

The IPPR's report, Mental Health in the Mainstream, is not by any means a document with nothing to offer beyond a grim litany of facts about a nation falling apart. On the contrary, the institute has far-reaching and rather inspiring suggestions about what can be done.

Essentially the IPPR calls for more community-orientated primary care, with the development of community health centres offering space to self-help groups and so on, according to local need, as well as the presence of health, social care and voluntary sector professionals. The report suggests that simply educating people about the benefits of things like reading, exercising and volunteering can have a huge positive impact on mental health.

The report also recommends the introduction of access workers as an alternative to GPs, offering fast and effective triage into specialist services, and also themselves offering time and attention, the "friendly ear" that GPs now find they have less time to proffer than they would like.

At present the reliance on prescriptive solutions is very great, and it is difficult for people to gain access through the NHS to other forms of therapy, such as psychological treatments. In order that patients can exercise more choice, the report suggests a voucher system whereby patients are given personal recovery budgets to access treatment. Finally, the report recommends an overhaul of inpatient services, including more places for people to go for short periods in order to stabilise and manage a crisis.

Is all this lovely stuff feasible? The report acknowledges that there are structural and cultural barriers, but remains certain that the case is so strong that these can and will be overcome.

I'm rather of the opinion that part of the West's descent into mental health problems is due to a spiritual malaise. The IPPR's practical solutions are good and right and sensible. But I can't help wondering if a more fundamental re-evaluation of Western values might help to save our sanity in the first place.

d.orr@independent.co.uk

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