In all the noise and fury that surrounded the pre-Budget report on Tuesday, something important happened. Something more important than the rise and fall of political reputations or the ebb and flow of party advantage. Alistair Darling, the Chancellor, published plans to increase spending on NHS psychological therapy to £30m next year and £170m a year by 2010-11.
This is a significant victory for this newspaper's mental health campaign. For five years now, The Independent on Sunday has sought to promote better understanding of mental illness and better provision for the mentally ill and their families. Partly because of the pressure from our campaign, the Mental Health Act that received the Royal Assent in July was substantially better than the illiberal law repeatedly proposed by ministers.
The connection between our success in lobbying against the early form of that law and last week's victory may seem tenuous, but it is real. The original Mental Health Bill was animated by fear. Ministers used it to try to reassure us that they were acting to protect us against the small number of mentally ill people who suddenly become violent. In doing so, however, they sought too much power to detain people who had committed no crime; the Act as finally passed contains important safeguards against the abuse of such power. The focus of public policy, we argued, had to be on better management of the mentally ill and earlier intervention to pre-empt crises.
This shift in priorities is also reflected in last week's announcement. The move from pills to "talking therapies", and from crisis response to early intervention, is all part of a welcome rebalancing of mental health priorities in the NHS. Until recently, the main response of the NHS to mental illness was chemical-led. GPs do not have time to talk to their patients if they complain of stress or depression; there may be an 18-month waiting list for counselling. Often, therefore, the default response is to prescribe anti-depressants. For many people, that is enough. For many others, however, it is a denial of a problem that will get worse.
Again, this is correlated with the prevalent fear of mental illness. Low-level mental health issues touch – and frighten – nearly every family in the country. Bipolar disorder, or depression; alcoholism; disabling stress or anger: they bring misery to millions but are often assumed to be things that have to be borne – until a cry for help that cannot be wished away. We now know that talk is the most effective treatment for many of these conditions, as Professor David Richards explains below. In the long run, it may even be cheaper than chemical alternatives – especially if we take into account the wider costs to society of mental illness.
Ultimately, though, this shift in NHS priorities is not about saving money. It is part of a growing realisation that the debate about the quality of life is changing. Mental health issues need to be seen as part of a – and this is a word that can be used now without sneering connotations – holistic approach to well-being. Richard Layard and Anthony Seldon are the unlikely leaders of this movement. Lord Layard, the Labour peer and author of Happiness: Lessons from a New Science, has done much to persuade health ministers to put more money into psychological therapy. Mr Seldon, by introducing lessons in happiness at Wellington College, where he is Master, bore the brunt of the mockery that is the price to be paid by any new idea.
The idea has now entered the mainstream. We worry about children being stressed, depressed and anxious even as we know, as Tim Lott illustrates today, that their material and emotional lives are better in most respects than those of any generation before. It may be that we understand these things better now, but that this understanding produces its own new anxieties. What is encouraging is that political leaders are now engaged with the issue. David Cameron, the Conservative leader, has made the promotion of general well-being a plank of his platform. And last week Mr Darling confirmed with hard cash a shift in public rhetoric that took place when Patricia Hewitt was Secretary of State for Health. In passing, we note with approval – unexpected in newspaper leading articles, which usually demand immediate transformation – the slowness of the change. These are not services that should be expanded too fast. Good therapists take time to train.
A more sophisticated understanding of well-being – even, if we are lucky, of happiness – is one of the defining challenges of our age. Last week's pre-Budget report will probably be remembered for a huge spat over the old politics of tax and property. It ought to be remembered for taking an important first step towards the new politics of happiness.Reuse content