Why have conversations around mental health become so watered down that they barely mean anything anymore?
This is something I’ve been pondering for a while. But in the midst of a global pandemic that has seen mental health problems rise alongside unemployment, and with an economic crisis hurtling swiftly over the horizon, it seems more important than ever that we have a conversation about how mental health relates to broader society.
Yet the gentle, feel-good, platitude-heavy approach, which has characterised the last decade or so of public conversations around mental health, continues its reign. Mental health awareness campaigns, which serve a clear purpose, but simultaneously are in abundance, have told us for years now to Be Kind™ and Reach Out™ about our problems. Memoirs and personal essays, which again, are crucially important for deepening our understanding of what it’s like to have mental health problems, have become a booming industry. Personal accounts of depression and anxiety – largely from white and middle class perspectives – are climbing the bestseller lists faster than ever.
But that only makes the question ring louder in my ears: if we are seeing an unprecedented level of “awareness”, then why, in recent years, have we seen a worsening mental health crisis in the UK?
The answer is perhaps unglamorous and harder to squeeze into a slogan: mental health is deeply intertwined with societal structures, and class structures in particular. In the UK, poverty has increased significantly in the last decade, while people in poverty are disproportionately likely to experience mental illness.
And why wouldn’t this be the case? To put the findings of a 2015 study in plain terms: our media and politicians demonise poor people to the extent that it influences their own self-perception, households living from payment to payment are more likely to prioritise survival over long-term planning, and mental illness can frequently cause people to fall out of employment, which will likely only make their mental health worse.
Meanwhile, the impact of economic downturns on mental health cannot be understated: the Mental Health Foundation says that the risk of suicide increases in a financial crisis, and that people who previously did not have mental health problems can suddenly develop them as a response to job insecurity and redundancy.
In terms of treatment, private support is often out of the question, and publicly-funded facilities are stretched unbearably thin. Many people living in poverty can’t even gain access, because of the gradual decimation of NHS mental health services under Conservative and Conservative-Liberal Democrat governments. For black people (a disproportionate number of whom experience the double assault of racism and poverty), a combination of lack of access, discrimination and subsequent mistrust in services means that they are far more likely to feel the wrath of the criminal punishment system before they get appropriate treatment. And the lens of criminality only persists in treatment – how can you be honest with your practitioner when black people are more than four times as likely to be detained under the Mental Health Act?
These are the plain facts of the matter. Yet a bestselling and widely-acclaimed mental health memoirist recently levelled the criticism that this kind discussion is, for lack of a better word, depressing; suggesting if they themselves were presented with a structural analysis of mental illness, capitalism and wage labour when they were in crisis, it might have led them to breaking point. That’s a valid personal perspective, but it doesn’t negate the need for us to have a bigger conversation as a society about how we tackle the rising prevalence of mental health problems in the UK. Uplifting, personal stories serve their purpose, particularly when we are looking for glimmers of hope. But if their prevalence leads to no material analysis, how will we ever agitate for adequate support for those worst affected?
Critics often argue that it isn’t only working class people who experience mental health problems. And that is completely correct – although mental health is tied to capitalism, this isn’t to say that only certain groups suffer. Such an assertion would be ludicrous, and would also deny the suffering of the many millions of middle class, wealthy, and even rich and famous people who experience mental health problems. Neoliberalism affects all of us. Consumer culture affects all of us. An increasing societal focus on the pursuit of individualistic, extrinsic goals (like popularity, attractiveness or wealth in excess) affects all of us. A culture of competition, which in turn, almost always leads to suspicion and alienation, affects all of us. The concept of a “ladder of success” affects all of us, because there is literally no ceiling. And there are also, of course, biological factors at play.
Mental health can, in theory, affect anyone, but it does still discriminate. Some people live under oppressive structures day to day, cannot get treatment and cannot easily escape their circumstances. For a white or middle class person it can feel like an affront to be told you’re in a position of structural advantage over some others, particularly when it feels as if you have seen the extremes of emotional turmoil. But a societal analysis doesn’t seek to undermine your individual circumstances. Your suffering is still valid – it’s just about acknowledging the hard stats regarding those at the sharpest end.
If we want to tackle rising levels of mental distress in our society, the first step is changing the conversation about mental health. The dominant mantras that we need to “open up” or “be kinder” are not necessarily false. But we should all be suspicious of apolitical approaches to mental health that label any attempt at material analysis as too doom-and-gloom. On social media and in publishing, these messages are deeply profitable – but without equal respect for structural solutions, they do little to challenge the status quo. Mental health is political – it always has been – and as mental health problems continue to soar in 2020 against the backdrop of an economic crisis, now is the time to face up to this truth.