Last week, the Duke and Duchess of Cambridge and Prince Harry joined other notable names, including the rapper Professor Green and the former Labour spin doctor Alastair Campbell, to record short films about modern approaches to mental illness. They all stressed that it was good to talk, or, in the terminology beloved of the mental health world, to “start the conversation”.
I agree – and salute their efforts. Talking and being listened to are therapeutic and are known to be what doctors call a “protective factor” when it comes to good mental health. They make us better able to deal with stress; talking also helps reduce stigma, which otherwise leads to discrimination and social isolation.
I know from first-hand experience the power of stigma. When I had my first major depressive episode nearly 20 years ago, I was a reporter at the Times. I was briefly hospitalised and ill for six months. But when I went back to work, I told no one in the newsroom that I had suffered depression. I didn’t just fear what my colleagues would think – I didn’t want to acknowledge the illness to myself.
Several years later, I suffered a second serious episode. Depression is experienced in different ways, but my illness was born of being an anxious striver who became overwhelmed by the stress of trying to do too much. Chronic insomnia, nausea, a palpitating heart and a terrifying sense that I was falling and had to hold on to something all featured as symptoms. I felt suicidal, not because I didn’t like my life but because of the physical pain of the illness.
It was only after this second episode, which lasted for 18 months or so, that I decided to talk openly about being unwell. I also resolved to discover the evidence-based strategies that would make a third episode less likely.
Fast forward 20 years, and, while we may have “started the conversation”, in many professional worlds stigma is still thriving. In workshops I run – alongside mental health charities – I often start by asking the audience to stand up. Invited to stay standing if they or their family have suffered any kind of mental illness, most stay standing. But when they are invited to stay standing if they’ve been able to talk openly about their experience of mental illness, most sit down.
This is common when I talk to groups at professional service firms: lawyers, accountants and bankers. Despite valiant initiatives such as the City Mental Health Alliance and the Bank of England’s mental health network, many workers feel it may damage their careers to admit mental ill health. They stay stumm, however much royals tell them it’s good to talk.
Part of the reason, I think, is to do with our assumption that a privileged life must entail privileged health. Depression, however, has no respect for background or profession.
For all the great work of celebrities, there’s also a sense in the room that the life of a famous person does not reflect the life of someone working long hours in an office. It’s almost as if the gods of screen or sport are expected to be a bit mentally unstable, given the vicissitudes of their professional life, even if such thinking is misguided. But someone with a steady, well-paid job? Why should they be depressed? Equally, we may think it more likely for those suffering from real social deprivation to experience mental illness. But someone who has his own business? Or a successful doctor or plumber?
So what’s to be done to destigmatise mental health issues?
First, employers need to do more to make it acceptable to be mentally unwell in the workplace. When the royals released the largest ever survey of attitudes towards mental illness last week, just 2% of the 5,000 surveyed said they had spoken to human resources at work. And all this despite almost 12m working days being lost to work-related stress, anxiety and depression in 2015-16.
Probably the most powerful change will be when more senior staff take the initiative and talk about their own struggles. A junior employee is never going to admit to problems if they feel their boss wouldn’t do the same. Meanwhile, employees need safe, non-judgmental platforms to discuss their feelings on a regular basis. Often, people with mental health problems find it harder to stay in work and progress in their career.
The second key change must be in the NHS. Last Friday, its chief executive, Simon Stevens, said that mental health will now be a priority. Talking therapies for anxiety and depression will be given to 200,000 more patients each year by 2020, and NHS England is committing £1.4bn in funding to expand treatment.
Welcome news, though we’ve heard promising announcements before. But we have decades of neglect and underinvestment to rectify. Last November, an analysis by the King’s Fund thinktank showed that 40% of mental health trusts had a fall in income in 2015-16. This was despite the government’s commitment to parity of esteem for mental health now enshrined in the NHS constitution, and despite assurances from NHS England that almost 90% of plans submitted by clinical commissioning groups last year included mental health funding increases.
I routinely talk to people who have had to wait months for cognitive behavioural therapy, the therapy of choice in the NHS, or an appointment with a psychiatrist. And Professor Sir Simon Wessely, president of the Royal College of Psychiatrists, warned last week that a lack of specialists means that mental health patients are not being treated by people trained to deal with their condition.
Another problem is representation. There are still precious few mental health experts on the boards that run the health service, including the boards of NHS England and Monitor (the health service regulator), or the Wellcome Trust.
I would also love to see the NHS adopt a more holistic approach to good mental health. My own experience is that we all need a toolbox of strategies, nutrition being one of them. Yet NHS doctors have almost no nutritional training.
As the royals said, simple conversations can change the direction of an entire life. But even more important is having access to proper services and getting proper care. And many don’t. So let us see the extent to which words translate into action.
Given the scale of change we need, I worry that too much talk may be seen as an excuse for not enough action. In fact, in a strange way, it will only be when the prime minister and the heir to the throne no longer need to publicise the problem that we will have defeated the stigma.
Rachel Kelly’s books include Black Rainbow, her account of her struggle with clinical depression. She is an ambassador for Sane and Rethink Mental Illness
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Talking about mental illness is no substitute for offering real help | Rachel Kelly
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