ANDY MAYERS - (@DrAndyMayers)
On September 21st, the BMJ interviewed Sir Simon Wessely, President of the Royal Society of Medicine (formerly President of the Royal College of Psychiatrists). The central message of that interview suggested that we should stop raising awareness about mental health.
The argument was that we do not have the resources to cater for those seeking help. Raising more awareness would, the article argues, only serve to put more pressure to an already over-stretched system.
In this blog, I will argue that we need more investment in those services; not fewer awareness campaigns. At the same time, we need to ensure that those campaigns are realistic, safe and appropriate.
I would like to start by stating my utter respect for Sir Simon. He has often spoken out for the need for better support for people with mental health problems. That is perhaps why I was so surprised when I read the BMJ article. A few of us took to Twitter to (I hope politely) challenge the arguments put forward. In his defence, Sir Simon stated that a short interview can only capture a small part of what he was trying to say. Nonetheless, what was said could potentially do a great deal of damage to people with a range of mental health difficulties. Perhaps there’s an argument there for writing one’s own press releases; I often do.
In one quote, Sir Simon said “We don’t need people to be more aware. We can’t deal with the ones who already are aware.” For me, mental health awareness campaigns are not about making people aware that they may have certain conditions. Most people, unless they lack insight or have a complex personality disorder, are aware that there are unwell; they just lack the confidence to seek help, or they fear stigma and judgement. Instead, campaigns should be about a whole raft of other factors – including persuading governments and commissioners that we need to invest in services, reducing social stigma, helping people not to feel guilty, and making it OK not to be OK.
I have been part of several campaigns that have influenced the Government.
Through the Maternal Mental Health Alliance (Everyone’s Business) campaign and
the 1001 Critical Days
initiative, we have seen commitment to investment that would not have occurred
without the awareness campaigns. The Time to Change campaigns have
raised awareness across all areas of society reducing stigma and getting people
talk positively about mental health. All of these campaigns have probably saved
I agree that, by successfully raising awareness about mental health, we have been the victims of our own success. More people are coming forward to potentially seek help. That is indeed putting greater strain on services. However, that should not be a reason to stop. It’s the investment that’s wrong. Reducing awareness and failing to tackle stigma will not make that problem go away. All it will do is make people less likely to seek support, which would put their lives at even greater risk. Not raising awareness will not reduce depression, bipolar disorders, or psychoses. Any more than diabetes will go away if we stop raising awareness about that. The conditions will still be there; they just will not be diagnosed and properly treated. Reducing awareness might place less burden on services, but it would be wrong and indefensible.
Furthermore, those coming forward to seek support need not
be a burden on NHS services. We need to radically rethink how we deal with
mental health. With the right investment, the charity and voluntary centre can
play a big part too. During the interview Sir Simon said “We should stop the
awareness now. In fact, if anything we might be getting too aware. One wonders
what’s happening when you have 78% of students telling their union they have
mental health problems—you have to think, ‘Well, this seems unlikely.’”. Of
course, it’s unlikely that three-quarters of students have a diagnosable
condition. But, there’s a lot more to mental health support than primary and
secondary care. At my own university, we have a whole range of support
services, where students are, essentially, triaged. It’s a question of
signposting to the right support. Many may need no more than simply directing
towards activities that might tackle low mood and anxiety. Others may need counselling
support. A few may need something more intensive. We frequently run awareness
events, and wouldn’t stop those for fear of overwhelming demand. Without
awareness, they might not seek help at all (and the problem could escalate). We
have responsibility to support our students and adapt to what we can offer or
In any case, mental health awareness is not just about
making people aware about mental illness. Far from it. Campaigns can also teach
people about how to lead better mentally health lives. We can show the
importance of exercise, diet, sleep, and work-life balance, for example. We can
also use campaigns to educate those with life-long conditions about tool kits
that can help them stay well and reduce relapse. There are many excellent
programmes across the UK doing just that. These very same people can be trained
to be peer supporters, using lived experience to help others. We need to use
public awareness campaigns to illustrate the benefit of peer support – to those
who give the support as well as those being supported. Investment in those
services, typically provided by charities, can help with prevention of relapse,
or escalation of mild mental ill health into something more serious. It could
save a great deal of money in future spending and, more importantly it can save
Sir Simon was cautious about promises made by the Government about mental health investment, especially on the recruitment of mental health staff. I share his concerns. But that should not stop the awareness campaigns. Instead, we must use these campaigns to show that the Government still does not ‘get it’. I said as much in a blog I wrote in August. We need a revolution in the way we see mental health. Our awareness campaigns should focus on how we can foster a mentally healthy population (through positive lifestyles). Mental health education in schools can teach young people about emotional wellbeing, and how to seek help if they become unwell (as well as look out for friends and family). Early intervention could prevent a lifetime of mental illness – and that intervention, if early enough, need not be expensive either.
I also agree with Sir Simon about the need for integrated physical and mental health services. Much of what he says in the latter part of the article (which many readers could not see without a subscription to BMJ) was applaudable. Sadly, the message about mental awareness campaigns, which pervaded the opening paragraphs, might have done more damage than Sir Simon might have imagined. Sure, many of these campaigns are not perfect. In fact, we have a duty to make sure that campaigns are realistic, safe, and appropriate. A campaign that is not underpinned by networks that can, at the very least, signpost to support is dangerous. But having fewer mental health campaigns is also dangerous. We run the risk of undoing all the work that has been done over the last few years.
I will continue to campaign and raise awareness, but I will also continue to lobby Parliament for more investment (partly through my political work) and to be a critical voice in mental health services (I am a Public Governor for Dorset Healthcare University NHS Foundation Trust). I will also continue to advocate the role that charities can play in providing services (I hold trustee and ambassadorial roles to several local and national mental health charities, including Dorset Mind). We can all play a role in putting mental health at the heart of everyday living. It is a public health priority.