09.11.2017
Offering a real cure
Ending the current chronic underfunding would be just the first step in overcoming the NHS mental-healthcare crisis, writes James Linney
The increasing incidence of mental-health conditions is probably evident to most readers, either because they have experienced it themselves or they know friends or family members who have suffered.
Unlike other illnesses - diabetes, for example, where we can easily diagnose and measure the condition according to physiological parameters - mental-health conditions have always been much more difficult to characterise and treat. Despite modern psychiatry’s best attempts, even some of the most commonly recognised conditions remain difficult to define. This is in part a consequence of the human brain’s infinitely more complex nature in comparison to our other organs. Don’t get me wrong: the kidney’s ability to filter out toxins, retain useful chemicals and help regulate our internal environment is in its own way genius; but, unlike the brain, the kidney’s contribution to human culture has been somewhat disappointing (so far).
In this article I will discuss the increasing incidence of mental-health problems, with an emphasis on the impact on young people in the UK and how the Tory-sponsored national health service crisis is have a devastating impact on their wellbeing.
Analysis of global trends seems to confirm an increase in prevalence of mental-health conditions in all areas of the world, particularly the poorest. Of the numerous recognised types of such illnesses, depression and anxiety are by far the most common and it is these that have seen the largest increase. In its 2017 report1 the World Health Organisation estimated that there had been an increase of 18.4% in worldwide cases of depression between 2005 and 2015, equating to over 322 million sufferers globally. Given the stigma attached to mental health - especially in less economically developed countries, where such conditions often go unreported and there is little or no treatment available - this number can only be a huge underestimation. Yet even this modest estimate means that depression is the leading cause of ill health and disability worldwide.
This increase is apparent in the UK too and is proportionally affecting young people more. A recent study in the BMJ (originally known as the British Medical Journal) found that the prevalence of self-harm rates in teenagers has risen by 70% in the past five years.2 It also concluded that children and adolescents who self-harm have a ninefold increased risk of suicide - which has actually now overtaken accidents as the leading cause of death in young people. Data gathered by NHS Digital has reported that the number of under-18s attending accident and emergency departments for psychiatric conditions doubled between 2010 and 2015.3
These statistics take on an even more worrying character when we take into consideration the Conservative government’s (mis)treatment of the NHS since 2010. The 2008 economic crisis opened the door of opportunity for the Tories to accelerate privatisation. What became the Health and Social Care Act 2012, as predicted, was the medium through which cuts and workforce demoralisation ran parallel to the selling off of services to private health firms (or ‘Any Qualified Provider’, to give them their true dystopian title). Not even children’s mental-health services have been spared this attack.
This is a service that had traditionally already been hugely underfunded, only receiving about 6% of the total NHS budget. But between 2010 and 2015 mental-health trusts faced real-term cuts of 8.5%, losing the equivalent of £598 million from their budgets each year. Hence the findings of the government’s own Care Quality Commission report last month on under-18s’ access to mental-health services came as no surprise. The report found that children face vastly uneven services across the country and that waiting times for counselling or to see a specialist were in most areas much longer than the 18-week national target.4 In some instances, children had to wait up to 18 months to be seen by a specialist. As well as totally unacceptable waiting times, there is also a critical lack of beds: more than 20% fewer than in 2010. Hence many children are having to be admitted into chaotic general medical wards or adult psychiatric wards, whilst others are transferred to hospitals hundreds of miles away from their home.5
Despite their best efforts mental-health workers are finding it increasingly difficult to provide basic care. Since the Tories came into power, nurses have had to contend with falling wages, the loss of their training bursary and an increasing workload. Nurse numbers, particularly those in mental health, have been severely reduced - the Royal College of Nursing has reported a drop of 15% in mental-health nurses since 2010.6 Lack of access to specialist support results in a greater number of mental-health sufferers getting to crisis point, leading to more unpredictable behaviour. This, coupled with chronic understaffing, puts both the staff and patients on mental-health wards at risk. Hence a 42% increase in mental health workers experiencing a violent attack or abuse over the past year.7
Alternative
A demoralised, depleted workforce and the sufferings of the nation’s most vulnerable under-18-year-olds is just one part of the legacy of seven years of Tory NHS policy. Just this week a King’s Fund report estimated that, based on current spending, the NHS will face a £20 billion funding gap by 2022.8
Jeremy Corbyn’s pledge that a Labour government would find £35 billion in extra funds by 2022 is a start, but nowhere near sufficient. Even the British Medical Journal recognised that this would not be enough to repair the NHS in the short term.9 But the left must recognise that being healthy, whether physically or mentally, relies upon more than just having an adequately funded health service. For young people that means fighting for their empowerment: this means a real living wage for all, the right to vote from the age of 16 years and free education for all up to and including postgraduate courses.
As well as our minimal demands, we must be clear in our belief in the fundamental role that capitalism has in the ill health of the working class. It would obviously be an oversimplification to state that ‘capitalism causes mental-health problems’: mental-health illnesses involve a complex interaction between both intrinsic and extrinsic factors. Polygenetic as well as environment factors interact to different degrees for each individual and each type of illness. Conditions such as schizophrenia and bipolar disorder, for example, seem to have a greater genetic component. It would also be utopian to believe that a communist world would be free of all depression and anxiety.
But what is clearly true is that, for the vast majority of sufferers, depression and anxiety are a direct result of the conditions in which they are forced to live. In the UK, in the past 10 years, the state has responded to the crisis of capitalism in the most predictable way: by shifting the burden onto the working class. Among other things, this has meant children being exposed to more poverty, having fewer opportunities for education and less secure employment. It is no major leap to link this to the increasing rates of depression and anxiety. In fact, there is a large body of evidence that already links inequality to mental-health conditions. To quote one of the leading researches in this area, Michael Marmot, “health inequalities and the social determinants of health are not a footnote to the determinants of health. They are the main issue.”10
And this only goes part of the way in understanding the role of capitalism in depression and anxiety in our society; unfortunately (or fortunately for me) discussion of Marx’s theory of alienation and its relationship to our mental health is beyond the scope of this article. But these are ills that modern psychiatry can never cure.
Let me be clear: I am not saying people with mental-health illnesses should not receive treatment that best available evidence supports, whether medications or psychological support, - full and timely access to this is the very least we should be demanding. Antidepressants, mood stabilisers and antipsychotic medication allow millions of people to control their symptoms and they save lives. Yet these medications, and anti-depressants in particular, are massively overused. This is partly due to doctors wanting to help, but having limited tools to do so; and partly a result of big pharma’s role in drug development and promotion (this is especially true in America).
However, as long as we only focus on individual pathological/chemical imbalances or thinking, we ignore the greater pathology within our society - where the accumulation of capital takes preference over all else and the health (both physical and mental) of the working class is offered as a daily sacrifice to this goal l
Notes
1. http://apps.who.int/iris/bitstream/10665/254610/1/WHO-MSD-MER-2017.2-eng.pdf.
2. www.bmj.com/content/359/bmj.j4351.
3. www.bbc.co.uk/news/health-38576368.
4. www.cqc.org.uk/sites/default/files/20171103_cypmhphase1_report.pdf.
5. www.independent.co.uk/news/mental-health-patients-out-of-area-placements-theresa-may-psychosis-anorexia-schizophrenia-a7611571.html.
6. www.theguardian.com/society/2016/nov/01/number-mental-health-nurses-nhs-drops-sixth-tories.
7. www.theguardian.com/society/2017/oct/07/rise-in-violent-attacks-by-patients-on-nhs-mental-health-staff.
8. www.kingsfund.org.uk/press/press-releases/4-billion-needed-next-year-to-stop-nhs-care-deteriorating.
9. www.bmj.com/content/357/bmj.j2404.
10. www.epimonitor.net/Michael_Marmot_Interview.htm.