Sean Bell: A global mental health crisis can only be defeated by changing the world that created it

“The pandemic has reinforced what should already have been obvious: our mental health is affected – adversely, more often than not – by the external circumstances we find ourselves in.”

ON MONDAY, with bleakly appropriate timing, Mental Health Awareness Week began in the UK.

This year’s efforts by the Mental Health Foundation and its collaborators are as laudable as ever, particularly under the fresh burden of unprecedented relevancy. Last week, a policy brief from the United Nations put the psychological ramifications of the Covid-19 pandemic into troubling context: the isolation, poverty, grief, fear and uncertainty afflicting millions across the world may yet lead to a mental health crisis of global proportions.

Predictably, reports already indicate an international increase in symptoms of depression and anxiety, particularly amongst certain high-risk population groups. The pandemic may finally have given the lie to any notion that these conditions are minority concerns: in China, 45 per cent of healthcare workers have reportedly suffered from anxiety since the Coronavirus outbreak began, while a full 50 per cent have experienced depression. Canada, dispelling any hope that such statistics may be an outlier, has found 47 per cent of its own healthcare workers reporting a need for psychological support.

Beyond those working at the frontline, children, adolescents, women, older people and those living with pre-existing mental health conditions have only been rendered more vulnerable by the crisis, their plight compounded by the widespread disruption of physical and mental health services across the globe. Yet as few need reminding, no one is invulnerable to the effects of our present reality: confronting the enormity of the situation whilst isolated in body and mind should not be underestimated.

I mean no insult to those promoting mental health awareness this week when I suggest their endeavours may be insufficient to the task: compared to the times we live in, David enjoyed better odds against Goliath. The Mental Health Foundation’s theme for this week is ‘kindness’, which is easy to sniff at until you have need of it. Raising awareness, especially now, is undeniably crucial to changing attitudes towards mental health issues, confronting prejudice, stigma and fear, and helping those who need it most – but awareness can only take us so far.

I will admit to some cynicism, chiefly due to my profession. I started my career during an especially weird period, when the British media in particular was in the thrall of what was often euphemistically described as ‘confessional journalism’. Others would call it exploitation. Journalists at the time – often young ones regarded less as human beings than personal brands to be developed – were encouraged (or sometimes instructed) to publicly spill their guts about the most difficult and traumatic facets of their lives, and the mental health struggles that followed. Addiction, eating disorders, sexual assault and family dysfunction were all grist for this particular mill. This was done in the name of… well, the excuses varied, but it was usually something to do with raising awareness. It certainly made me aware of a few things, though perhaps not what was intended.

Eventually, as usually happens with media trends, the bottom dropped out; produced to excess, some idly wondered if confessional journalism had “gone too far” (the kind of question the industry usually only asks once the answer has become obvious). It would be nice to think such belated hesitance was prompted by ethical considerations, but from what I remember, accusations of narcissism were the order of the day. This was the thanks received by many for exposing the most painful and private parts of themselves.

I absolutely do not mean to suggest that anyone going through mental health problems should remain silent, or refrain from reaching out to those who can help. Nor do I feel that writers – or anyone else for that matter – should hold back from from drawing on their own experiences as a means of tackling a profoundly difficult subject. Journalists far braver than me have done so, with great insight and beauty.

What I do believe is that it should not be necessary to trot out a heart-rending anecdote about one’s own travails with mental health before the entire world in order to make people care, and that no one should ever feel pressured to do so. Where once the motivation was to make the issues surrounding mental health – and their human cost – ‘relatable’, the Coronavirus has demonstrated that concern is no longer relevant. If you want to universalize the question of mental distress, it’s hard to beat a plague year.   

I am not the first to suggest that we need more than ‘awareness’ when it comes to mental health; once you’re aware of a problem – a problem which, if you didn’t consider it a global crisis already, may become one with terrifying speed – what do you do about it?

Responding to the UN’s brief last week, Dr Tedros Adhanom Ghebreyesus argued that mental health needs “must be treated as a core element of our response to and recovery from the Covid-19 pandemic.” Putting this into action, he said, “is a collective responsibility of governments and civil society, with the support of the whole United Nations System. A failure to take people’s emotional well-being seriously will lead to long-term social and economic costs to society.”

It remains to be seen whether the nations of the world will rise to this, one more challenge they did not seek and for which they are ill-prepared. However, even if a renewed, worldwide effort to provide better care and support for mental health comes to fruition, such efforts will be purely palliative if they do not reckon with the conclusions Covid-19 has made impossible to ignore.

The pandemic has reinforced what should already have been obvious: our mental health is affected – adversely, more often than not – by the external circumstances we find ourselves in. For the likes of the World Health Organisation, this is so apparent it is barely worth articulating – yet much of how our society deals with mental health is predicated on a refusal to grapple with this connection.

As Public Health Scotland has highlighted, mental health problems are not distributed equally across the national population. Adults in the most deprived areas of the country are twice as likely to have common mental health disorders than those in the least deprived (22 per cent versus 11). Poverty, poor housing, unemployment, childhood adversity, family conflict and chronic health problems “all contribute to a greater risk of mental health problems, particularly if several occur together and there are no protective factors to offset their negative impact.”

Social ills do not exist independent of policy: In December 2017, a study from Vox, the Scotland-wide third sector coalition of mental health charities and advocacy groups, found that three quarters of Scots with long-running mental health problems felt their recovery have been negatively impacted by austerity-driven cuts in public spending.

Despite the mounting evidence, successive Conservative and Conservative-led governments have long resisted acknowledging or dealing with the mental health consequences for those made to suffer under their policies. Both in the UK and beyond, there still exists a substantial and influential political current, chiefly on the Right, which has invested greatly in an alternative narrative: that the prevalence of certain mental health issues can be attributed to the coddled weakness of snowflake generations raised too indulgently, and that the appropriate medicine for those raised in the shadow of endless war, the creeping apocalypse of climate change and world-shaking capitalist recessions is to ‘toughen up.’

As the professionally wrong Brendan O’Neill wrote in the Spectator on 16 March: “Performative weakness, identitarian self-obsession, ageist aloofness from older people and their wisdom: this is the storm of influences that have stripped the young of the ‘strong nature’ that is so central to a strong and healthy society.”

O’Neill may fear for those he deems too psychologically fragile to withstand the demands made by the pandemic. I would gently suggest that it is he and his ilk who lack the fortitude to face the uncomfortable truth: the systems and institutions in which they are so invested, under which much of the world is forced to live without choice, are actively damaging to our mental health. If you worry that drugs, alcohol and social media are bad for the brain, wait ‘til you see what life under capitalism does. Austerity, neoliberalism, economic collapse and environmental destruction are not the opiates of the masses, because as I understand it, opioids can occasionally be fun. Without changing these realities, we cannot hope to offer anything other than a sticking plaster to the victims.

In 1964, Philip K Dick wrote a science fiction potboiler called Clans of the Alphane Moon, set on an interstellar psychiatric facility abandoned by its colonist overseers, where the inmates have taken over the asylum and formed a reasonably functional society. Readers concerned about the frequent stigmatization or stereotyping of mental illness will find much to criticise in the novel: according to the caste system of the clans, paranoids become politicians, those with mania become warriors, while obsessive-compulsives become bureaucrats. Even so, Dick – who was, to put it mildly, not unfamiliar with mental illness – was characteristically prescient; he imagined a society where ‘good mental health’ was not a likely option for the vast majority, and which therefore adapted, albeit strangely, to suit the condition of its people. In this, sadly, we still lag behind science fiction.

Today, we can envisage a world with less stigma, with greater and better mental healthcare, where the challenges they face do not include a fear of what might happen if they reach out and ask for help. However, for the most part, we can barely conceive of changing the world – or even our small corners of it – so that problems of mental health become less than endemic and less than inevitable.

I do not propose a utopia of perfect mental health, because I have no idea what that would be. ‘Good Mental Health for All’ makes a nice slogan, but one could argue over whether it’s a credible aspiration. As Phil Dick wrote: “Being alive means being exposed; it’s the nature of life to be hazardous – it’s the stuff of living.” The challenges of mental health will always be with us, one way or another. Instead, it is worth considering those realities that may be less permanent, if only we could defeat them.