Stigma

Continuing my theme for this week of posts on mental health, I’m turning my attention to the stigma that society attaches to mental illnesses and those who suffer from them. To illustrate this point,  I suffered this in a relatively modest way last year and am sharing this story with you.

I lost a friend. Nothing major in the great scheme of life, it happens all the time. But not as a result of someone’s ignorance. Briefly, I had been due to attend this friend’s annual house party weekend, but a family event was arranged for the same weekend and, given the distances involved, it wasn’t possible to do both. I decided, as I think most of us would do, to put family first and gave my apologies. Things were strained for a month or two until the weekend of the event itself, when I was treated to the worst that modern day friendships can bring: yes, I was unfriended and blocked on Facebook, thrown out of the WhatsApp group, and unfollowed and blocked on every social media platform through which we were connected. I was later told by another friend that my reason for absence had not been believed, coming as it did after my having to drop out of a previous gathering earlier last year due to illness. It was deemed by She Who Knew Everything that my real reason for not attending either event was that I was a depressive and was making excuses for not being able to attend these events. Firstly, that was untrue. Secondly, what qualifications did she have to make that judgement? Thirdly, how dare anyone judge someone on this basis, and choose to end a friendship as a result? And fourthly, even if she had been correct in her assumption, wouldn’t a true friend have attempted to help, rather than act the way she did? Sadly, a few of the others from our circle of friends chose to follow her lead – which my other friend described as ‘bullying.’

I’m telling you this not as a way of avenging what I feel as having been wronged – I wouldn’t use my blog for that, it’s too petty, and if anything were to be said it should be in private – but because what my ex-friend was doing was stigmatising people who have at some point suffered from a mental illness. Having suffered the debilitating effects of depression, people don’t need to be judged as being in some way inferior by those who don’t know any better. The fact that some others followed her approach speaks volumes for how entrenched such ignorance is in our society.

Let’s take another example. On Monday I reblogged a post from three years ago about the crass stupidity of Asda and Tesco in selling ‘mental health patient’ costumes for Halloween. I’ve since looked at their websites and am pleased to see that this year’s offerings don’t include anything so offensive. Sadly, though, such behaviour does still exist. It didn’t take me long in searching through the online fancy dress specialists to find similar examples still being offered for sale. This, for example:

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Or maybe this:

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What can possibly be funny, entertaining, or appropriate for public display about mocking an illness which causes so much damage and hurt, both to those who suffer from it and to those who love and care for them? Again, I see this as being caused by ignorance and the ease with which mental illness is stigmatised by society. Would someone think it right to offer a ‘cancer patient’ costume? Maybe, but they would very soon be told how offensive they were being. Partypackage Ltd and Wonderlandparty – consider yourselves named and shamed. When, if ever, are you likely to enter civilised society?

Is there an answer to this? In one word, the answer is ‘education.’ Better education, from an early age, about the effects of mental illness, its causes and treatments, and a basic sense of human decency and courtesy in dealing with sufferers, will of course help to improve the situation. But it is facile to say this and expect it somehow to happen by some process of osmosis. This will take a huge amount of time, effort and resources to encourage people out of behaviours which have been developed over centuries. Here in the UK funding – as I showed yesterday – is being diverted away from mental health treatments, so it would be naive in the extreme to expect an enormous amount of money to be found for the education programme which is so badly needed. The fact that a candidate for the US presidency can go public with mockery of people with disabilities – and people defend him – suggests that this isn’t only an issue in my country, either.

Many organisations are involved in providing education around mental health issues. Here in the UK they come together via the Mental Health Foundation. But they rely largely on donations, and are not as far as I’m aware in receipt of Government funding – if I’m wrong in that I’d be happy to put the record straight! Even so, resources are limited: there would still be many who would not be reached by such a message or are too entrenched in their views and prejudices to want to hear it.

Can I do anything about this? Can you? It’s very easy to assume that being little people inside a vast machine means that we can’t help. But we can. Take some time to learn more about this. Visit websites like the Mental Health Foundation or Time To Change and see what others are saying about their experiences. If you’re in the US you can click on the logo at the top of this site to get to the Stand Up site. Then share this knowledge with friends and family. As the saying goes, ‘great oaks from little acorns grow’ and we can all do our bit to increase awareness. After all, one in four of us is affected by a mental health problem at some point in our life, so it may be closer to home than you might think!

Mental Health Matters

At the risk of repeating myself, I started this blog to share my experience of depression in the hope that it would help others. I worked for more than 20 years in the NHS for a large mental health Trust and although I haven’t blogged much about it recently mental health is still a subject about which I care deeply. Last week there was a story in The Times which alarmed me about the way mental health is supported, and which I felt I had to share. This post is about the situation in England but I suspect that the issues are common to many other countries around the world.

A little bit of background: when the Tory-led coalition government came to power in 2010 they embarked on a major restructuring of the NHS. There had been no mention of this in their manifesto, but that’s another story. One of the key changes was the creation of Clinical Commissioning Groups (CCGs) which were intended to put the power in commissioning health services into the hands of health practitioners (largely, General Practitioners, i.e. GPs) as this would, in theory, mean that those who knew best would be commissioning the services needed by their local population. There is an ongoing debate about how effective this has been and a range of other issues too, but I’m not going there. What interests me at present is this:

Copyright Times Newspapers' Click to enlarge

Copyright Times Newspapers. Click to enlarge

Apart from the fact that they are going against Government policy and misusing their funding, I am horrified that so many CCGs fail to see the importance of providing good mental health services. These are supposed to be the experts, those who know best. It beggars belief that they can be so ignorant. The Times commented further on this in their editorial section:

Copyright Times Newspapers. Click to enlarge

Copyright Times Newspapers. Click to enlarge

I’m with them 100%. The figures speak volumes, both in terms of the abuse of power these CCGs are engaged in, and of the pressing need for more investment to be made in mental health services. I started working in mental health in 1993 and even then it was recognised by many to be a Cinderella service, pushed into a corner and under-supported. And children’s mental health services were seen as the poor relations within that! Finally, it seemed, we had a government that was doing more than say nice words about this, but they are being let down by the very people who they thought would be best qualified to enact their wishes.

There have been many studies which have shown how good mental health can be of benefit to physical health, and vice versa. One of the problems in these days of evidence-based treatment is in measuring the effectiveness of mental health care. With a physical illness it is relatively easy to assess, likewise with injuries, such as broken limbs: there is clearly visible evidence available in such cases. But this is not always true of mental illness. To use my own case as an example, the diagnosis I was given nearly five years ago was treated, I returned to work until I retired, and since then I have not felt any recurrence of the original symptoms. So, does that mean I am a successfully treated case? Probably, as I’m no longer costing my local CCG anything for treatment, but who is to say that I am ‘cured’ or whether that is even possible? And does that mean that my local CCG shouldn’t spend the money it has been given to treat people like me on people like me, that it can choose to use it for other treatments? I think not!

People with mental illnesses have for far too long been discriminated against and stigmatised. Whilst this may be recognised by some, far too little can be done, both in terms of treatment and education, as the funding just isn’t available to do all that is needed. I know that the NHS in general is underfunded and that CCGs are under severe pressure to balance their books, as are provider services, but to take money away from the most needy part of the service is totally unacceptable, particularly when that money is supposed to have been ring-fenced for those services. Are the CCGs deciding on their service commissioning on the basis of discrimination and stigmatisation? Who can say, but it could be argued that they are showing signs of doing this. If the supposed experts don’t take mental health seriously, what hope is there that the general population can come to recognise the need to do so?

(Footnote: I am having a week of mental health awareness posts. This is my second, after yesterday’s reblogging of It Asda Be from three years ago. More is to come.)