The trouble with Mental Health Awareness Week

We've never been more aware of mental illness, and we've never been more mentally ill.

Heads up: this blog deals with mental health and mental health care. It mentions topics some people find upsetting, like self-harm, suicide and eating disorders.

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I would never claim to be an expert in mental health - but I’ve always taken an interest in the area and particularly how it affects children and young adults.

Last week, I met with a Lib Dem MP to discuss this question: what isn’t working? At a time when we’ve never been more aware of our mental health, a time when there’s never been more investment in mental health - there’s also never been higher rates of suicide, self-harm and reported mental illness.

People lay the blame at the state of mental health care in this country: but mental health care is receiving more investment than ever. The NHS spends £12 billion a year on mental health (£500 per household per year!), and yet things seem to be just getting worse.

What is going on here?

An overabundance of awareness is simplifying and diluting mental health narratives

Last week was mental health awareness week, and we’re subjected to a barrage of these awareness days, weeks and months.

It’s been that way for more than a decade, now, and not enough research has asked the question: is all this awareness actually a good thing?

For example, one of the unintended side effects of all this awareness: we now use the language of psychology to refer to a whole spectrum of emotions, from normal emotional responses, right up to serious psychological conditions.

We're using 'anxiety' to describe the feeling before giving a big presentation, a state of higher-than-usual nervousness and alertness, and debilitating anxiety disorders.

It's like if we said "I have a cold" to describe everything from a sniffle after being outside all day, to having the flu, to being on the brink of death with pneumonia.

This overabundance of awareness also creates a very real risk of pathologising the human experience. If we create a culture and narrative where normal and proportionate emotional responses are seen as abnormal or 'disordered' we're creating an expectation that we should be going through life as emotionless blobs - and encouraging young people in particular to avoid situations that might give them moderate anxiety. Avoiding those situations contributes to the development of serious, clinical anxiety.

Advice is unhelpful and untailored

Because we're not differentiating between mental wellbeing, emotional responses and mental illnesses, we're giving out untailored and often unhelpful advice. The advice that is given in pastel-pink Insta stories and viral Twitter threads tends to be geared towards coping strategies for our everyday emotions. This advice is absolutely helpful for many - going for a walk or spending time with friends is great advice for someone who is feeling low after a break-up or anxious about an exam.

It's not so helpful for someone who has intense suicidal ideation, or who is hearing voices. It's this oversimplification of the spectrum of mental wellness that means advice isn't being properly tailored.

What that's led to, at least by my observation, is people growing frustrated with advice that isn't helpful or suitable for them - and that public frustration leading others to believe all advice is useless. It's almost a trope on Twitter now for people to scoff at mental health advice like "drink more water". But actually, for many people that is something they might find helpful and should try. The myriad of people who are receiving it as the wrong advice and vocally criticising it means many people now dismiss it on sight, don't try it, and consequently don't see any improvement. There's a sort of mass-fatigue about this sort of advice that means it's ignored, even when following it might be helpful for many.

There's one repeated call to action that unifies all of these mental health campaigns. "Just speak to someone", "just reach out", "just open up". Speaking out is presented as the biggest step that, once a sufferer does it, the process of healing will begin immediately and as if by magic.

But systematically, there isn't enough help out there for people who do reach out. Helplines have hours-long waiting times, the NHS has months-long waiting lists, private therapy is expensive beyond most people's means. Beyond the systematic, we're also not socially equipped for people to reach out. What would you do if someone told you they were harming themselves, or secretly skipping meals? I think it's safe to say, most of us would probably panic - and maybe suggest something, something therapy. That's not a criticism of those that would react that way, it's a criticism of the message that just reaching out will bring a solution.

A lot of mental health campaigning, then, seems to be overpromising and under-delivering. Promising that just opening up will kickstart a journey to recovery - when in reality most of us don't know how to respond to someone who opens up, and the services aren't equipped to handle it. Promising that following simple steps will improve mental health - when in reality most of these tips are geared towards handling everyday emotions and not more serious mental illnesses.

The expectation of a cure

The biggest problem with the mental health ‘lobby’ is that it’s created a widespread feeling that there is a simple solution to poor mental health, that if only there was more NHS funding, or if only the establishment cared more, or if only mental health was taken seriously - then everyone could receive 'the cure'.

But the harsh reality is that 'the cure' does not exist. All of these campaigns seem to vastly understate the enormous complexity of mental health conditions.

I always remember a piece of research I read on swallowing pain. The question this research posed was 'how accurately can patients describe and articulate their own swallowing pain?'. The answer was ‘almost completely inaccurately’. Patients can't reliably quantify the amount of pain they feel, they struggle to describe how it feels, and they can't pinpoint where it is located. So gastroenterologists, this paper concluded, should carry out their own investigations instead of relying on patient testimony.

If it’s difficult to describe our own physical symptoms, describing our mental and emotional symptoms is a near-impossible task. When it comes to physical symptoms, doctors can cut us open or carry out scans or poke cameras around to find the problem. When it comes to mental and emotional symptoms, they only have our highly unreliable reports to go off.

Emotions and thoughts are transient and leave no trace - it's very hard to describe how you were really feeling in a given moment and almost impossible to verify. A really bad day, when time passes, often seems like it was nothing. Or after a rough day at work, we can easily forget the hundreds of great days and conclude that every moment in the job has been miserable.

Most aspects of mental health - in fact most cognitive functions in general - are poorly understood, if they're understood at all. They're caused by a range of factors: some combination of childhood experiences, brain structure, neurochemicals, ongoing life experiences.

Sometimes, experiences that end up in mental health treatments are reasonable and proportionate responses to the context the person is living in. Someone experiencing homelessness or abuse is very likely to have poor mental health. In that case, though, treating the poor mental health without addressing the underlying cause is stupid.

Similarly, a lot of people experiencing loneliness end up in the mental health support system. The feeling of loneliness is absolutely a distressing mental experience, but it is a reaction to being alone. A much more effective solution here would be to offer social support. How many mental health problems could be addressed if funding and attention was directed to initiatives that address these sort of underlying issues, rather than simply to campaigns that repeatedly tell people to 'speak out'?

So it’s no wonder that things are in such a state. We're using psychological language to describe a whole spectrum of experiences; which is resulting in untailored and unhelpful advice that's causing a sort of mass-fatigue about wellbeing advice. Campaigns are making the claim that just reaching out will bring results. We're understating the complexity of mental health and promising cures that don't exist. And we're ignoring underlying contexts, treating the symptom rather than the cause.

These campaigns mean well - if anything they are victims of their own success. I remember less than a decade ago, nobody really spoke about mental health and there really was a stigma attached to what we now see as common mental illnesses like depression and anxiety. The reality is that there is now substantially less of a stigma attached to these disorders now (though stigmas persist in some specific cultures, and other less common disorders - like personality disorders or psychoses - still face stigmas of their own).

But the result of breaking down stigmas and relentless awareness raising has created an obsession with poorly defined ‘mental health’ - that means that we're all on completely different wavelengths about what mental health actually means, and all have radically different expectations about what 'good' mental health care looks like.

So, where do we go from here?

1. Refocus our energy on mental wellness, as well as mental illness

We’ve raised awareness for mental illnesses but we haven’t done the basic work of teaching people how to be mentally well.

Therapy teaches some great strategies for managing your own mental health - but teaching them in therapy is far too late. It’s like teaching someone to drive when they’re halfway round the M25.

These skills, like mindfulness or cognitive restructuring, should be taught in school.

2. Reallocate resources away from ‘awareness’ and towards scalable, social treatments for mental health complaints

Mental health charities should not be spending their income on further raising awareness of complex and rare mental illnesses. They should instead be implementing scalable interventions that meet the right people at the right time.

That means the public at large should get information about looking after their mental wellbeing. Rather than a list of diagnoses to choose from, they should be supported with preventative measures and guidance to deal with mild emotional distress. People with mental illnesses should receive appropriate support, be that 1-1 or in group sessions (or even, for some, self-guided).

Too many mental health charities are in ‘campaign mode’, calling for more and more therapy: but the entire country can’t get 1:1 therapy, there simply aren’t enough therapists. These charities should instead be at the forefront of devising something better.

3. Focus in on the most deadly and dangerous aspect of mental illness - suicide

Suicide is the ultimate failure of a system meant to protect people. It is, by definition, the point at which nothing else worked. And yet suicide prevention remains one of the least funded, least innovative, and least targeted parts of the mental health system.

Yet, generally, we just bundle it in with the wider narrative around mental health.

There needs to be more targeted focus on suicide prevention. Many of the most effective interventions in this space have not been related to mental health, they’ve been about social design - reducing the number of pills in a pack of painkillers, or making household gases less toxic led to two of the biggest drops in the numbers of suicide. There needs to be lots more innovation, and lots more focus, on this space as its own field.

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We can’t keep awareness-raising and campaigning our way out of the mental health crisis.

If we’re serious about tackling mental illness we need to stop pretending more money or more therapy is the answer. We need to split the problem into parts: emotional wellbeing, mental illness, and suicide. Each needs its own language, its own strategy and its own system.