OK to be mentally ill?

Richard Hallam writes.

Mental health charities are keen to promote themselves as playing a valued role in advancing the interests of the mentally unhealthy. Can we rely on prevalence figures for ‘mental health’, whatever that is, and what could charities be doing to improve the situation? According to the Mental Health Foundation (tinyurl.com/l33v9k8), a survey of respondents (called ‘panel members’) revealed that 65 per cent had experienced a mental health problem, and for the lowest income group the figure was 75 per cent. The MHF seems to be spinning the figures somewhat: in a random sample of the population of England, 44 per cent reported ever having had a mental disorder (diagnosed or undiagnosed); and for only half of this group the problem was current (tinyurl.com/y8tn8f7t).

A recent NatCen (www.natcen.ac.uk) survey, based on a random sample of the British population, is also of some interest. People were asked about their worries or concerns. After money or debt, physical health was the next highest concern in 38 per cent of the lowest income group. A concern about mental health was much lower at 18 per cent. (Concern about physical health was at similar levels in higher income groups but mental health data were not reported.) The same survey also asked whether respondents felt they had the power to improve their situation, and who exercised this power. For the lowest income group, 74 per cent rated ‘myself’ as being able to do a little or a lot to influence both physical and mental health concerns. A partner or family member was their second choice. Only 3 per cent thought their GP had the most power (as first choice) and 8 per cent (as second choice). Given that health was highly rated as a concern, and the fact that the GP is usually the first port of call for access to treatment, one might have expected greater faith in the power of GPs to improve matters. The population certainly expects help from the state because 96–98 per cent of the whole sample considered that it was the government’s responsibility to provide health care.

I infer from these data that any campaign to raise ‘mental health awareness’ will encounter major resistance from a stoical ‘stand on your own two feet’ attitude. It is not an attitude that is likely to be easily dented by raised awareness of ‘mental health’. It is possible that the prevailing public attitude of self-reliance may be adaptive in the face of adversity or a poor response from state services. People are unlikely to believe that ‘it is OK to be mentally ill’ or ‘it’s just another kind of illness’. The charities could perhaps put out a more positive message, such as ‘You can overcome your problems – and here’s how’. However, given that mental health/ill-health is a near vacuous concept, the message would need to be refined to refer to kinds of problem and types of help. It is obvious that not all kinds of so-called mental ill-health are equally responsive to help. An honest appraisal of what works in practice, and how to obtain it, would serve the charities better than a mindless underwriting of the illness myth.

It is unquestionably the case that some people are resistant to the idea of asking for help. One survey showed that only around a third of people would feel comfortable talking to a therapist, and over 40 per cent wouldn’t want anyone to know about it if they did. The resistance of young males is higher still; 80 per cent would not be comfortable talking to a therapist (Anderson & Brownlie, 2011). Perhaps this resistance is partly due to a fear of ‘mental illness’ and ignorance about the variety of options for working on problems. This situation is unlikely to change while ‘mental ill-health’ remains such an ill-defined concept, confounding madness, illness and understandable responses to adversity.

Richard Hallam
Independent practitioner

Anderson, S. & Brownlie, J. (2011). Build it and they will come? Understanding public views of ‘emotion talk’ and the talking therapies. British Journal of Guidance and Counselling, 39, 53–66.

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