I was asked if I would write something on Twitter to mark #timetotalk day, and I found that I couldn’t fit everything I wanted to say into 140 characters, so I’ve written this.
Nobody used to talk about mental health
Nobody talked about mental health when I was a child. I did have an art teacher, let’s call her Miss V, who was frankly a bit weird from the perspective of a child. Lots of other children said "she’s been in Lancaster Moor” – that was our local asylum. I have no idea whether that was true or not. I do know the other teachers, who must have known what was said, did nothing to address it.
Nobody talked about suicide. I was 21 before I learned that my father’s brother, who I did know had died before I was born, had killed himself in Australia, far away from his family.
Nobody talked about alcoholism. There was Frankie Cunningham, the local tramp, everyone knew who he was, everyone knew he drank, but he was basically harmless. When the Queen came to visit Kendal the police allegedly bribed him to take a holiday in Morecambe with a bit of money for booze. Frankie died at the age of 56.
Nobody talked about dementia. My grandmother was 'away with the fairies'.
Nobody talked about depression, or anxiety, or eating disorders, or schizophrenia, or any of the multitude of common and less common mental illnesses.
But lots of things – and people - were ‘mad’ or ‘loony’ or ‘bonkers’ or ‘psycho’ or ‘crazy’. And none of those words, or others of their kind, were ever used in a good way.
Mental health in the NHS
I suppose I had never really thought about it, but it didn’t occur to me, when I joined the NHS back in 1992, that the NHS provided mental health services as well as physical health services. So it was pretty accidental that as a finance trainee I found myself involved in the long stay hospital closure programme, and commissioning the services in the community that replaced them.
‘Care in the community’ – there’s another phrase with bad connotations. For its detractors, it was a Thatcherite conspiracy to strip money out of the NHS and to dump dangerous and unpredictable psychopaths into leafy suburbs. But for me, and the people I worked with, it really was about care. We worked with some deeply institutionalised people. I used to be responsible for the ‘old long stay census’ which tracked those who had been in the long stay hospitals since 1970 – and this was in the mid to late 90s, so I was tracking people who had been in institutions for 20, 30, 40 years, a number of them since childhood. It was heartbreaking at times. Not everyone coped with the change. But many did, and thrived, and continue to live their lives as people, not as patients.
I stayed working with mental health services for the whole of my 21 years in the ‘front line’ of the NHS, both as a commissioner and working in a mental health trust. I did a lot of work with social care services on integrated commissioning and provision, because a person is a person, it’s pretty difficult at times to separate out their health needs and their physical needs.
We must talk about mental health
services are often described as ‘Cinderella services’, usually by people who
are seeking more funding. I agree with the perception, but it’s not so much
about the money for me – not that more wouldn’t be welcome – it’s about the
attention it gets. When 1 in 4 people over the course of their lifetime, and 1
in 6 adults at any given time will be experiencing mental ill-health, how can
we not talk about it?
I know some of the answers to that – it’s nothing like as visible as a broken leg, it can be scary, we don’t properly understand it, the ongoing stigma means that we are hesitant about asking someone if they might be mentally unwell in case they are insulted. But I used to stand on platforms and remind people of the stigma which was attached to cancer not so long ago, and wonder when we’d get to a time when it was okay to talk about mental health, and mental ill-health, in the way it is now to talk about cancer.
A change in perception
I think we might be finally getting there. Over the last 12-18 months I’ve seen a perceptible change in the profile of mental health issues in a really good way. Celebrities have talked about their illnesses and their recovery, and the world hasn’t fallen in. Employers have begun to understand the benefits of supporting people to maintain their mental health in the workplace. Some of the most prominent members of the royal family have spoken out about the importance of mental wellbeing.
I was deeply moved at a recent event when a number of people, tentatively at first, but then more and more powerfully, spoke about their own experiences of mental ill health – about the things which had helped them, and the difficulties they sometimes still experience. And deeply impressed by the way in which those people were listened to – with respect, support and love. I am not sure that would have happened even two or three years ago.
Whatever I do and wherever I go in the future, I will continue to champion the cause of mental health, and the services which support people to maintain their mental health. I owe that to Miss V, to my Uncle Jack, to Frankie, to DoDo and to the millions of other people like them. It’s always #timetotalk.