Has mental health culture gone too far? Thea Joshi welcomes Andy Bell to unpack recent comments from government ministers and proposed plans to reduce access to benefits for people taking time off work for their mental health. They discuss what’s driving this backlash, and explore where we’re actually at on our journey from mental health awareness to mental health literacy.
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Listen to the episode on Spotify or Apple Podcasts. The full transcript is available below.
Show notes
- Check out our blog that spotlights how much work still needs to be done to improve mental health for all
- Read our response to claims of a ‘sick note culture‘
- Download our plan to build A mentally healthier nation
Transcript
Alethea Joshi (AJ): Hello and welcome to Centre for Mental Health’s podcast. Centre for Mental Health challenges policies, systems and society so that everyone can have better mental health. I’m Thea Joshi, and each episode I speak with our guests about mental health and social justice. And today I sat down with Andy Bell, the Centre’s chief executive to discuss the recent rhetoric which has been making headlines around mental health culture and whether it’s gone too far. We heard from government ministers in recent weeks about this idea or concerns that we’re over medicalising the normal worries of life. And we touched on the journey that mental health awareness has been on in the last couple of decades. And what’s maybe behind this backlash. Andy and I chatted about the distinction between mental health awareness and literacy, and why narratives which minimise people’s mental health struggles can be so harmful. Hope you enjoy this episode.
So I was thinking about this the other day, and I remember when the Time to Change campaign first started, I was first aware of it in 2007/2006, that kind of time. And I remember seeing figures like Alastair Campbell and Ruby Wax and like, you know, people off the telly, sort of admitting to the fact that they had struggled with their mental health. And for me, as a young person, having just been diagnosed with a mental health problem that was actually really quite groundbreaking to be like, Oh, this is a thing that people are now going to start talking about and kind of bring out the shadows. And obviously, you know, it goes without saying that this idea of mental health awareness, and the notion of mental health, in our collective understanding has been on a big journey since then. How have you, Andy, seen that unfold in your time in mental health and at the Centre?
Andy Bell (AB): That’s really interesting. And I think it is worth reminding ourselves just how groundbreaking it was. We almost take it now for granted don’t we, that people in the public eye will talk about their mental health or talk about experiences of mental ill health in a fairly natural way. And they’ll do it on talk shows, or they’ll make television documentaries, or, you know, post it on YouTube. That wasn’t normal. That was very abnormal. I think Stephen Fry perhaps was first to talk about his experiences of bipolar disorder. And that was genuinely revelatory for a lot of people. And it was genuinely liberating, as you say, for a lot of people. And it has now become the norm. And in a sense, that’s a quite seismic, social change. And I think it’s seismic because it’s reflected in what happens in everyday environments that we’re all in, you know, it happens in schools, it happens in WhatsApp groups, it happens in cafes, family homes, there is just that greater openness, and particularly among younger age groups. And that is a quite extraordinary social change. It’s very easy now to take for granted as something that happened. But it happened because a lot of people put a lot of hard work in and some people were extremely courageous in being prepared to name it and share it.
AJ: Yeah. And it not being the end of a career, or the end of relationships. And that’s not to dismiss the really hard things that can come from disclosing things. It’s not like we’re now in this brave new world where it’s all fine. But as you say, I think it’s easy to just forget quite how far the conversation has moved on. And to get to a point now where we’ve got government ministers saying that mental health has gone too far feels almost laughable when we look at how relatively recently we were having very different conversations. You’ve written and we’ve spoken about how we feel about those comments. And we’re obviously clear that mental health and the conversation has not gone too far. So I won’t ask you if it has, because that’d be a very short podcast. But I guess I’m kind of interested to ask you, where do you feel that this backlash, and it’s not just Mel Stride’s comments, you know, there’s been narratives and rhetoric and lots of things in various newspapers and lots of media. Where do you feel that this backlash is coming from and what’s it being driven by?
AB: This is something we’re learning as we’re going along, in a way, isn’t it? And I’m thinking it’s not that long ago that Naomi Osaka, the tennis player, talked about her experiences of mental health difficulty and didn’t get a positive response from a lot of people. And there is clearly an element of racism and misogyny in some of the responses to that but there was a really negative response from a lot of angles. There were lots of positive and kind responses as well. But we haven’t gone that far, have we? You know, we scratch the surface a bit of our greater awareness and understanding and compassion and we find that there are some pretty challenging attitudes and narratives around our openness about mental health. So we are still on that journey. And I think there is an inevitable almost tendency for when we make social progress, if you like, you know, social change is very threatening for some people. It’s not always popular. Not all social changes are good. And so there are inevitably reactions to it. And I think we’re beginning to see that. Some of it is, of course, wrapped up in other debates. So the comments about so-called mental health culture from the Work and Pensions Secretary, were very much wrapped up in quite legitimate concerns about young people particularly increasingly being out of work and having poor mental health as as a reason for that. But of course, some of the narrative there was very belittling and stigmatising. And it is that association between mental ill health and poverty, that actually you can go right the way back to the beginnings of the Poor Law and you can see there is a connection there and some very harmful attitudes that lead to very dangerous policies.
AJ: Yeah, very much almost a sense of right, pull your socks up, come on, get a job, crack on, you can’t keep hiding behind this excuse. As you say, it wasn’t a helpful or constructive kind of comment. There was a lack of compassion. And I think we’re seeing that in a lot of the conversations that are coming out now. But, having said all that, and completely agreeing with that, do you think there are problems or perhaps sort of unintended consequences about the way that mental health is currently discussed at the moment? Obviously there’s lots of angles to that.
AB: Yeah and this is really important, isn’t it? Because we have to acknowledge that some of the anxieties, no pun intended, that are being expressed about growing mental health awareness have quite legitimate reasons. Whenever you kind of increase awareness and knowledge about a topic, it can sometimes create misinformation or poor understanding. Many people living with serious mental illness, for example, will say that they feel that a lot of public awareness campaigns have focused on more common mental health difficulties, and perhaps have kind of ignored the severity of difficulty that they’re living with. And so I think we have to acknowledge that’s undoubtedly true. A lot of the campaigns that have sought to reduce stigma have not really engaged with the experiences of people with severe mental illness as much. And that hasn’t always been helpful. So there is some learning to be done there. I think there are also real worries that if we are more aware about our mental health, and people are more able to seek help, which is incredibly important, and a huge, huge step forward if people are more willing to seek help for their mental health. But of course, if you don’t find the support is there, you might seek help and find nothing, and that can be really, really damaging. So our awareness is going at a rate which is probably a bit faster than our ability to offer people the right sort of help. And of course, that doesn’t always mean mental health services, that can mean resources available online, it can mean the ability of schools and workplaces to respond to mental health in those settings. You know, not everything has to be medicalised, not everything has to have a diagnostic label. Not everyone needs to formal treatment. And of course, the earlier you offer help to someone, the less treatment you need, you can have relatively simple interventions that can help people a lot earlier on. So it is a complex picture, there isn’t anything straightforward about this. It is a profound social change, and all profound social changes come with quite significant challenges.
AJ: And without getting hung up on the language, there is something about the language that we use and how easily even we conflate mental health and mental ill health or say one when we mean the other. And it kind of brings me back to the spectrum that we produced or shared with the world many years ago now of that sense of from struggling to coping and the fact that we are all somewhere in between that and that’s something that you said a lot as well. You know, we know this stuff, but it so easily goes the wrong way when we have these polarising conversations, that we all have mental health, and that we’re all somewhere on that spectrum. And sometimes we will be essentially ill and other times we will be well and it feels like we don’t quite have the language yet to put to what we’re trying to talk about, these really complex things we don’t quite have the words for almost.
AB: Yeah, and I think language is always evolving as well, isn’t it? So if we think we know we probably don’t because it changes and generations kind of change the language and meaning. So there’s never a point at which we’ve kind of got this exactly right. But I think what you say is really profoundly important. It’s such a cliche to say we all have mental health. But guess what? We all have mental health every day of our lives. We’re all somewhere on that spectrum. And around about a quarter of us will be at the red end of that spectrum, experiencing mental illness, or mental ill health of some description. In other words, our mental health is bad enough, it’s having a significant and sometimes really, really bad effect on our quality of life. So it’s important to acknowledge that but of course, there are also groups of people who are really struggling with their mental health, but not necessarily experiencing mental ill health at that time. But again, that shouldn’t be dismissed. Because if you are in that situation, then you can go one of two ways can’t you? And struggling with your mental health is still pretty hard. And if you offer people support, who are struggling with their mental health, they may never need formal services, because they may never experience mental ill health. So it is important to be clear about terms. In some ways we struggle because mental health is sort of the opposite to physical health. And we don’t talk about our physical health, we talk about particular things that you might have, you know, we use diagnostic labels because you can do a blood test for pretty much most physical health problems. Or you can physically feel it because you’re in pain, and an MRI will pick it up. You can’t do the same with your mental health. The diagnostic labels we use are more ways of describing people’s thoughts and feelings and experiences.
AJ: Yeah, and obviously, we’re aware that there’s a lot of conversations about how helpful these diagnostic criteria are. And that kind of over medicalising can be a problem. And it’s just a whole mess of stuff that sometimes I feel like, physical health doesn’t have to deal with this a lot more straightforward in some ways. Or maybe, you know, we’re just at that point in the journey of mental health. We were saying earlier, I think with any sort of thing that’s been in the shadows, and been sort of stigmatised and not talked about, there’s a lot of stigma, but there’s also a lot of misinformation. And as the stigma lifts, the information and the awareness has to increase. As you say, it’s not just awareness on a very general level, it’s literacy. And knowing what these things mean, and how we talk about it in a way that’s meaningful, and accurate.
AB: And that’s one of the next big challenges isn’t it? To move from awareness to literacy. And what I think we mean by that is not necessarily having yet more national campaigns, though they have their place. But it’s probably what happens at the micro level. I’m thinking about the work that Children in Need did a few years ago, the Million & Me programme, which was largely about creating mental health literacy in the places children are, whether that’s at home, whether that’s at school, whether that’s in youth groups, and it’s all about using communities that exist and relationships that children have with trusted adults, to help build mental health literacy there. And I think that’s where there’s some really exciting work still to be done. And of course, as with any literacy campaign, it has to be done in a way which is equitable and engaging. Because otherwise you end up increasing inequalities, if you do work that isn’t really attuned to to the needs of all different sections of society.
AJ: Yeah, that’s really helpful. And I’m kind of interested about what else is needed do you think? What would take us to the next level of greater literacy in mental health and really understanding what we’re talking about?
AB: Yeah, I mean, we’ll find out when we get there won’t we? I think part of it is it relates to that wider work we’re doing looking at the things that determine our mental health and wellbeing and noticing that this isn’t about our innate characteristics. It’s not about you know, are you a resilient person or are you not. And the word resilience is, in some ways, incredibly helpful, as a term for understanding the things that can help you to have good mental health during your life and deal with life’s ups and downs, but it’s so often used as a way of judging people.
AJ: You just need to be more resilient.
AB: That’s right. And it comes down to this kind of notion of personal choice. And I think, the more we learn about mental health, the more we realise that it is socially and economically determined. So if we do something about the conditions in which people live, we do something about poor housing, poverty, racism and racial discrimination, violence against women and girls, you know, these are the factors which are causing enormous amounts of harm, both in and of themselves, but also the knock on effects on people’s mental health and the knock on effects of that on people’s physical health, as well. So I think we’ve got a long way to go in understanding that. And again, mental health literacy also means knowing what to do about something, it doesn’t mean just knowing about it. And so I think investing in communities and investing in our ability to support one another, and create workplaces that look after mental health to create schools that look after mental health, help families to be able to support one another with their mental health a bit more. So yeah, there’s a lot more that kind of collective responsibility for our mental health, if you like. And we do, of course, need government to show some leadership also. And that, of course, is why we think it’s so important, there is a kind of national mental health plan that goes across government. And of course, it brings in civil society and business and everyone else. But we really do need that kind of overall leadership.
AJ: Definitely. And, obviously, you’re referring that to our a mentally healthier nation campaign. And I will link again to that in the show notes. It’s something we’ve talked about before, but calling for all parliamentary candidates to commit to building a mentally healthier nation through a load of really tangible, clear policies. So I will link more to that. But I was interested in about what you said about part of the mental health literacy piece is just knowing where to go for help I think sometimes, and knowing that the help is there, critically, because I think that’s where a lot of the resistance about mental health awareness and campaigns has been that people are just told: seek help if you need it, talk about your mental health in this quite generic way. And whilst that is important to a degree, and it’s a fundamental basic principle, people need to know actually, if they’re struggling in this way that this is the kind of support they will be able to access.
AB: Yeah, I mean, I think it’s a really interesting one, isn’t it? When we look back on some of the campaign slogans we’ve used, or that have been used, some of them sometimes now feel a bit jarring. So you know, I think it’s great that we say it’s okay not to be okay, because we don’t want people to feel blamed. But it’s also not okay for people to be left not feeling okay without the right support. When we say, you know, just talk, you know, talking is great, well, yes, it is. But you need kind listeners, and you need to know what to do with what you’re sharing so that you do get access to the right support. So I think, to some degree, we have to learn from what’s gone before. And we have to really think about, you know, in future campaigns and in future work to build literacy and have more mentally healthier approaches to public service, government, business, schools, workplaces, that we really draw on what’s actually going to be helpful for people.
AJ: Yeah, and that doesn’t mean that those steps weren’t super important. It’s just that we can’t stay there because, it’s cringy but this is a journey. And so we just need to keep going. And this is where we’re at now. Just interrupting our conversation briefly with a quick plea. Centre for Mental Health is an independent charity. So if you appreciate this podcast, you can support our work either by following and rating this podcast, or by donating at www.centreformentalhealth.org.uk/donate. We really appreciate it. Right back to the show. Taking us back to the initial comments that we began speaking about, these narratives that suggest if anything we’re too open about our mental health now and that people are trying to medicalise the normal ups and downs of life. We’re clear that we disagree with that. But what would you say in response?
AB: Yeah, I mean, I think part of our openness about mental health is actually trying to move away from medicalising it, from that notion that you’re either mentally well or mentally not well. And it’s only a few people who are others who are mentally not well. And in a sense, the whole point of talking about the spectrum of mental health and that we all have mental health is that notion that actually mental health isn’t just about medical intervention is not just about diagnostic labels, it’s good to do things to look after your mental health. You know, if people are saying, well, I’m doing such and such because it’s good for my mental health. Well, if it actually is, then that’s a good thing to do, and you should be doing it and feel proud of it.
And that’s not medicalising normal life. I think when there are discussions had in the newspapers or wherever about growing numbers of people who are on out of work benefits, and particularly disability benefits due to their mental health, it’s really unhelpful and frankly untrue to paint a picture where somebody is just wanting to have some time off for their mental health and getting signed off by their GP very readily. If you’re on those benefits you’ve been through a really tough test, a test which actually is often extremely harsh, and it’s just been made harsher in fact. So the bar is incredibly high to be recognised as being off work due to a mental health problem and qualifying for higher rates of Universal Credit. So it’s simply a nonsense to say that this is people doing it too easily and too readily.
I think we just have to look at the figures around numbers of people in surveys saying they’re experiencing mental health difficulties. And that’s not just because someone’s saying, Yes, I’m experiencing mental health difficulties, they’re answering survey questions that test out whether that is indeed the case. If you look at referrals to NHS mental health services, they’re all going up and they’ve been going up rapidly, particularly among younger age groups. Now, there may be a small part of that, which is people being more readily answering truthfully to surveys, that people may be seeking help a bit more than they were in the past. That people when they aren’t able to work, you know, in the past might have said they were off with a physical health problem when really they had a mental health problem. So we might be being a bit more truthful.
AJ: Which isn’t a bad thing.
AB: Which is not a bad thing! But it therefore means that it slightly skews the figures. But the figures are so dramatic, and particularly since 2020, it’s been so dramatic, that that can’t just be a shift in public attitudes. There has to be something there which is quite significant. And we have to work with that and find a way of helping people so so that we have the right kind of approaches and policies to help more people back to better mental health.
AJ: And then leading on from that, I guess, it’s worth just asking, you know, what do you see as the implications of this kind of rhetoric around mental health culture and, you know, ups and downs and all of this kind of stuff we’ve been talking about.
AB: I think it comes real risks. And partly that risk is that people don’t get believed as much. You know, if people are brave enough to share with their work colleagues, or their family, or their friends at school, or their class teacher that they’re struggling with their mental health, you want to know you’re gonna get a compassionate and believing response. If people are going to turn around and not believe you or you worry people aren’t going to believe you, you’re not going to share because you’re making yourself vulnerable to share that. If you go to see your GP, you want to know they’re going to understand and they’re going to be helpful, and there might be something they can do. So it’s really important that we actually create a positive culture around this, so that we don’t go back to the days of people being afraid to share, afraid to open up and ask for help. We’ve come so far, and if we try and put this back in the box, it will cause a lot of people a lot of harm. So while it may be challenging to have this greater openness, actually, if we work with it, and find ways of making sure that we’re using the right words, that we are helping people to understand better what they’re going through, or what their work colleagues or family members are going through. And we’re able to actually build on where we’ve come from, and keep learning. But we do need to create that safety around us.
AJ: Yeah, that’s a really helpful point and I think kind of bringing us back to where we started and almost going full circle. As we look back at what’s happened over the last sort of 10/15 years and the journey, for want of a better word, that we have been on, it’s worth thinking what would get us to a better place 10 years from now where, as someone with lived experience, you’re not having to defend your own experience, or prove it or justify it, but you’re able to say, actually, this is me, and it’s not all of me. And it doesn’t mean I am this label, whether that’s diagnostic, or whether that’s kind of a social label, but equally, I don’t have to hide that. What would take us to that next step?
AB: Yeah, I think that’s really interesting. And I think in a sense, you’ve almost kind of said some of it because it is about creating a culture where it’s okay to do that. So it’s okay to talk about not being okay. It’s okay to say that you’re having a bad day with your mental health today. And that the labels we use to describe mental illness are not as associated with negative things as they are still today, particularly some diagnostic labels, they still seem to do quite a lot of harm to people. So we’ve got some continued culture change to do.
I also think there’s something really important about the provision of mental health support. One of the things that can really help to reduce stigma and it has in areas of physical health is knowing that there is support that’s available, that things are treatable that people can get well or be more well, or recover. And indeed live with chronic conditions and live kind of reasonable lives. So I think there is something about keeping improving and investing in mental health services, we can’t forget that. And we really do need to focus on what we can do to prevent and create better, mentally healthier communities to live in. We’ve seen a massive reduction in public health spending across the UK. And we really do need to see some investment in prevention and things that are happening at community level, very, very local level, to boost mental health and wellbeing.
And I think the other thing is, we need to keep learning from people with lived experience, from community groups, from user led groups, many of whom are beginning to and for a long time, in fact, have been challenging social norms and challenging the discrimination that they experience in their daily lives. And a lot of the most important and exciting movements have come from lived experience. They haven’t come from established organisations. And so there’s something about how we keep listening to what people are saying, and be led by that not be led by stereotypes or assumptions about what’s good for people.
AJ: 100%. Well, I think that is a perfect note to there, Andy. So thank you so much for helping us think about these things in in a helpful, constructive, nuanced way. These are messy things to grapple with, I know. But it’s really important we keep having this conversation, because yeah, we won’t be shut back in a box, as you say. But it’s helpful to kind of feel equipped to have the conversations. So thank you.
AB: Thank you.
AJ: Thanks for listening. I hope you enjoyed this episode. And we’ve got more content on this topic, as well as many others over on our website where you can also donate to our work. See you next time.
