197 Views
1 Comments

How mental health lost the war on disease

The BBC reported a “crisis in mental health provision” last month, after an NHS trust was told no mental health beds were available anywhere in the UK.

In response, one MP said: “It is simply unimaginable that in the event of a heart attack someone would be left with no A&E bed available anywhere in the country. Why is this accepted for those with a mental rather than physical health crisis?”

One might also ask why, if mental illnesses account for 28% of morbidity, the NHS spends only 13% of its budget on mental health services.

Joshua Hutton, a PhD candidate working in Sussex’s Science Policy Research Unit, argues that this inequality can partly be explained by the way we talk about health issues. He tells me the language we use to frame policy problems is important because it can impinge on the response. He argues that health policy has been led astray by the language of war (think: “fighting” cancer). While war logic appeals to our adversarial side, Josh believes its use in health policy discourse has contributed to the chronic underfunding of mental health research, and also to the disparity of esteem between mental and physical health.

In Josh’s opinion, it is only natural that war logic should have gotten mixed up with health: “War and health have been meshed together forever. Some of the initial advances in health in the 20th century benefited mostly the war effort. Advances in influenza surveillance were made because Spanish flu was affecting the First World War massively—in certain years of WW1, Spanish influenza deaths outnumbered battlefield causalities. Penicillin was a huge innovation initially because it stopped people from dying of battlefield wounds.”

War requires distinctness. Without this, whom are we fighting? Josh tells me that, historically, thoughts on health have met this criterion: “Illness has tended to be framed as something external. You have the practice of leeching, where you have to leech the ailment out of the body, because it’s something that’s gotten in; you have faith healing, where a demon has to be purged from the body. Even with the advent of germ theory, again, it’s an externality.” In every case, the lexis of war can be coherently applied, because there is a clear divide between them and us.

But mental illness is not so easily framed as a foe. Josh says: “With mental health it is very different. You have something which is intrinsic to the working of the mind, which almost becomes part of your identity; you don’t really have something external to fight. Policymakers always talk about combating disease, or combating obesity, or combating diabetes, whereas mental health doesn’t really get talked about that way. The distinction would be hard vs. soft. It’s tangible vs. very intangible.”

Consequently, mental health is deprived of the fanfare that the war drums excite: “In the case of disease outbreaks, they’ll say x or y disease is a threat to national security, and that allows for much more attention and financing of that particular issue. And what you get is more policies being put to that particular issue and you end up with a lot more money being flooded into it.”

It’s easy for humans to think in terms of self and other. The War on Cancer, for example, beginning with Nixon’s signing of the National Cancer Act of 1971, capitalised on the visceral and ancient appeal of banding together to destroy a common enemy; Samaritans’ ads, on the other hand, are broody and macabre, usually starring a haggard, unshaven face—sadly, this just does not rouse us in quite the same way.

All of this helps to explain why a measly 6% of the UK’s health research budget is spent on mental health—in spite of the fact that one in four people experience mental health problems. The framing of health policy as a war has skewed the distribution of resources, and opened a vast chasm between the mental and the physical.

In turn, this dearth of research has “created a lack of understanding in both policy and in some scientific circles, and that lack of understanding has reinforced a lack of political will.”

As Josh tells it, policymakers rely on experts to inform them of the causal chain that leads from good health to bad: “With physical conditions, health experts have a very good grasp. We know the causative agent behind, say, ebola, we know we can make a vaccine against it, we know how to treat the symptomatic elements of the disease that eventually kills people.

“Whereas with mental health issues, many of the causal processes are not well understood. We know some of the molecular predispositions towards bipolar disorder and depression, because we know how the drugs that treat it work. But experts are not able to clearly, and in a way that policymakers would understand, define the way in which mental illness is caused. That means there is no causal process to interrupt.”

He explains this is why policymakers bludgeon the sugar industry in national obesity campaigns, without paying any attention to the socioeconomic and psychological factors that motivate binge eating.

But, I complain, there are many evidence-based treatments for mental health problems. Perhaps a lack of knowledge of the causal processes might explain the lack of national campaigns, but can it really explain simple discrimination—whereby those suffering from mental rather than physical emergencies are denied an NHS bed?

Josh responds: “The overall privileging of physical over mental health issues on a macro-scale informs the micro-decisions that get made. There is a socially constructed disparity between physical and mental illness, in that society puts more of a premium on securing physical health than it does on securing mental health, because of that intrinsic logic that a population as a whole can fight against something external, whereas the population as a whole cannot fight against something that’s internal.”

However, he gladly concedes that “there are a lot more facets to this issue, and there are a lot of people who can give you more specifics on the micro-level, and on the psychological and neurological levels. What I’m talking about is the intrinsic thought processes and the ways in which political structures reinforce a particular way of thinking, which can in some cases lead to particular decisions being made on a micro-level.”

Finally, Josh puts on his accountant’s hat and answers what the proper ratio of mental-to-physical health spending should be: “I think that there has to be equal relative funding, or at least more equal relative funding.”

Equal relative funding means a percentage of funding equal to the percentage of caseloads. Therefore, since mental illnesses accounts for 28% of morbidity, mental health should, according to Josh, get 28% of the NHS’ funding—instead of the 13% it receives today.

But “it’s not just about finance.” Josh says we need to change the way we think about mental health: “mental health needs to be considered as a more integral part of health as a whole, instead of just an add-on.”

Mark Tovey

Image: Official US Navy Imagery

Get the best viral stories straight into your inbox!

Don't worry, we don't spam

One Comment

  1. great reading Mark if only politicians adopted the same priorities life for the people suffering mental illness would be possibly a lot easier G-Dad

    Reply

Leave a Reply

Join the Badger Team

Apply today!

Latest Posts

Union obliterates the debate – unwritten requirement used to shut down free speech debate
Campus News
536 views1
Campus News
536 views1

Union obliterates the debate – unwritten requirement used to shut down free speech debate

Jordan Wright - April 27, 2018

Student society Liberate the Debate’s most recent event was cancelled over a lack of compliance with the Students' Union's (USSU) requirement for a neutral chair - a…

Verve Couture – Musicality, kitsch & ignition: the beginning of a series
Arts
74 views
Arts
74 views

Verve Couture – Musicality, kitsch & ignition: the beginning of a series

Ricardo Reverón Blanco - June 17, 2018

Pictured: Zac Black At Proud Cabaret audiences were spellbound as if at night at the circus, yet this was not like Angela Carter’s magical realist novel; Verve…

Fleabag on stage at The Old Market – review
Arts
109 views
Arts
109 views

Fleabag on stage at The Old Market – review

Florence Dutton - June 11, 2018

[caption id="attachment_35513" align="alignnone" width="2400"] Fleabag at Soho Theatre[/caption] Last Monday at 8pm at Brighton’s The Old Market, I sat myself down in my theatre seat eagerly awaiting…

Fleabag preview
Arts
107 views
Arts
107 views

Fleabag preview

Florence Dutton - June 2, 2018

[caption id="attachment_35513" align="alignnone" width="2400"] Fleabag at Soho Theatre[/caption] Following the mass success of the Bafta award-winning BBC Series, DryWrite and Soho Theatre are about to hit the…

Brighton Festival: Ezra Furman at the Dome
Arts
131 views
Arts
131 views

Brighton Festival: Ezra Furman at the Dome

Georgia Grace - June 1, 2018

Having completed my final semester of university with modules on punk history and queer arts, it was fitting that I rounded off my end-of-assessment celebrations by attending…

Arts
147 views

The Tempest review

Georgia Grace - May 30, 2018

As the sun begins to set over Hove Green, tinnies of Red Stripe are cracked open, tartan blankets are strewn, and families tuck into their picnic hampers.…

A Glass Half Empty review
Arts
158 views
Arts
158 views

A Glass Half Empty review

Georgia Grace - May 27, 2018

For those of us coming to the end of another year of university study, the prospect of careers, marriages and babies may seem a long way off.…

DollyWould at The Old Market review
Arts
149 views
Arts
149 views

DollyWould at The Old Market review

Alex Hutson - May 27, 2018

Sh!t Theatre’s DollyWould is a hilarious, thoughtful and experimental performance piece. The award winning show has the Sh!t Theatre duo integrating comedy, storytelling, personal experience and music.…

UCU Launch Petition to End the ‘Hostile Environment’ at Sussex
Campus News
244 views
Campus News
244 views

UCU Launch Petition to End the ‘Hostile Environment’ at Sussex

Billie-Jean Johnson - May 26, 2018

The Sussex branch of the University and College Union (UCU) has launched a petition calling for Vice-Chancellor Adam Tickell to end the 'hostile environment' at Sussex. The…

Arts
116 views

Shakespeare in the sun – The Tempest preview

Georgia Grace - May 24, 2018

In a world of dystopian King Lears and female Hamlets, Shakespeare’s classics are constantly being reimagined for the modern day. There’s something oddly refreshing then about the…

Review: Nick Cave Double Bill at The Old Market (TOM’s Film Club)
Arts
230 views
Arts
230 views

Review: Nick Cave Double Bill at The Old Market (TOM’s Film Club)

Sophie Coppenhall - May 23, 2018

What a phenomenal contrast these two films present when watched side-by-side. In essence, together they are capable of tracing inner and outer metamorphoses of their subjects. The…

Dollywould at The Old Market preview
Arts
149 views
Arts
149 views

Dollywould at The Old Market preview

Alex Hutson - May 22, 2018

From the 22nd May - 25th May 2018 DollyWould will be showing at The Old Market. An exciting new show, presented by Sh!t Theatre, who won the…

Exhibition: Io-sono Fedilouu
Artist Focus
222 views
Artist Focus
222 views

Exhibition: Io-sono Fedilouu

Ricardo Reverón Blanco - May 16, 2018

Last week artist Fedilou made her debut exhibition in the downstairs space of Morelli Zorelli, a quaint vegan Italian restaurant in Hove, featuring a collection of intimate…

Interview with Philosophy faculty and COGS director Ron Chrisley
Interview
157 views
Interview
157 views

Interview with Philosophy faculty and COGS director Ron Chrisley

Nikolaos Manesis - May 15, 2018

Ron Chrisley is a Reader in Philosophy, on the faculty of the Sackler Centre for Consciousness Science, and is the director of COGS (Centre for Cognitive Science).…

Adam review
Arts
223 views
Arts
223 views

Adam review

Ketan Jha - May 13, 2018

If you have been a stranger to the stage this spring and decide to see one contemporary show, let it be Adam. This reviewer went in entirely…

Brighton Fringe Preview: Nick Cave Double Bill at The Old Market (TOM’s Film Club)
Arts
250 views
Arts
250 views

Brighton Fringe Preview: Nick Cave Double Bill at The Old Market (TOM’s Film Club)

Sophie Coppenhall - May 13, 2018

In celebration of iconic Brighton local, legendary alt-rock musician (and episodic actor) Nick Cave, TOM’s Film Club are hosting a double-bill screening of his films at The…

Whimsical fairy-tale meets class war – Standard: Elite review
Arts
288 views
Arts
288 views

Whimsical fairy-tale meets class war – Standard: Elite review

Georgia Grace - May 11, 2018

Meta-theatricality and interactivity are becoming all the more vogue in contemporary theatre, and in a world where the arts are becoming increasingly open and democratised, I find…

A Year of Art Society: The Best Picks
Artist Focus
200 views
Artist Focus
200 views

A Year of Art Society: The Best Picks

Alex Leissle - May 9, 2018

  [gallery type="slideshow" ids="35385,35386,35387,35388,35389,35390,35391,35392,35393,35394,35395,35396,35397,35398,35399,35400,35401,35402,35403,35404,35405,35406,35407,35408,35409,35410,35411"]

More Brit(ish) than ever: A review of Afua Hirsch at Brighton Festival
Books
214 views
Books
214 views

More Brit(ish) than ever: A review of Afua Hirsch at Brighton Festival

William Singh - May 9, 2018

Afua Hirsch’s 2018 book - part memoir, part polemic - provokes mixed feelings. So too did her discussion of the topic at this year’s Brighton Festival. Don’t…

Ethnic-bioweapons: between conspiracy and reality
Science
267 views
Science
267 views

Ethnic-bioweapons: between conspiracy and reality

Luke Richards - May 8, 2018

Bioweapons exist, while ethnic-bioweapons are whispered conspiracies. Pandemics can fairly hazardous to human life, the 1918 Flu Pandemic killed 20-50 million people. A man made pandemic could…

Breaking: Spring referenda results announced
News
273 views
News
273 views

Breaking: Spring referenda results announced

Jessica Hubbard - May 4, 2018

Students have voted to support the BDS (Boycott, Divestment and Sanctions) movement, reject Prevent and adopt new Gender Equality policies. Results for the Students' Union referenda were…