Without expanding the discussion, mental health awareness will remain the charitable endeavour of the privileged. The organisations who are asking urgent questions about structural and social determinants are few and far between. Mental health is political, so let’s start treating it as such.

By Miranda Dunne

Mental health awareness is what one journalist likened to ‘thoughts and prayers’; we often see these meted out by politicians in the face of tragedy – lots of sympathy and well wishes, but none of the policy implementations required to affect change. In other words, mental health is not politically neutral, despite it often being represented as such. This assumption is perhaps drawn as anyone, regardless of background, can experience mental illness (and at least 1 in 4 of us do). The proliferation of mental illness and poor mental health, particularly since the onset of coronavirus, is undeniable; it’s a deeply complex issue that cannot be rectified by the mental health awareness equivalent of well-intended thoughts and prayers.

Despite this, the saturation of mental health awareness campaigns such as the royals’ Heads Together is actively preventing a meaningful conversation about mental health. Mainstream dialogue focuses too much on individual resilience and not enough on the social conditions that influence an individual’s mental health, and experience with recovery. Important as conversations about speaking up and practising self-care are, it is time that structural determinants of mental health experiences are centred. Not only are waiting times for vital services increasing, as are vacant staff posts for mental health services, but, inequality, too, is a pivotal determinant of poor mental health due to the burden placed on people living in lower socioeconomic conditions. Parity of esteem can only be realised by addressing funding shortfalls and structural influencers, including tackling poverty, economic inequality and discrimination, amongst other social determinants.

Resilience?

Prominent mental health charity Mind defines resilience as the “capacity to adapt in the face of challenging circumstances, whilst maintaining a stable wellbeing.” On a surface level, this does not seem controversial, but one must ask: what are the ‘challenging circumstances’ that people have to adapt to? 

In July 2019, health secretary Matt Hancock held a social media summit in which he emphasised the importance of teaching children to become more resilient. He claimed this is “how we build a safer, healthier world for our children to grow up in.” However, his focus on individual resilience diverges with the NHS’ assertion in the Five Year Forward View for Mental Health (2016).  This report demonstrated that people in marginalised groups are at higher risk of developing mental health difficulties stating:

“Mental health problems disproportionately affect people living in poverty… and who already face discrimination. For too many, especially black, Asian and minority ethnic people, their first experience of mental health care comes when they are detained under the Mental Health Act, often with police involvement… To truly address this, we have to tackle inequalities at local and national level” [sic].

Siobhan (name changed), is an occupational therapist who works in an inpatient mental health hospital. Whilst acknowledging some of the struggles that OTs face, she emphasises the importance of honing individual resilience when helping people with their recovery.

“At times it can feel frustrating working with limited resources in certain aspects. It would be great to be able to do more, but we’re still creative and adaptive with what we have and try to give our best to all our patients.

“We use the recovery star model to support goal setting. It’s a really useful tool to show someone their progress. We use a range of 1:1 and group sessions using people’s meaningful activities to help them to achieve goals and support their recovery.

“We also take into account a whole range of different factors when assessing and working with someone such as many of the unrecovery factors, considering their environment, etc. As an OT, our work is client-centred and looks at what is important to an individual.”

Expanding the discussion

Amongst those asserting that mental health is political is alternative grassroots mental health campaign group ItMatterswho call for policymakers to address structural determinants of mental health. ItMatters is a young persons’ led mental health campaign which uses digital/social media to empower young people to engage with dialogue surrounding the mental health crisis. They attribute the mental health crisis to “A lethal combination of social media, unrealistic pressures in our education system and deeply entrenched structural inequalities”

The group also highlights how mainstream dialogue surrounding mental health is blind to the impacts that anti-black racism and racial inequality have on mental health.

“Mental health discourse doesn’t take our black lives and experiences into account. Our trauma and mental health journeys have been impacted by our skin colour. There are so many stereotypes and attitudes to vilify our emotions and our mental health journeys. It’s so ingrained in society and people need to do more to challenge these harmful stereotypes about us.” 

“We’re told that an honest examination of our lives and mental health experiences is “too political”. What’s political is how the neutral default silences and erases us. Mental health won’t matter until black mental health also matters.”*

The promotion of personal resilience in the face of mental health issues is in no way redundant. It is, surely, unhealthy to think of oneself as lacking the agency to forge for change in one’s life; this certainly is not what I am arguing, and it would be condescending to do so. We should be open to sharing our experiences regardless of our backgrounds (especially men, for whom suicide is the biggest killer). However, personal resilience only comprises 50% of the solution, and when this component is painted as the entire picture it can actively work against the interests of marginalised groups, and the majority who cannot afford private treatment. 

The disproportionate focus on personal resilience is unsustainable. According to the NHS itself, this issue cannot be tackled without equally looking at structural determinants of mental illness and experiences with mental health care (as exemplified by the Mental Health Foundation). Due to an underfunded NHS, many struggling with mental illness that is not “bad enough” are waiting months to get the support they require, which is especially risky for people under the age of 25. Young people, surely, need to have access to adequately funded resources in order to build resilience in the first place.

Without expanding the discussion, mental health awareness will remain the charitable endeavour of the privileged. The organisations who are asking urgent questions about structural and social factors are few and far between, or otherwise not being adequately represented in media dialogue. Either way, it is time this becomes the norm. Mental health is political, so let’s start treating it as such. 

* an organisation that accounts for the impact of race on mental health is an organisation called Mentivity. Find out more on their website or donate to their Crowdfunder here. Shout out/with thanks to Lily of the Sussex BAME soc for this

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