12 October 2016

UK Government Mental Health Policy

My comment on the story in The ConversationMany wealthy countries face a mental health crisis – here’s what governments can do. 4 August 2016.

Your policy approach is entirely focussed on after the horse has bolted. Palliative approaches are always more expensive in the long run than preventative approaches. It is better vaccinate against the disease than to wait for the epidemic and treat everyone in hospital. This is axiomatic in health care, and yet one that is almost never applied to mental health.

You say the most worrying trend is the rise of mental ill-health is in young people. But you want to wait until they are unemployed to help them. You miss the most obvious government intervention which is to introduce resilience training to schools to help young people stay mentally healthy and not succumb to mental illness. A variety of approaches are available, though most of them threaten to undermine the education system churning out obedient workers and insatiable consumers. Which may be why think-tanks and governments are unconsciously reluctant to consider them.

Secondly we need to look at underlying causes for mental illness. The most serious problem we have is social dislocation and alienation. Not only is this implicated in problems like depression, but it is also the main underlying cause of addiction problems also.

Free market capitalism is predicated on ignoring human needs in favour of profit (this was what Marc and Engels complained about 150 years ago and is just as true under the modern version). Families and communities are torn apart because investment does not go where the workers are, but workers are forced to go where the investment is. With no extended family and no community, workers are reliant on nuclear families and these cannot sustain the load - they are increasingly breaking down. Capitalism as we currently practice it is driving the atomisation of society. And the atomisation of society is driving the rise in mental health and addiction problems. At which point a welfare safety-net becomes stretched to breaking point. And at this point we watch in horror as the government begin to dismantle the safety-net, making it considerably less safe, and to demonise and punish people who use it, with the negative emphasis most on those who need the safety-net the most.

So government policy needs to invest in and strengthen local communities. And lately it has massively cut local government spending. Two 30% cuts in funding since 2010 in my county. Though in out county we are fortunate to have high employment we also have a very acute housing shortage, with attendant high housing costs and high homelessness. Local communities need to be able to provide work, housing, and social services. At present many cannot.

More and more people are struggling to afford shelter and food. The government pays out nearly £20 billion a year in subsidising rents through Housing Benefit. Meanwhile there is a chronic lack of housing, and an acute shortage of affordable housing. If basic needs are not met comfortably, then people are stressed. If they are stressed and there is no community support, then they may become mentally ill. This is not rocket science. The government needs to build 250,000 mainly lost-cost houses. But it knows that if it does this the housing bubble will collapse, the middle classes will be left with negative equity, and they will be voted out next election. So they promise to build 25,000 houses at some point in the future, at a cost of £1 billion, and proclaim themselves the party of the workers. The irony is so acute that one would impale a rhino on it.

In order to formulate effective policies any government needs to clarify whose needs they prioritise. Clearly there are many constituents, many communities, many powerful lobby groups, divided loyalties with political parties, and pressures from international trading partners. All we can hope is that the cost of mental illness becomes unsustainable and forces the government to formulate effective policies. As it is the crisis has not yet peaked and government are still betting on pandering to powerful business lobbies and the 1%. I predict it will have to get a lot worse before government take any action in the right direction, and we may continue to see effective cuts to mental health funding as in recent years.

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Note. George Monbiot has written on the same subject: Neoliberalism is creating loneliness. That’s what’s wrenching society apart. The Guardian. 12 Oct 2016.

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