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Mental health – Utopia for Realists

I’m in Carluccio’s. I love Carluccio’s. I wanted somewhere quiet to sit and think after a busy morning. Back in January, I met the civil servant who operates as Head of Campaigns for the Cabinet Office, Claire Pimm. We exchanged some ideas about mental health and the future of policy, and particularly in reference to a public information campaign that Public Health England are going to roll out in the autumn. I think it’s an amazing opportunity to shape the debate for the next decade, and I want to get stuck in in terms of helping it to be as progressive as possible. Claire and I arranged to meet, and I’ve been eagerly awaiting my opportunity ever since. It finally came today. I’m now having my lunch and digesting the aftermath of a half hour conversation.

In preparation for the meeting, I read Utopia for Realists by Rutger Bregman. It’s an interesting read on the benefits of Universal Basic Income, measuring productivity by standards other than GDP and like minded provocations. When I spoke to Claire originally I told her my theories about actively managing mental health – and how everyday I keep myself out of hospital I save the NHS £400. I feel that we should move from a deficit model of mental health to one where we value people for the contribution they make to society and celebrate their skills. As I was talking to her, Claire started staring over my shoulder. Oh, I thought. She’s completely bored. She turned her attention back to my face. “Sorry” she said “I was just thinking of the implications for policy.”

Woah. I lit up inside. I’d love to make a difference to the agenda. So, in the interim, I’ve been thinking of the implications for policy myself, and off the back of the blue skies thinking of Bregman’s book, I’ve come up with some fairly radical provocations myself.

What if the skills based agenda around mental health became mainstream? What would it look like, how would it manifest? How could it be propagated? How could we do it in such a way that we boosted people’s confidence, helped them to fulfill their potential, and contributed to society and the economy as we did so?

So, these are the kind of ideas I’d like to test. What if for example the NHS and CCG’s operated on the basis that mental health care was a short term intervention, rather than a long term one, and turned the focus around so that the idea was to skill people up rather than create dependency? What if the focus became on the individual to manage their mental health within their community? Loneliness is a factor in mental health, let’s mitigate against loneliness. But not by creating dependency, but by surrounding them with peers. Let’s put a value on social capital. We only seem to be able to value things by giving them a price tag. Let’s see what value there is in social capital in terms of its contribution to the economy. Let’s see what value people with mental health conditions contribute to the economy in terms of volunteering and skills. Let’s value people for their contribution, not penalise them for their dependency.

Practically, what difference would it make to treatment and care? Every individual treatment would be explicitly focused on developing the skills base of the individual, wherever they were on the spectrum of mental health need at the time of the intervention. So, if you were having a six week course of talking therapy, at a month in there would be a review session to see what skills you had acquired, wanted to develop further, and if there were any gaps before you could manage independently for the moment. Then the sessions would taper down to one every two weeks until they stopped, with a review session at the end and maybe a reading list or links to peers to connect with. Likewise, on the higher dependency end, if you were entering an acute ward, you could be given a notepad and crayons to document your stay. Your entries could be reviewed on a one to one basis, and photos taken of them for your notes if you permitted it. You would be actively encouraged to keep your own diary, and at the end of your stay there would be a review of what skills you had acquired and what you want to learn next. Employers could be encouraged to accept and ask for CV’s in which soft skills managing a mental health condition were highlighted, in much the same way that mothers returning to work highlight the skills they have acquired parenting small children. These are just some ideas, there are lots of potential manifestations of this kind of change in thinking.

We need to turn the whole argument about mental health around. It’s not what you can’t do, it’s what you can. This is a societal shift and it would have to be implemented through a series of behavioural nudges. I’m not expecting change overnight. I think that the lowered life expectations and reduced confidence of a generation of mental health service users will take time to reverse. We can’t afford as a society however, for those attitudes to continue. Nor can the individual service users afford the reduced quality of life and life term earning potential cost of a mental health diagnosis. If we can’t solve it with money, we go towards it with an attitude shift. An apology, an acknowledgement that we haven’t got it right, and a commitment to changing the effects of stigma, self stigma and discrimination, will go a long way.

I’d love to believe in utopia. I have to be a realist. Sitting opposite the table from Claire Pimm and her colleagues this morning, I had to be real about what could be fitted into half an hour. But she has committed to introduce me to the people designing the Public Health England campaign, and the section of the Department of Health and Social Care that looks at mental health policy. So I’m in. Onwards on the skills based agenda.

If you’re reading this, you’re interested in the future of mental health. I want your views. What’s good, what’s not good about these ideas? How can I represent you and your opinions as well as my own? Mental health is something that affects us all. You have your expertise as I have mine. Tell me what you think. I want to know. Let’s get the conversation going.