Today is the 20th World Mental Health Day. Orchestrated by the World Federation for Mental Health and supported by the World Health Organisation, the annual event has sought to improve awareness of mental health, and to bring it to parity with physical health as a medical priority worldwide.
Much has been achieved since the event began two decades ago. Investment in mental health care has increased around the world, and there is a growing recognition that mental health demands the same rigorous clinical attention as a broken leg or a dodgy heart.
And yet, as if on cue, two articles published this week have demonstrated quite how much we have yet to achieve.
The first of those articles, published in the Sunday Times (but handily reproduced on Alastair Campbell’s blog, since The Times removed itself from public discourse by installing a paywall), has already been the subject of a so-called ‘Twitterstorm’ – that increasingly common, and increasingly short, social media phenomenon. On Monday, India Knight attracted the ire of mental health charity Mind, following an article in which she derided as narcissistic those who talk about depression. There is, she insists, no longer a taboo surrounding mental health issues. We are free to talk, so why go on about it?
"I can’t say it enough," Knight wrote. "There is no stigma."
Knight was quick to insist that she had been misquoted by Mind, that her irritation solely concerns celebrity depression memoirs. She conducted herself startlingly poorly on Twitter, referring to those who took issue with the article as "deranged." Mind twisted her quotes, but as originally published Knight’s views are those of someone with no understanding of mental health problems. Stripped of its Christmas bestseller-bashing hook, the crux of her column is twofold: that there is no longer any stigma attached to depression, and that depression is not a potentially fatal illness but rather a minor irritation to which we are all subjected.
She is, of course, wrong on both counts – dangerously, startlingly wrong. "Everybody gets depressed," Knight blithely asserts; a sentence as blisteringly inaccurate as one suggesting that everyone gets the occasional spot of MRSA, or suffers from an annoying recurrence of brain tumour. Despite railing on Twitter about her late father’s depression, it is clear that Knight has absolutely no conception of the illness; clear that she lacks the critical faculties to distinguish between a bad day and a mental disorder.
Not everybody gets depressed, just as not everybody gets cancer and not everybody loses a limb. In any given year, around one in four British adults will experience at least one mental disorder. Of those, depression and anxiety are the most common. Depressive episodes can be all consuming. They can render life unfeasible, exploding our capacity to deal with the minutiae of daily existence. They often come hand in hand with psychoses – delusions, hallucinations, an inability to interact with the world at large. Recurrence is common: more than half of those who experience a depressive episode will suffer from at least one more. Depression is chronic for one in five sufferers. It is not the same as feeling a bit mardy.
India Knight’s second claim is more insidious, perhaps less obviously incorrect. In the UK, we have become gradually more willing to accept depression as a clinical problem. We talk more about mental illness. GPs are better equipped to identify the signs. Parliament recently moved to end a ban on those with mental health problems serving as company directors, jury members, or MPs – a positive step that is entirely at odds with the government’s general tack on health and employment law.
But despite these advances, we remain phenomenally bad at dealing with mental health. Certainly we talk about it. Depression hides in plain sight, sitting beneath a thin veneer of conversation. We are adept at platitudes, but the conversation is always about someone else; someone to whom we can offer sanguine, non-committal moral support. We never talk about ourselves, not really. Knight says "there is no taboo." How wrong she is.
The taboo affects everyone. Campbell points to the case of a nurse who has felt obliged to remove from her CV a six month period during which she was suffering from post-natal depression. That she is employed by the NHS demonstrates how deeply the stigma still runs. Similar stories are everywhere around us. Think about your friends. With how many of them have you had a serious conversation about mental health? About a quarter of them is likely to have endured a depressive episode. Would you ever know?
Yes, the taboo affects everyone, but this inability to articulate our disease seems particularly acute in men – and it is compounded by articles like that written by Tony Parsons in this month’s GQ.
It is, of course, a match made in a particularly displeasing corner of literary purgatory: a furiously impotent Boy’s Own for the metropolitan Tory, commissioning a man whose lad-lit-lite journalism is founded on the sort of greasy misogyny favoured by men in shiny leather jackets leering from the corners of suburban pubs, ruddy cheeked in the mid afternoon. And, surprisingly enough, Parsons’ article is illustrative of men’s blindness towards depression, and of continuing, dangerous prejudices regarding suicide.
The piece is a response to a suicide note; not so much a eulogy for a dead friend as a 2000-word suggestion of where it all went wrong. Two thousand words about promiscuity in the Philippines, about arguments in Bali, about drugs and alcohol. Two thousand words and not a single mention of mental illness, not a single mention of depression.
"Most men will not kill themselves, no matter how life humiliates us," Parsons says. "Why not? Because the choices we’ve made in our lifetimes make suicide unthinkable. It is only when you get enough of those choices wrong that suicide becomes an attractive option."
For Parsons, suicide is something that happens when you fuck up. Men who kill themselves do so because they "choose sex instead of love, drink instead of gym, the late night instead of the early morning." Make these choices and you are, Parsons says, in a delightfully dehumanising turn of phrase, "a suicide waiting to happen."
Parsons’ outlook belongs in the last century. It is this suggestion of weakness, this insistence that suicide is primarily a result of poor decisions, that renders so many people unwilling to seek help when they need it.
Suicide is the biggest single killer of young men in the UK. Every year, more men take their own lives than die in road traffic accidents, or of drug overdoses, or as a result of accidents at work. Almost twice as many women as men are treated for mental health problems, and yet men are three times more likely to commit suicide. We do not feel comfortable seeking help – and our reticence is killing us.
CALM was established in 2006 with the aim of reducing the rate of suicide amongst men under the age of 35. Its director, Jane Powell, says that Parsons’ article "illustrates how difficult [suicide] is to comprehend, understand, vocalise, and empathise with for the non-suicidal."
"The idea that suicide is the recourse of those who’ve tired of life simply can’t be true," Powell says. "There are lots of young men out there who’ve barely stepped out the house and barely lived, let alone got bored – who don’t have the confidence to talk to anyone, who aren’t cold-hearted bastards but quite the opposite.
"A large number of callers to our helpline aren’t living it up abroad and flying fancy free. They’re trying to support a family, trying to get exams, trying to ply their trade as a plumber or carpenter or electrician and see their children on a regular basis, and who are so bloody stressed out and under intolerable pressure that they don’t see any other recourse but to leave."
The suicide rate had been gradually declining before 2007. Now though, despite the valuable work of CALM and others, the number of people taking their own lives is back on the rise. The economic collapse looms large. Between 2008 and 2010 there were 1,000 more suicides than expected – and according to recent research published in the British Medical Journal, two fifths of those are associated with job losses. Men accounted for 85 per cent of that 1,000.
"The taboo around suicide pretty much ranks alongside incest as a no-go area," Powell says. "Men don’t feel able to talk about emotional or mental health at all, and this is shockingly clear from the suicide data. Last year there were around ten male suicides in the UK a day. We’ve a very long way to go."
Parliament may have voted to allow mental health sufferers to stand as MPs, but the government is decimating the services on which we rely. Spending on mental health was cut by £150 million this year – the first fall in a decade. Crisis resolution, early intervention, and outreach services saw their budgets slashed by £30 million.
Were it not for the remarkable efficiency of Tower Hamlets mental health services, I might not be writing this article. As the crisis continues, these cuts will kill. They likely already have.
But it is not just money that is needed. We must continue to fight against stigma, must continue to reject the old prejudices and the new blindness of people like Parsons and Knight. Until we learn to talk about depression, until we stop treating suicide as an unspoken weakness or a failing of character, people will continue to suffer and continue to die. It is a tragedy that every day, men and women take their own lives because they do not feel able to seek help – a perception that is only bolstered by people like Parsons and Knight. Now, more than ever, it matters what we say when we talk about mental health.
