Paying lip service to the need for change in mental health care?

I’m officially old. Well, that is according to our youngest child. On Thursday we were discussing her lips. She had her lip filler dissolved recently and wasn’t sure if her lips now looked like she wanted them to look. Jane and I had a look and both said they looked lovely and she had a great smile. ‘Yes’ she said ‘but you are an old man and woman’, I think implying we wouldn’t know what ‘good looked like’ when it came to lips or smiles.

There were lots of things last week that might have made me feel a little depressed, but being reminded I was an ‘old man’ wasn’t one of them. In fact, the reverse was true and we had a chuckle about her comment, which proved a source of amusement throughout the evening. That said, anxiety and depression for all kinds of reasons seem to be rising at an alarming rate. The Department of Health and Social Care (DHSC) recently published an interim report of their independent review into mental health conditions. It’s an interesting, if a somewhat long read, have a look here. I found it a fascinating account.

It is clear that there has been a rise in the numbers of people experiencing anxiety and depression and psychological distress over the last two decades. This rise is particularly prevalent in young people and young adults. There has been an epidemiological shift too. Historically, the evidence showed that people experienced these common mental health problems in midlife, more so than when folk were younger. Today the situation is reversed. It is younger people rather than those in their 40s who report higher levels of distress. It’s a trend that predates the Covid 19 pandemic uptick in mental health diagnoses, and can be traced back to starting in the 2010 years.

Interestingly, it is the common mental illness and distress that seems to be on the rise. Rates of people experiencing severe mental illness, such as schizophrenia, bipolar disorder and other serious conditions seemed to have remained stable. The exception appears to be eating disorders where prevalence rates have risen (again with younger people). However, whatever the severity of the mental health problem, the impact upon the individual and the wider society can be challenging and disruptive.

What is important in all cases, is that for the individual, their experience of distress or poor mental health, will be real. All providers of care need to understand that individual experience, even where the person’s presentation doesn’t fit into a clearly defined diagnostic category. This is not a new concept. Professor Sue McAndrew and I have published a number of papers that explore the impact on individuals where a person’s lived experience is ignored.

Last Monday I visited one of our Early Intervention Services. As always, it was an informative and interesting afternoon. Talking to my colleagues, it was absolutely clear that intervening early, and particularly with people under the age of 35, helped ensure that many individuals don’t go on to have a lifetime’s engagement with secondary mental health care. It is an approach that the DHSC report makes clear requires further investment.  Again interestingly, the report also tackles what at times, are perceived to be increases in the prevalence of ADHD. Often both politicians and the public share this perception. The evidence, however, is clear. Epidemiologically, over the last 10 years, ADHD prevalence rates have remained stable. What is different is a substantial change in the recognition of the diagnosis. Probably more importantly, is the link of a diagnosis and access to clinical services and disability benefits such as personal independence payments (PIP). Last week it was reported that every day 1000 new individuals are claiming PIP. That is each and every day. Think about that for a moment.

Such a situation is not sustainable or desirable. There is no date agreed for when the final DHSC report is to be published. I hope I’m not too much older before it is finally published. I also hope that it will contain strong, evidence-based and affordable recommendations as to how we change the current situation.

Later this morning Jane and I will be attending our church Harvest Festival. It is one of my favourite services of the year. I may indeed be an ‘old man’, but I will enjoy singing the familiar hymns first heard when I was a school boy! It is a service that always brings a smile to my lips, although I might just check them before I go.