According to the 2013 Global Burden of Disease study, depression is the predominant mental health problem worldwide; closely followed by anxiety, schizophrenia and bipolar disorder. In the same year, there were 8.2 million reported cases of anxiety in the UK alone; and fast forward to 2017 when there were almost 6,000 recorded suicides in Great Britain alone. If we reflect back to the decade between 2003 and 2013; 18,220 of those who struggled with mental health problems committed suicide, making it the most common cause of death in England and Wales.
With all of this considered, where does mental health and psychological well-being stand in the 21stCentury, and more importantly, why is it still not getting the recognition and attention it deserves?
I was 12 when I was first introduced to the concept of mental health and psychological well-being. What fascinated me was not only how deep and complex the issues were, but also what seemed like everybody else’s lack of understanding and lack of willingness to attempt to. I vaguely recall my teacher called depression “extreme sadness” while anxiety was explained to me as “being too afraid to do things” and anorexia was branded as “not eating”. My parents who had jobs that couldn’t be further from the field of psychology and mental health had probably never coined these terms had no idea. In fact, I don’t recall mental health issues being talked about. To some extent, they were perhaps taboo.
I have to hand it to my early teenage curiosity for wandering into territory that no-one wanted to be in, but I wanted to learn about what everyone else appeared to fear because I believed resolving even the most complex and difficult issues started from understanding. I was 13 when I started searching and learning everything from mood disorders to eating disorders and beyond- I don’t remember but can only imagine my search history; and what I learnt should have terrified me out of being curious…but it did the opposite.
I didn’t know, but this was where it all started- where the roots of my passions grew. At 13, I knew I wanted to know but I didn’t know my interests could be my career. I didn’t realise how much time and energy I was willing to dedicate my career and life to. Because as time passed, this fascinating and frivolously interesting world was my world and the more I learnt, the more I realised mental health was and is, a huge and booming issue; but I didn’t understand why it was so under-rated, misunderstood and stigmatised. I felt the brain was just as important as the body, and that’s when it clicked for me- why has mental health been living in the shadows of physical health for so long, and why is there not more attention given to the illness that is affecting and stealing the lives of this generation?
Mental health describes the level of one’s psychological well-being, and is the absence of mental illness. Individuals with good mental health are resilient against life stressors and emotional fluctuations to enjoy life and be successful. Treatment of mental illnesses has existed since the 17thCentury, but its awareness only started growing in the past decade or so when recorded rates, hospital admissions and drug prescriptions skyrocketed. Treating physical illnesses has always been the norm but mental illnesses have not received the same amount of respect and attention.
Care for the mentally ill was very different, almost unimaginable and inhumane as pre- 1950’s treatment consisted of mental institutions with padded cells and straitjackets, and lobotomies (removing brain sections)- all of which were of course, useless and rudimentary. In 1953 the NHS saw nearly half its beds used for mentally ill patients and nearly 40% of the budget on improper care for them- the cry for help that major change was overdue for Churchill’s government to found the Commission integrating mental health services into the community, followed by manufacturing the first successful antipsychotic Chlorpromazine.
Three years later, mental illness was called to finally be regarded equal to physical illness, achieved only if psychiatric hospitals were operated as similar as possible to normal hospitals. This was succeeded by the 1959 Mental Health Act and conference which revolutionised the perception of mental illness, acknowledging them as normal fluctuations experienced by most to some degree at some point in life.
This breakthrough mentality change in the 60’s was led by pharmacological advances, allowing mental health to be re-invented and re-established, and problems finally being resolved practically. By 1975, the belief that psychiatry was part of the medical family grew, which drove innovations in mental health treatment; however, followed by its nemesis, the antipsychiatry movement, which brought the sins of psychiatry from an era of ignorance and primitive understanding to light. Some argued while debilitating, mental illness was a normal psychological coping mechanism for irrational life experiences, while others labelled it merely a myth.
Although ugly, this forced the community to realise most, if not all, mental difficulties have bio-psychosocial elements to consider and tackle to effectively resolve. Antipsychiatry ignited much of the mental health stigma which remains a battle we are fighting today, as well as the psychiatry versus psychology rivalry, but this eventually emphasised the importance of collaboration between medicine and the mind- psychiatry and psychology in mental health.
Since the sudden discovery of Chlorpromazine, psychopharmacology has been highly demanded as benzodiazepine prescriptions climbed steadily throughout the 1970’s, and SSRI’s increasing threefold from ’95 to ’96 and again between ’06 to ’07. The NHS prescribed a record 74.7 million antidepressants in 2016, a massive 109% increase from 2006; which more than doubled yet again over the last decade. This raises two significant questions: are doctors more lenient with drugs, or has the reduced stigma and increased awareness improved the identification and diagnosis process so psychological problems are tackled more effectively? With better education and newfound open-mindedness, we hope it is the latter.
The Mental Health Foundation believes many mental health problems are preventable and the development of interventions and recovery methods has increased the potential of sustained success. Since mental well-being rapidly garnered public attention, child and adolescent mental health quickly became the elephant in the room; as evidence shows most problems start around this critical time period of development in young people’s lives, but is also their most vulnerable.
The Adolescent Mental Health surveys covering 1999 to 2004 found 10% of 5-16-year-olds had a clinically diagnosable mental health problem, and decade later, nearly 20% of those 16+ in the UK exhibited anxious or depressive symptoms. In the same year, there was just shy of 42,000 recorded self-harm hospitalisations in England for young people 10-24 years, making its prevalence of under 25’s to be 367 per 100,000- an increase from 330 per 100,000 six years prior. Eating disorders in young people are also double that of any other age in the UK, affecting 165 in every 100,000.
The extent of mental difficulties in young people is not well known or understood due to lack of knowledge, awareness and regular up-to-date information, but learning that children seeking help from Child and Adolescent Mental Health Services (CAMHS) has more than doubled since 2017 should be eye-opening enough to propagate change. The complication is that today’s generation of young people succumb to the normal pressures of transitioning through child, teen to adulthood; but are also exposed to increasingly negative media information. It is no surprise social trends set by influencers in the public eye catalyse problems- unrealistic and unattainable standards leading common adolescent mental issues including body dysmorphia, eating disorders, depression and anxiety; not to mention unnecessary surgical procedures to attain these ideals. Thus, mental health problems in young people are multi-dimensional and cyclic, and education and awareness should be the first step to acknowledge and target them.
Mental health is a large and growing problem because it consists of many different issues; one being despite much research data being collected from Western countries so far, it very much concerns the entire world. In 2011, 36 million suffered depression in China, but only 10% accepted treatment. Nevertheless, antidepressant sales peaked at 2.61 billion- a 19.5% increase from the previous year. Bolivia has a National Mental Health Plan promoting awareness and treatment but services are underdeveloped due to limited resources, and statistics found 30% of hospitalisation is from substance abuse and suicide rates are disproportionately high. Furthermore, those suffering mental health problems in Zambia don’t come forward because of cultural stigma- communities still regard it as family misfortune or punishment from God so treatment relies on traditional healers. The scarce research in Africa is perhaps a reflection of the blind eye turned to the problem combined with lack of education, exemplified by a 49% population growth followed by a 52% increase of mental and substance abuse disorders between 2000 and 2015. This urges needs for better education, awareness and further research to target and incorporate interventions holistically.
Another huge issue is the growing gap in rates of mental disorders between men and women. In 1993 young women were twice as likely to display symptoms of common mental health problems- 19.2% compared to 8.4%, which rose to nearly three times as common, 26% compared to 9.1% in 2014. The APMS also found all common problems were more prevalent in women, especially in significance for general anxiety disorder, phobias and panic disorders. Recent research has also attended to a possible relationship between gender, sexuality and mental health as 42% of heterosexuals suffer from depression, compared to 80% of gays/lesbians and 88% of bisexuals, with women consistently surpassing men.
So back to the question- how do we heal the body when the mind is under attack? I took you through my experience of discovering mental health problems, the history of its treatment, breakthroughs and revolutions in terms of young people, and issues under the umbrella term; all while emphasising the roots of the problem- lack of education, awareness and therefore, stigma. My intention is not to name, blame and shame- I have been passionate about mental health since I was 12, and set out to explain why my passion about the issues in my generation allowed me to decide I never want to make a difference in any other career, and I did. I am not going to sweep things under the rug- alike to antipsychiatry, we are ignorant to what we don’t know, but similarly, I am proud to be part of the generation that are facing problems head-on rather than pretending they don’t exist. We are seeing hope and improvement that generations succeeding us can be happier and healthier, and this article reflects just a scratch on the surface of that.
Mental health has been in the shadows for too long. With a sound understanding of what it involves and how to treat, we are seeing improved awareness and less stigma, but we need to work even harder. We need to break down the physical/mental health rivalry as the two need to be somewhat equal to have a long-lasting impact, but because the latter is usually put on the back foot, we only worry about the physical part of the person instead of considering the person as a whole. We need to ensure help is offered to everyone who needs it and that it is internalised, to be beneficial going forward. Most importantly, we need to raise the standards of education so mental health is more widely understood, and from a young age to build resilience.
We started at the bottom and now we’re here. But we still have such a long way to go.