On not being Freud and Nick Clegg’s impending psychosis

Unusual for a party leader to put mental health at the heart of their party’s manifesto promises, let alone at the centre of their conference speech but Nick Clegg has highlighted what I believe is one of the most important political promises of the year. He has pledged to put mental health care on the same level as physical health care and to improve waiting times for urgent mental health issues. Perhaps he’ll be one of the first beneficiaries, as the coalition breaks apart and he wakes up sweating realising he no longer has to agree with David Cameron about things. At that flicker of psychosis when he starts seeing imaginary old Etonians in bow ties popping out behind his wardrobe, he’ll be seen within two weeks. It is mind boggling, when you think about it, that this doesn’t already happen. It’s a hangover of the way that society privileges the body over the brain. The statistics speak for themselves. One in four British people will experience a mental health problem in any one year. Forty per cent of people will not tell their employers if they’re experiencing one. Suicide is the biggest killer of men aged under thirty five. Personally, I’ve experienced the NHS as being good on the few minor physical problems I’ve ever had- from dermatitis on my finger, to bronchitis to a cut foot. Efficient, quick and conscientious. However, when I presented with bulimia in my early twenties, a Doctor asked some very random questions, didn’t refer me anywhere or suggest any treatment and sent me on my way. Apparently only one in ten people receive treatment for eating disorders-though they have the highest mortality rate of any mental illness. About half the people with them also meet the criteria for depression. At the time, the Doctor’s dismissal of my problem contributed to my sense that it wasn’t very important. Now, I’m much more aware of the sort of things that countries value. Perhaps I might be able to frame it as a bad economic decision on his part. “Okay Doctor-a me more prone to mental health suffering is also a less economically productive one who is less likely to pay tax and therefore contribute to future funding of YOUR job”. Funnily enough, that’s not the sort of argument that leaps to mind when you’re in the grip of illnesses which affect your self esteem. On the other hand, someone I’m close to, has finally sought treatment for depression after living undiagnosed with it for over thirty years. Their Doctor put them straight on anti-depressants but, crucially, also arranged for some counselling with a free service on Teesside which was appropriate for their needs. There was only a two or three week wait, no limit on the number of sessions they could have and, although there is no quick-fix, they say they have fewer anxious and suicidal thoughts than they have for many years. Many studies suggest the combination of medication and talking therapy is the most effective way to treat depression- but this is still not always a standard offering from the NHS.
As with most healthcare though, prevention is so much more efficient for society than cure. I can see a connection between this and a disturbing story in the news this week. A woman accused of sending thousands of messages filled with hate towards the McCann couple was found dead in her hotel room. Journalists and commentators had suggested there should be more charges for “vile Twitter trolls”. Indeed. But surely it doesn’t take Sigmund Freud to see that a woman obsessively sending messages expressing outrage at what she saw as the lack of protection given to a child was having some deep emotional issues of her own triggered and could do with some treatment or monitoring? Better mental health awareness will go far beyond Doctors being less crap when confronted with normal human despair and confusion, and involve public services and private individuals realising that human fragility which goes unheard and unrecognised tends to become worse and eventually cause harm to others. It’s in all our interests to prioritise tackling it.