The psychiatrist Simon Wessely once said his spirits sank every time there was a mental health awareness week. “We don’t need people to be more aware. We can’t deal with the ones who already are aware,” he said.
Yet awareness spreads and propagates, even as queues outside psychiatrist offices trail around the block. This year’s big week, run by the Mental Health Foundation, starts on Monday. Its theme is anxiety, a disorder affecting a quarter of adults, according to the foundation – a statistic that sounds unbelievably large until you read its description of the condition, which seems almost broad enough to take in the full sweep of human experience.
“Lots of things can lead to feelings of anxiety, including exam pressures, relationships, starting a new job (or losing one) or other big life events. We can also get anxious when it comes to things to do with money and not being able to meet our basic needs, like heating our home or buying food.”
Britain is certainly more aware than it used to be. Diagnoses have broadened – more of us see grief and stress as mental illnesses than we did a decade ago. Therapy-speak infuses the language: triggering, boundaries, projection, self-care – stiff-upper-lipped Brits have expanded their vocabularies.
This slow medicalisation of our lives has attracted criticism but surveys show it seems to have had a positive effect: discrimination and negative reactions to mental illness are increasingly taboo. People feel able to seek the help they need without risking their jobs, relationships or social lives. Britain’s Time to Change campaign that ran for 14 years to 2021 was shown to have caused a “significant” drop in stigma.
But behind this good news story is something more important. Mental health awareness has its limits. While attitudes towards milder and more common mental health conditions such as anxiety, low mood, stress or burnout have improved, more serious disorders such as schizophrenia and psychosis trail far behind. In fact, when it comes to schizophrenia, we seem to be getting less enlightened. A study of 10,000 people spanning the three decades to 2020 found that by nearly all measures, stigma towards the disorder had worsened. People were less likely to want someone with schizophrenia as a housemate or co-worker than in 1990. They felt more fear and less desire to help.
Other research backs this up. Some 88% of people with severe mental illness say they experience stigma. Few people would recommend someone living with schizophrenia for a job, and even mental health professionals hold negative attitudes towards them. A study last month, meanwhile, found that one in three people living with sufferers of severe mental illness were themselves discriminated against.
Why this hierarchy? These two-track attitudes are everywhere. While nearly all employers acknowledge they have a responsibility towards their staff’s wellbeing, and promote mental health awareness, some 15% of employees still face dismissal or demotion after they reveal their mental health problem. There are also troubling reports that some mental illnesses are being weaponised. The army makes much of its “resilience” training and mental health resources. Yet a report in January alleged that female members of the armed forces who accused their colleagues of rape were being “misdiagnosed” with personality disorders in order to discredit their accounts.
Media coverage does not help the cause of those with psychosis or other severe mental health issues: where they pop up in the news it is to most frequently be associated with (rare) violent incidents. And though psychology and psychiatry have for the last decade gripped the film industry – the traumatic backstory is a staple – psychosis still gets a bad press: it is the stuff of horror films and murder stories. In the United States, meanwhile, a narrative linking mental illness to gun violence is being pushed by some politicians. Following a mass shooting in a mall in Texas this month, Greg Abbott, the Republican governor, deflected pressure for gun control by calling for more mental health resources, defining these problems as the “root cause”.
These narratives are skewed: the connection between violence and mental illness is weak at best. A recent scientific review into the link concluded that, even if psychotic and mood disorders were eliminated, “96% of violent acts would still occur”. But the stigma persists.
Severe mental health disorders are therefore more in need of destigmatisation campaigns but get fewer of them. The theme of last year’s mental health awareness week was loneliness. Previous years have covered nature and mental health, kindness and body image. ITV’s Britain Get Talking campaign last year, Public Health England’s Every Mind Matters, and the NHS Help! campaign all focused on milder conditions, such as low mood and sleep problems, urging people to talk to those around them.
These awareness campaigns seem to work by stretching the concept of mental illness into the realm of common experience – linking anxious feelings to anxiety, or relating depression to the stresses of everyday life. Researchers speculate the recorded improvement in attitudes is due to the less severe images that come to mind when answering survey questions: if everyone has experienced depression, the stigma goes.
But there’s a problem here. It might be that campaigners have not “normalised” mental illness so much as broadened the definition to the point that it includes the mentally well.
If the method of lessening stigma is to consider mental health disorders relatable and “sane”, reactions to a stressful environment, illnesses out of the realm of common experience, such as schizophrenia, are left out. And with so many new anxiety and burnout sufferers, there’s a risk that the severely ill are crowded out of the conversation altogether.
• Martha Gill is an Observer columnist
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