Down with “mental health”?

I was lucky, early in my career, to meet Professor Geoffrey Rose.  One of his (typical) quietly provocative remarks was that there are no categories in nature – I remember we touched on dead/alive and pregnant/not pregnant and then gave up trying to think of examples to prove him wrong. So for a long time I’ve been keen on the idea of illness or disability as being on a spectrum or continuum.

In my own field the umbrella term “mental health” has come to represent this idea – not that all mental disorders are the same but that they all share something important that makes them related to each other, belonging in the same category of illness.  Recently I’ve begun to wonder if it’s such a good way of talking.

An article in the Guardian newspaper this month highlighted a damning series of investigations by the Care Quality Commission (CQC) into the care offered by privately run mental health units. As I read to the end my eye was caught by the line of tabs at the bottom, linking to “related stories”, and particularly this first one in the row.

Really? How is the anger and dismay of let-down football fans “related” to the neglect and abuse of vulnerable and severely disabled inpatients in special units?

I have come to see some serious disadvantages to “mental health” as a catch-all.  There are several versions of an unintended but malign effect of the term – which can trivialise or distort the true nature of mental disorder.

• Success or “recovery” stories from one part of society can overplay the likely benefits of intervention in what are essentially intractable problems, as pointed out recently by the parent of a child with autism, who wrote:  ‘These stories don’t show the child who is non-verbal, who screams and growls for hours on end and attacks his or her parents on a daily basis’…”For once I’d love to see a story that celebrated a child managing to say “drink”, rather than screaming for two hours. That’s our idea of success.”

• When “diagnostic” labels are applied (especially following self-diagnosis) the result can be misleading and demeaning to others. Being socially awkward isn’t the same as having autism; lacking emotional equanimity isn’t the same as having bipolar disorder; being greedy isn’t the same as having bulimia.

• Well known people “coming out” about their own mental problems may indeed be helpful.  A healthy society needs to be able to acknowledge and respond to all aspects of the lives of its individual members, and we are all better off for the brave people who have in recent years talked about their sexuality or emotional problems.  There is however a downside to the invited comparison, as there is to all celebrity endorsement – most people with mental disorders aren’t rich or creative or successful: if they are lucky they are ordinary; if unlucky then they are disabled, poor and harassed. 

• In the name of “mental health” millions are being spent on psychological therapy services that won’t see people who are suicidal while self-harm services are in disarray and inpatient services for the most severely ill are dismally under-resourced.

I have concluded that we’d be better to drop the term “mental health” – making the effort instead to be specific about each particular problem in which we are interested.  Maybe it’s evidence of rising levels of distress or anxiety in school students, or self-harm in middle-aged men, or moderate levels of depression in people consulting their GP. With more specific use of vocabulary we can have a more meaningful discussion than we do currently about public health and health services for those struggling with emotional disorders and mental illness.  Changing how we discuss things is easier said than done, but I’m going to give it a try.