We often talk of a widespread mental health ‘crisis.’ In the last twenty years, common mental health conditions like anxiety and depression have become more ubiquitous here in the UK and elsewhere. Undoubtedly, aided by social media, there is now far more discussion and acknowledgement of mental health and it is beginning to be recognised in parallel with physical health problems. Employers, educators and governments offer far more concessions and understanding. However, less common conditions such as bipolar disorder, borderline personality disorder, dissociative identity disorder and schizophrenia receive much less attention in the press and on social media.
These conditions are stigmatised and misunderstood and the prevalence of sectioning (formal detention in hospital) under the Mental Health Act (MHA) is barely mentioned in mainstream public discourse, despite a growing number of specialists criticising coercive psychiatry.
This investigative piece documents my own mental health struggles and time spent in a psychiatric hospital for psychosis. In particular, I explore the reasons — historical and contemporary — for the rise in mental health diagnoses and hospitalisations. Arguably, the roots lie in not only declining collective wellness but also in the medicalised, pharmaceutical approach to mental illness that makes people heavily dependent on prescribed mental health medication to even semi-function in society.
Calls for a New Approach
There are calls for a new psychiatric framework and a growing global conversation around the issue. The possibility of a new model of treating mental illness is on the horizon but we need more scrutiny and a more open dialogue around mental health that incorporates and removes the lingering stigma around the more severe conditions.
In the UK and the US, psychiatrists and psychologists who criticise the ‘psychopharmacological’ model for treating mental illness and the economic power of the pharmaceutical industry are forming networks and partnerships and writing books. The Critical Psychiatry Network was founded in 1999 to mount a science-based challenge to the dominant model determining the nature and causes of mental disorders and to scrutinise the effects of psychiatric interventions.
‘Not so much side effects but indescribably terrible effects.’
According to a 2016 research paper on adult psychiatric morbidity, the number of people with common mental health problems (primarily anxiety and depression) went up 20 per cent between 1993 and 2014. A 2018 survey by the charity Mind revealed that around forty per cent of GP appointments involve mental health. The proportion of people receiving some form of treatment is rising, from 23 per cent in 2000 to 37 per cent by 2014. Less data exists covering the last ten years, but it seems unlikely that the proportion has decreased given the national discourse around worsening mental health. Undoubtedly, the overstretched state of the NHS has been aggravated by the demand for mental health treatment.
Perspectives on Mental Health
What are the reasons for the UK’s mental health crisis?
I asked patients and staff at the Farndon Psychiatric Hospital in Nottinghamshire what they think.
Two healthcare assistants shared their thoughts. One said, ‘The most recent factor could be the advent of COVID and the isolation caused by that.’ Another mentioned the ‘pressures of life.’ She talked about her personal experience: ‘I’m a mum, a girlfriend, a student at uni and I’m working. I have a lot of external pressures as well as financial.’ In the last twenty years, with the unprecedented expansion of globalised capitalism, rising living costs, the rapidly increasing ubiquity of technology and then the unexpected arrival of a global pandemic in 2020, life has become less manageable. However, as one patient commented, the pandemic has also ‘made people more compassionate and empathetic because we were all in the same boat … or perhaps we realised we were in the same sea.’
The default approach to treating mental health is medication. In 2014, one adult in eight was receiving mental health treatment, with 10 per cent of the population receiving medication and 3 per cent receiving psychological therapy. Interestingly, only 1.3 per cent reported receiving both medication and psychological therapy. From my experience of psychosis, a combined approach has been the most effective. The aim could or perhaps should be to taper off the medication as the individual integrates their experiences and heals via therapy and self-work. Rufus May, a member of the Critical Psychiatry Network, promotes alternative recovery approaches such as exercise, creative activities and engaging with auditory hallucinations for those experiencing psychotic symptoms, drawing on his own experience of schizophrenia.
Despite the growing presence of psychologists promoting alternative therapies, the reality for many individuals with rarer diagnoses is prescribed medication for life. NHS psychological support is not always available in the community, and private therapists are extortionate. May’s holistic approach could pave a new way forward but it is not yet incorporated into the orthodox paradigm. Medication is the default solution, yet it does little to address the root causes of mental illness and there are endless side effects, referred to by one patient as ‘not so much side effects but indescribably terrible effects.’ Antipsychotic medication in particular sedates and worsens executive functioning. Personally, I have found an antipsychotic injection helpful for countering a severely delusional state of mind, but in the past, another stronger antipsychotic in tablet form caused me to go through a severe period of depression and anhedonia (an inability to feel pleasure during generally pleasurable activities).
For those being treated in a hospital, medication is usually compulsory. The debilitating effects of psychological trauma, while written about extensively in books and academic journals, are barely addressed. I have benefited personally from occupational therapy activities and access to gym equipment while in the hospital. I have also been seen by a brilliant in-hospital psychologist which has helped with my recovery journey. However, not all patients have had such positive experiences. One woman I spoke to said: ‘Hospital just becomes this holding space — it may keep me safe in the short-term, but if there’s no access to therapy and no joined-up plan for when I’m discharged, I’m released back after two, three, four weeks or even months, and nothing has changed.’
This experience of being in and out of hospital over the years is common and suggests that the hospitalisation model isn’t working. Furthermore, the diagnoses themselves can be problematic. Patients don’t always feel that their diagnosis reflects their struggles and this can leave them feeling frustrated, alienated or misunderstood. The Diagnostic and Statistical Manual of Mental Disorders (DSM) attempts to categorise mental illness, but the reality is that every individual is different. One patient who is a therapist remarked that ‘post-traumatic stress disorder is not taken into account.’ She also said, ‘I ended up with a psychiatric diagnosis that I’m not happy with and was forced to take medication that I didn’t want to take.’
A Transdisciplinay Approach for an Evolving Society
So what needs to change?
Another healthcare assistant shared his thoughts: ‘There’s lots of information about and research into mental health but with little practical applicability. We try to apply past research to the present situation but society has evolved so much with time.’
Perhaps it’s time for a more transdisciplinary approach to the research that drives the way mental health conditions are treated, with less emphasis on medicine and more on classical psychology, sociology and history. The pioneering early twentieth-century psychologist Carl Jung incorporated the exploration of the unconscious mind and the role of ego into his work, emphasising the importance of the quest for self-actualisation. Sociology examines the relationships between the individual, the community and social structures which could enable a more psychosocial approach to treating mental health that takes into account the individual’s relationship with the world. Meanwhile, history shows us that in the past, mental illness has been severely misconstrued. It was often misinterpreted as witchcraft or demonic possession. People with mental illnesses were feared and inhumane treatments like trephination and exorcism were practised. In the recent past, we have seen the development of psychotherapy and community-based care, but psychiatry is still coercive and shrouded in fear and stigma.
‘Hospital just becomes this holding space’
If we draw on different disciplines, the potential for a more nuanced and individuated framework for treating mental health problems emerges. Moreover, specialists are forming global partnerships. This includes UCL professor Joanna Moncrieff who is particularly critical of the predominantly pharmaceutical approach to mental health treatment. The Inner Compass Initiative, pioneered by American writer and activist Laura Delano, is a global, web-based organisation that offers advice and guidance for anyone looking to make more informed choices about taking and withdrawing from psychiatric medications. It critiques the mental health ‘industry,’ encouraging people to navigate their way through recovery by reclaiming their knowledge, wisdom and power. Clinical psychologist John Read, who emphasises the importance of incorporating childhood experiences into mental health treatment, has worked in mental health services in the UK, the US and New Zealand.
From my experience of being in hospital, there seems to be a large subgroup of people who end up suffering from mental illness because they reject social norms and find they don’t ‘fit’ into society. Some are going through a spiritual crisis, while others are frustrated with the state of the planet or have huge ambitions to change things that they struggle to work towards fulfilling due to their poor mental health. This suggests that mental illness is down to more than brain wiring, as Moncrieff has sought to prove. Society tends to ‘eject’ the people who question it. Imi Lo’s book Emotional Sensitivity and Intensity frames this in terms of more ‘intense’ individuals possessing ‘abilities and traits that differ from that which is neuro-typical. In that sense, they live outside the dominant societal standard of what is “normal”.’ The model of neuro-typicality and neuro-divergency is employed in educational settings to support students who learn in different ways from the majority, but it hasn’t yet intersected much with the discourse around mental health.
The environment of psychiatric hospitals is often not conducive to recovery and can even aggrevate an already poor mental state or lead to negative habits and behaviours. One patient said she took up smoking while in hospital under peer pressure. Some end up being placed in a hospital that is hours away from home because there are no free beds in their local psychiatric unit. Patients have also said that being in hospital has worsened their physical health, made them experience more stress, higher blood pressure, and contributed to a worse diet and poor sleep. Under the MHA, it is also legal to inject pharmaceutical drugs against the patient’s will, something I was subjected to in 2022. The trauma of that experience hasn’t left me.
According to recent NHS data, detentions under the MHA decreased by 5.7 per cent in 2021-22, but there was a steady increase between 2016 and 2021. Moreover, the raw number of people being sectioned is high — over 50,000 new detentions were made between 2021-22. Sectioning exists to keep people safe when an individual is deemed by consultants to be a risk to themselves or others. It is employed in different ways, such as when an individual’s mental state is considered to be too unstable for them to look after themselves, or when a minor crime is committed such as arson or antisocial behaviour. Sometimes, sectioning can be necessary for safeguarding, but it often conflicts with the will of the individual. Fundamentally, detaining people who are unwell (or classed as unwell) without requiring their consent is archaic and reflective of a dark past in which mental illness was misconstrued and seen as a threat to social stability.
The framework of hospitalisation and medication does not adequately treat people suffering from mental illness. A more holistic, individualised and compassionate approach to treating mental health is sorely needed and the potential for this does exist so long as we’re willing to embrace change.
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Shannon Rawlins
Young political commentator from Kent - interested in British politics and youth issues
