News     25/03/2022

Jo’s Blog: The New Cinderella

Over the years many activists including me described mental health as a “Cinderella” service compared with the support provided for physical health problems. But this description has not been used much in recent years, maybe because the UK and Welsh governments have recognised the problem and genuine progress has been made to redress the balance.

I’d say that there was still a way to go on that but I will acknowledge that at least the argument has been won even if the reality is still catching up.

But there is a new Cinderella who is being left at home to scrub the floor: I mean services for the most vulnerable patients with serious mental illness.

One of the reasons that mental health has become recognised as important is because of the reduction in stigma. The public at large is much more sympathetic towards people with mental health problems and so, for example, it is no longer a career-stopping moment when famous people come out about their mental health challenges. That’s great and we should all celebrate the progress being made while keeping up the good work.

But public interest and discussion has also created a problem. It is all too tempting for people to move from recognition of mental health as a concern for everyone to think that mental health services can help everyone – or at least far more people. But this is a false conclusion and a dangerous one.

In fact if individuals, families, schools and employers take better care of people’s mental wellbeing and help people when they have lower level mental health problems this should reduce the calls on mental health services, not increase referrals. But the opposite appears to be happening.

The situation has been further confused by the Covid pandemic. There has been an increase in referrals and that has been widely expected. But pause for a moment: are specialist mental health services really the right people to support people affected by the anxiety and disruption caused by Covid? Surely not, except in a very few cases – typically those people who already have serious mental health problems (and they have anyway been badly affected by withdrawal and disruption of mental health services during Covid).

So why is the increase in referrals a problem? Let me try to explain:

  • It’s bad for people who are referred unnecessarily because they are subject to long delays and end up either being sent back to other forms of support or (worse) receiving treatment they don’t really need
  • It’s bad for people who really need specialist services because they too are subject to long delays (competing with all the unnecessary referrals) and are put at risk as a consequence. And when they do get a service it is likely to be under-resourced because limited funds are being used to support people who would be better helped by non-specialists

So it’s a “lose lose” situation.

And at the heart of all this is something more dispiriting. The truth is that people with serious mental illness, especially those who are languishing in hospital or prison with psychotic symptoms, just don’t fit well alongside the popular image of mental health – the ‘zany’ celebrity disclosing their well-controlled problem or the middle-class dinner party discussion comparing mindfulness candles.

Did I say stigma was diminishing? The fight goes on for those who are most vulnerable – and I will return to this topic with ideas about how to ensure that they too can go to the ball.

Meanwhile hats off to my friends in Adferiad Recovery who have highlighted the unfair treatment of those with high needs: see their response to the Senedd’s consultation on mental health inequalities here

Jo Roberts is a mental health campaigner who was on the receiving end of the Mental Health Act for over 30 years. In the past she has received compulsory treatment; some of that treatment was deeply unpleasant and even terrifying. Jo is campaigning for a progressive Mental Health Act fit for the 21st Century – an Act that gives patients and carers in Wales and beyond a fairer deal.