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Mental health

Mental health awareness – time to re-focus

Lucy Foulkes argues that campaigns may not be helping, and in some ways may actively make people worse.

07 February 2022

Have you heard that, every year, one in four people experience mental health problems? If you have, it can likely be traced back to Time to Change, the charity campaign launched in 2007 with the goal of ending discrimination and stigma around mental health. It starred Stephen Fry and Ruby Wax as its cheerleaders, and 'one in four' was its flagship stat. Today, its name certainly seems apt: Time to Change triggered a shift in how we talk about mental health forever.

Now, mental health campaigns are everywhere. To give you a flavour: Heads Together, a charity set up by the royals, recently ran Heads Up, using football and footballers to start conversations about mental health. The charity CALM had Be The Mate You'd Want, encouraging men in particular to check in on their friends. The suicide charity Papyrus ran Spot The Signs, about detecting who might be at risk of suicide; Mental Health Foundation asked people to wear a green ribbon pin to show their support. The NHS is in on the action too, telling us that Every Mind Matters. Many of these campaigns promote the same key message: if you're struggling with your mental health, help is available… you just need to ask for it.

In many ways, this message is vital and true. Talking through problems often helps; there are many wonderful helplines and support groups out there; and there are treatments that work. If this message means someone is more likely to reach out when they're struggling, then this is all progress from the time when having a mental health problem inevitably meant suffering alone. 

But the message is also flawed. With every pithy hashtag and shiny celebrity endorsement, I keep coming back to the same conclusion: despite their theoretical benefits, I'm not sure how much these campaigns are actually helping. In the course of my academic work and writing on this subject, I have spoken to dozens of practising psychologists, teachers, parents and others who share my concern: that in some respects, the current public messaging about mental health might even be making things worse.

Just seek help

There are several issues with the 'just seek help' message. The first is that it situates the solution to mental health problems entirely within the individual. It implies that a person just needs to tell someone what's going on, and then change something about themselves: exercise more, reframe their thoughts, take medication. Of course, for some people, this advice is invaluable. Indeed, it can still be invaluable even when the difficulties are obviously triggered or exacerbated by a person's external circumstances: domestic abuse, unstable housing, chronic illness or thousands of other possibilities, many of which have been fuelled or exacerbated by a two-year pandemic. But the brevity of these messages can imply that the sole cause and solution of mental health problems lies within the individual, in their biology and their behaviour, and for many this is not a helpful or accurate way of framing their suffering.

A great number of what we often view as 'symptoms' – low mood, anxiety, paranoia, disordered eating, whatever it might be – are actually direct, understandable responses to difficult, stressful lives. That doesn't make biology irrelevant, but it's fundamentally true that a lot of people are deeply unhappy and unable to cope because awful things have happened or are happening to them. At the moment, campaigns don't promote this message enough. Many solutions proposed by the campaigns, from self-care to medication to mindfulness, can therefore feel foreign or frustrating to a person trapped in systems and circumstances that actively contribute to their suffering.

Even when speaking up could theoretically help, you soon run into a different problem. Very few people know how to actually respond to someone with mental health problems. 'It's good to talk', the campaigns say, to which I would add: only if the other person knows how to listen.

Let's say, for example, that your friend confides in you that they're binge eating and can't control it, or have stopped wanting to eat altogether. What if they're having intrusive thoughts about terrible things happening, or hearing a frightening voice speaking to them in their head? What if they tell you that they want to die? Unless you happen to be a mental health professional, it can be hard to respond to these admissions in a way that's helpful to the person suffering. The solution proposed by the campaigns is therefore one-sided, or half-formed, with little consideration about what happens the moment after you decide to speak up.

Often, listeners simply suggest this: 'Maybe you should see someone'. In some cases, this is absolutely right – expert intervention and treatment is essential. But here's the kicker, and another issue with the campaigns: getting professional help isn't easy either, not at the moment.

Where is the help?

In 2017, the psychiatrist Simon Wessely said: 'Every time we have a mental health awareness week my spirits sink. We don't need people to be more aware. We can't deal with the ones who already are aware.' This comment could be interpreted as callous or flippant, but it's undeniable that NHS services are desperately overstretched. We are funnelling people into a system that is already full. In 2019, Channel 4 released a Dispatches documentary entitled Young, British and Depressed, which explored the reports of increased mental health problems in young people today. Jenny, a young person featured in the programme, said this: 'These campaigns are asking people to reach out for help, it's okay to feel this way, it's okay like there'll be help there if you reach out. There isn't. There isn't help. And so I actually think it's dangerous that we're telling people that and it's not the case.' 

There is also the rather more subtle issue that, for some people, professional help might not actually be needed. Alongside telling everyone to seek help, the campaigns have promoted another idea – that mental health problems are common – and this too has led to confusion. The trouble is that the term 'mental health problems' covers so many different phenomena that the notion they are widespread is essentially meaningless. Sometimes, the term refers to transient, unpleasant emotions – in which case, of course, mental health problems affect us all. In other contexts, though, the term is used as a more sanitised, friendly synonym for severe mental illness and crises, from psychosis and suicide attempts to life-threatening eating disorders. The message that mental health problems are common, or even universal, is therefore not useful because it's unclear what type of problem we're actually talking about. 

The message might also be actively harmful, because it can lead to the wrong advice being directed to the wrong people. At one end, the opacity of the language in these campaigns means that too many negative emotions and experiences are interpreted as disorders, or things that should be feared and obliterated as soon as possible. People experiencing garden-variety difficult emotions end up being told that there's something wrong with them, something that needs to be fixed by outside professionals. This is particularly relevant in schools, who now teach young people to notice and make adjustments for any negative feelings they might have, thereby inadvertently (or sometimes explicitly) promoting the idea that emotions are medical problems. This comes with the very best intentions and, of course, is useful when it leads to help that's badly needed. But some teachers and psychologists that I speak to are concerned that it can also lead to a sense of helplessness among the very adults who would be well-placed to provide support for common difficulties. 

At the other end, someone who is seriously unwell, maybe actively suicidal, ends up seeing advice about taking a hot bath or downloading a mindfulness app. Such direction is misguided and insulting; at its worst, responding to severe, acute distress with self-help suggestions could even be fatal. Mental health awareness campaigns might therefore be underserving everyone: some people's problems are unnecessarily viewed through a medical lens, while others who are seriously unwell are not getting the help they need.

A call to continue, to adjust

I have a great deal of sympathy for the people trying to design and run these campaigns, I really do. They have a genuinely difficult brief: they are trying to condense an immensely complex and layered topic into straightforward soundbites and universal advice. Despite the challenge, their work to date has been worthwhile. The changing public discourse has undoubtedly increased access to understanding, support and treatment. I am not here to dismiss the efforts that have led us here. Rather, this is a call to continue, but to adjust our focus.

Future campaigns need to move beyond raising awareness that mental health problems exist and towards explaining their complexity. This topic is vast and deep, and so far, campaigns are only swimming in the shallows. For starters, campaigns should promote understanding of the myriad factors that contribute to mental health problems: that a person's brain and mind does not produce these 'symptoms' entirely on its own, but very often as a response to the context in which the person lives and the difficult things that have happened to them. 

On that note: campaigns could also focus on reducing some of the outside factors that cause so much stress in the first place. Then, we wouldn't need campaigns to raise awareness of and treat all the mental health problems that inevitably occur as a result. This isn't a naïve call to resolve all societal ills. There are existing practical initiatives and programmes that tackle all kinds of difficulties, from school bullying to workplace stress to loneliness in older adults. I'm suggesting that we could channel funds towards these, rather than exclusively running campaigns that raise awareness or tell people to talk. It's not going to change the world or eradicate mental health problems altogether, but it might go some way to improving people's distress and suffering.

We could also raise awareness about how to actually listen to someone in distress. 'Active listening' is a simple concept – for example, ask open questions and check you have understood – but it's not well known. Some organisations do share this information, like the Samaritans, but it needs to be promoted more widely. Then, when a person opens up, they will more likely be talking to someone who can genuinely comfort and help them. This might also help with the sense of helplessness and disempowerment people often report feeling in the face of someone struggling.

Last of all, the next generation of campaigns should promote the unfortunate reality that the topic of mental health is an unwieldy, untameable beast. In particular, I'd like to see a campaign that conveys the idea that mental health problems lie on a spectrum. This is an inconvenient truth, because it reveals that our experiences cannot be neatly packaged and labelled as 'healthy' and 'unhealthy'. But far better to be aware of this complexity than to pretend any of this is easy. 

The notion of a spectrum provides useful context in which to convey many other messages. For example, you can use it to promote the idea that different parts of the spectrum require different levels and types of support. When I discuss mental health campaigns with practicing psychologists, Five Ways to Wellbeing (a 2011 public health initiative) is sometimes mentioned as a useful alternative to highly medicalised approaches. They're right, but such an initiative would be more useful if it was combined with the message that mental health is a spectrum, and that some suggestions, such as going for a walk or volunteering, are not useful across the board. Only then will it be clear that some approaches are invaluable for some people, but unhelpful and even actively dangerous for others. And any campaigns that promote the idea of a spectrum mustn't ignore the extreme end of the problem either, particularly the disorders that are still badly stigmatised and misunderstood. Sharing information about the nature of disorders such as OCD, PTSD and schizophrenia, for example, could help reduce the casual misuse of these terms, and also help increase compassion and support for the people who have these diagnoses. 

If we better understood all of the above, future mental health campaigns might truly bring about a reduction in suffering across the board. This is not about one in four, but about four in four, about all of us and what we can do to help.

About the author

Dr Lucy Foulkes is an academic psychologist and writer with expertise in mental health and social development, particularly in adolescence. She is a senior research fellow at Anna Freud National Centre for Children and Families and an honorary lecturer in psychology at University College London (UCL).

Her first book, Losing Our Minds, was published in the UK in April 2021 (Penguin Random House) and in the US/Canada in January 2022 (St. Martin's Press). She is currently writing her next book, about adolescence, which is due for publication in 2024 (Penguin Random House).

Dr Foulkes will present a British Psychological Society webinar, 'Is social media actually bad for adolescent mental health?', on 16 February. 

Do you know of mental health campaigns that go beyond talk, to action? We would like to hear about innovative practice that is making a difference. Get in touch with the editor Dr Jon Sutton on [email protected]