Mental health awareness is not enough

By Paul Ray

You’ll probably have seen a lot of your male friends growing horrible little moustaches recently as part of Movember. One of the main purposes of Movember is to raise awareness of men’s health issues, especially men’s mental health. This cause is unimpeachably worthy, with suicide being the single biggest killer of men under 45 in the UK.

Why are we so mentally unwell, especially (but not only) men? Is it because there’s a stigma around men’s mental health, that we’re too repressed to talk about our feelings and find it embarrassing to seek professional help for mental health crises? That’s the predominant narrative, the narrative favoured by the “awareness” approach, but my recent experience of mental ill-health suggests to me that this narrative is flawed. The hellish experience of a mental health crisis in the UK isn’t primarily due to individuals suffering in silence, it’s caused by a chronic lack of NHS resources.

Think about it. You’re a man, you’re experiencing a sharp decline in your mental health. Maybe you’re depressed, or you’re experiencing mysterious daily panic attacks. Due to mental health awareness campaigns you realise that there’s a problem and you need to do something to change your situation. You can candidly talk to your family and friends about what you’re going through, they can offer you their emotional support and make accommodations, fantastic. That doesn’t cure you, though, so what do you do next?

You might see your GP. Due to the coronavirus pandemic, all mental health appointments take place over telephone. They usually last about five minutes, and end with a doctor telling you to self-refer to the local mental health service for some talking therapy.

There is very little the NHS can do for you

In Durham the mental health service is called Talking Changes. The “first level” of their cognitive behavioural therapy is entirely self-guided. It’s online self-help. Every week you log onto a website, watch some videos, and read some tips about dealing with stress, each online module ending with a relaxing meditation video. Once a week someone from the service will log in and check your progress and leave some notes about which module you should work through next. You never have a live conversation with a mental health expert.

What if this doesn’t help you, you keep getting worse? You have two options. You can either ring up Talking Changes (or its local equivalent) and ask to be “stepped up” to the next level of CBT, weekly thirty-minute telephone consultations. The waiting list for this was six weeks in September — a Talking Changes administrator told me that at the start of the pandemic it was six months. You can either wait or beg your GP for medication.

So, let’s say you’re plunged into a full-blown mental health crisis, klaxons blaring, feeling like you’re losing your mind. You might have reacted badly to medication (Sertraline side effects can be brutal), or maybe your health has just deteriorated through lack of quality professional support. You might ring the NHS’s emergency mental crisis line. It’s staffed by a volunteer without medical training who tells you to do some ironing to take your mind off it. It doesn’t cut it. You can’t take it. You go to A&E. You wait three hours and finally get seen in person by a specialist mental health team. 

We are deeply privileged to be able to access this mental health support offered by Durham

For me (did the second person pronouns confuse you?) this is where the story finally takes a positive turn. They suggested more appropriate medication, and soon afterwards I started at Durham University, whose mental health counselling service is excellent. We are deeply privileged to be able to access this mental health support offered by Durham: most people going through mental health crises aren’t students at elite universities, and don’t have access to what is essentially a private form of mental healthcare. 

The mental health crisis in the UK is fundamentally not one of awareness or stigma. This is especially true of students, who are probably the generation most comfortable talking about mental health in human history. The problem is that there is very little the NHS can do for you. They all want to help, you can hear the empathy in their voices and see the concern on their faces, but they can’t put you to the top of the waiting list, they can’t put you in front of an experienced psychotherapist, they can’t give you a personalised diagnostic session to find the right medication for you. Until they can do those things and do them efficiently, mental health awareness will not help people suffering mental health crises.

Illustration: Adeline Zhao