Mental Health — time for a re-think in approach?

Since 2020, we have been inundated with a slew of statistics — all of which point to a deepening worsening picture of the UK’s mental health which has led to levels of workplace absence crippling efforts to grow the economy.

The headlines

• HSE statistics (2021/2022) reveal an estimated 914,000 new or existing cases of anxiety, stress and depression linked in whole or in part to the workplace — a rise of 14% from the previous year.
• The Times Health Commission Survey revealing a 22% increase in people reporting “mental illness and nervous disorders” as a reason for economic inactivity.
• 4.5 million referrals in 2021/2022 to NHS mental health services.
• The Lancet reporting an additional (global) 75 million cases of anxiety, stress and depression brought on by the pandemic.

Discussion

The workplace

To take the workplace statistic first, we remain troubled by the accuracy of both the volume and the increase for the following reasons. whilst the majority of white collar workplaces have changed since 2019, most employees will say that this has been for the better. Pre-pandemic, many jobs involved five days a week office work with an attendant time-consuming, expensive and often stressful commute. 

Post-pandemic, the overwhelming majority of employers offer a hybrid working pattern which allows for a better work-life balance. For the most part, this allows white collar employees to fit work around childcare or family caring responsibilities and to choose the level of face to face social interaction they want from colleagues. Further, the hybrid model reduces the opportunity of co-worker conflict which is often a catalyst to the instigation of grievance procedures or claims for bullying and harassment.

Whilst we are not oblivious to the occurrence of “cyber bullying” or exclusion/social isolation, now workplaces have thrown off

the shackles of “presenteeism”, the change ought to ameliorate, not worsen, workplace mental health. For blue collar employees and key workers, the lifting of social distancing requirements has effectively meant a return to “business as usual”.

Diagnosis and over-labelling

There have been significant changes over time in our approach to the diagnosis of mental health disorders. No-one wants a return to the dark days of the First World War where cases which would today qualify as post-traumatic stress disorder are dismissed out of hand as “weakness” or in some cases given a label of “nervous shock”.

We do however question whether a variety of quite natural and normal emotions — unhappiness, grief, sadness and worry have translated into diagnoses of “anxiety disorder”, “depression” or even “post traumatic stress disorder”.

The most ordered life — whether we like it or not — will throw up challenges and unhappiness, whether this is bereavement or worry about work or finances. The majority of us will suffer with greater or lesser periods of loneliness or a perceived lack of physical or emotional support. Those emotions should, however, be contextualised rather than labelled.

As for diagnosis, those who have sought mental health support will know that the diagnosis is made almost wholly on the basis of self-reported symptoms, whether this is against the Beck Depression Inventory or a requirement for patients to rate on a checklist and scale of 1 to 10 how they are feeling.

We suggest that in a number of cases, such checklists encourage exaggeration and become a self-affirming prophecy with the path leading only to diagnosis and label. Any patient seeking help from a mental health professional fears, when compiling the checklist or inventory, being told that they are “normal” and thus undeserving both of a diagnostic label or access to treatment, whether this is medication or “talking therapies”.

The impact of the pandemic

The pandemic has had an undeniable effect on the nation’s mental health provoked by illness, grief, social isolation and loneliness, employment or financial worries, fear of illness or difficulty in accessing medical services.

It has induced widescale changes to schooling, social and occupational routines, though for the most part, the world’s population is now living free of restrictions. With that return to normal, albeit a “new normal”, we should anticipate a reduction in levels of anxiety, stress and depression which, if the statistics are correct, simply hasn’t eventuated — a situation which we find perplexing.

The need for resilience

The ‘Generation Z’ demographic (those born in the late 1990s to 2010), is often (unfairly) dubbed “The Snowflake Generation” for their perceived lack of resilience and speed to take offence at the slightest perception of an insult.

We would argue that the absence of resilience are traits currently showed by other demographics to include Generation X (born in 1964 to 1982) — evidenced by the number of 50 plus workers turning their back on work with many citing “poor mental health” as the excuse.

From Generation Z to “baby boomer”, we need to build back up the nation’s resilience encouraging and valuing robust parenting, hard work and ambition and rejecting the tendency to “over label” natural emotions of sadness, sorrow or unhappiness which provide some with excuses for inactivity.

Conclusions

In recent years, many organisations and mental health charities have encouraged sufferers to speak out and articulate their concerns and feelings and not to “suffer in silence”. Instinctively, that feels the right approach, although not all will be capable of being timeously seen, assessed or treated by mental health professionals.

For those in employment, the provision of trained mental health first aiders should be encouraged and made mandatory for organisations employing 20 or more workers.

For those outside employment, the concentration should be around involving those isolated into community activities, whether this entails learning a new skill, sport or pastime with targeted funding provided by local and central government.

For the younger generation, this may require a more nuanced approach, rejecting the current approach of labelling symptoms and instead drawing a distinction between often transient unhappiness and a true anxiety disorder.

To do otherwise risks mental health services continuing to be deluged by a tsunami of referrals for the foreseeable future.