It's not all in the mind

The prevalence of mental illness in the UK is widespread, but so is the stigma that surrounds it. What is being done to help?

The term ‘mental illness’ has a whole host of connotations and can provoke numerous emotions. For some, it can spark a feeling of empathy; for others, it can result in quite the opposite, and for many, it can feel like it defines their existence.

Unfortunately, in the UK, it is the latter that is becoming increasingly common. According to new figures released by the Health and Social Care Information Centre (HSCIC), one in four people suffer from mental ill health. But mental health problems, in a whole host of forms and with different levels of severity, are more widespread than formal statistics indicate.

James Harris, head of media and communications at the Mental Health Foundation, comments: “What’s important about the one in four statistic is that it’s one in four in any given year. And that’s at the extreme end when people have a diagnosis. We all have mental wellbeing and we all go through stages in life where our mental wellbeing fluctuates and we need to bear that in mind.”

Attitudes to mental illness

Despite mental illness being so common, there is still a damaging taboo surrounding the issue. Almost nine in 10 people (87 per cent) with mental health problems experience stigma and discrimination, and a fear of intolerance means that 60 per cent of people wait over a year to tell the people closest to them about their problem – a fact that can often hinder recovery.

James recognises that understanding something you can’t physically see can be challenging and explains that it can therefore be difficult for people to “put yourself in other people’s shoes”. Data from the HSCIC report revealed that this is certainly the case. People who had direct experience of mental illness, whether themselves or in someone they knew, were shown to hold less prejudiced and more tolerant views about the issue than those who had no experience of mental illness.

The survey also demonstrated differences in attitudes to mental illness among various demographic groups. Overall, women were found to be less prejudiced and more tolerant towards those with mental illnesses than men. Younger people aged 16-24 showed the lowest levels of tolerance and support for community care, and older people aged 65 and over held the most prejudiced views. When it came to economic factors, people with lower levels of education, lower household incomes and higher levels of deprivation held the most prejudiced and least tolerant views compared with those with less deprivation and higher levels of education and income.

Encouragingly, the importance of tackling mental health and the social stigma surrounding it is being increasingly recognised and acted upon. James explains: “Evidence suggests that stigma is breaking down and as a society we’re becoming far more tolerant. This is partly due to celebrities and other people talking openly about mental health and highlighting its importance.”

Certainly, mental health charity ambassadors and media drives such as the BBC’s recent In The Mind season, all play a part in bringing mental health issues out into the public sphere and normalising them. But perhaps the most noteworthy initiative in helping to improve attitudes to mental illness is ‘Time to Change’. Launched in 2007 by mental health charities Mind and Rethink Mental Illness, this campaign aims to empower people to speak openly about their own mental health experiences and, in doing so, to challenge and change the attitudes and behaviour of the public towards people with mental health problems. Since its inception, the campaign has reached millions of people across England and has so far helped to improve attitudes towards mental health by 8.3 per cent.

The powers that be

Changing public attitudes towards mental health is only half the battle. According to the NHS independent Mental Health Taskforce’s new report – Five Year Forward View for Mental Health – three-quarters of people with mental health problems receive no support from mental health services at all. Among those who are helped, few receive the full range of help recommended by NICE. This is where the Government comes in.

In recent years, tackling mental health issues has been gaining prominence on the Government’s agenda and, in January, David Cameron became the first serving prime minister to give a speech addressing the issue. He referred to the mental health taboo, saying: “Mental illness isn’t contagious. There’s nothing to be frightened of. As a country, we need to be far more mature about this. Less hushed tones, less whispering; more frank and open discussion. We need to take away that shame, that embarrassment, let people know that they’re not in this alone and that when the clouds descend, they don’t have to suffer silently.”

To achieve this, he committed to putting in place measures to make accessing help easier for people with mental health problems, including 24/7 assessment and treatment in A&E, and access to treatment in communities and homes as an alternative.

James believes that David Cameron’s speech and pledges are a step in the right direction: “Politicians in Scotland and Wales, as well as Westminster, are quite right to focus on mental health. Is this enough? My answer would be ‘not yet’,” he says. “There is a massive focus on crisis care – intervening when people reach crisis point. This puts pressure on A&E and the police and can have a huge impact financially too. We need to, as a society, upstream support and care much earlier and this is where pharmacists, pharmacy staff, GPs and other healthcare professionals have a huge role to play in spotting and preventing it getting to that crisis point.”

Since David Cameron’s speech, the Mental Health Taskforce’s report has been published, which sets out a detailed five-year plan for mental health services. It proposes a three-pronged approach to improving care through prevention, expansion of services to ensure people get the right help at the right time, and the integration of mental and physical healthcare – particularly achieving parity between the two. In response to the report, NHS England has pledged £1 billion of additional investment in mental health services, which it hopes will help more than a million extra people by 2020.

The report also champions the Time to Change campaign, recommending that the Department of Health and Public Health England continue to support such behaviour change interventions to contribute towards improving attitudes to mental health by at least a further five per cent by 2020/21. As to whether any of this can or will be achieved, only time will tell. But for now, there’s a variety of ways pharmacy can get involved in supporting their customers with mental health problems and helping to prevent them.

Exercise and social interaction can help boost mental wellbeing

Play your part

It’s widely understood that early intervention in mental health is critical. “Mental health is the same as physical health in that the longer you leave it, the worse it becomes and the more difficult it is to overcome,” says James. His biggest frustration is the stigma and discrimination that stops people from seeking the help they need to manage and overcome their problems.

This is where pharmacy staff can help in recognising signs that customers might be struggling and providing reassurance and support where needed. There are many different types of mental health problems, each characterised by combinations of different symptoms, but there are some common ones to keep in mind when talking to customers:

  • Sudden or dramatic mood changes or emotional outbursts
  • Difficulty concentrating
  • Lack of energy
  • Busy and/or repetitive thoughts
  • Low spirited, irritable or anxious
  • Withdrawal
  • Weight or appetite changes
  • Sleep problems.

If they’re experiencing several symptoms at any one time then it’s worth recommending they speak to a doctor.

James particularly highlights the importance of keeping an eye out for these signs of mental illness in people living with diabetes or other longterm conditions which affect their quality of life, as these people are more susceptible to developing problems. He says: “Pharmacy staff develop relationships and get to know these patients if they dispense their medication regularly and they should bear in mind that there’s a strong chance that person will have other problems too.”

Relationships and social interaction also have a considerable effect on mental health, and loneliness in particular is a main concern. “For older people especially, loneliness can be damaging,” explains James. “We often take for granted the situations of older people and think that quality of life issues are just part and parcel of getting older, but that’s not the case. Pharmacy staff can provide a support network for them that they might not have elsewhere.”

So whether it’s talking about the mental health issues they’re facing, or just a friendly chat, any interaction with customers and patients can help boost their mental wellbeing. Broaching the subject of mental health with patients can be daunting, but James says that, in reality, talking about these issues is just the same as discussing embarrassing physical health problems.

“Taking a customer to one side for an open conversation can be all it takes, or very simply asking them how they are. You have to be guided by the patient, and pharmacy staff have the ability to do this for physical health so this needs to be transferred to mental health,” he says. “Booklets, leaflets, helpline numbers and a wealth of other information from mental health charities can all be displayed in the pharmacy as a prompt for patients to seek further support,” James adds.

The parallels between mental and physical health are many. Much of the advice that pharmacy staff provide customers with daily as a foundation for good physical health can actually be of wider benefit. James says: “Getting outside and exercising as much as you can, eating well, not drinking excessive amounts and managing stress can all have a positive impact on mental health and wellbeing. So even if someone is knee deep in small children or is struggling at work, making time for themselves is important.”

Almost nine in 10 people with mental health problems experience stigma and discrimination

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