A worthy desperation to shock policy-makers into action is clearly what motivates a mental health report published this week by the chief medical officer – and I seek to criticise neither the report’s recommendations nor its intentions, which are broadly positive.
I do, however, find the language and focus – and, by extension, the way it has been reported – problematic. “People with mental health problems should be given faster treatment to avoid taking time off work, says the England chief medical officer” was how the BBC’s morning news headlined the report on Tuesday.
Throughout the day other networks had a similar focus: the headlines almost invariably centre on cost. Viewers were informed repeatedly that mental illness was the top reason for people taking time off work; how much it costs the economy per year, per month, per day; how many “working days are lost to” depression.
One had to wait until the more in-depth analysis to hear any mention of the patients themselves, the misery mental illness causes, the impact on their families, the premature-mortality rates. Occasionally such considerations never even entered the discussion. This is hardly surprising, if one looks at the way the report is structured, with an economic focus chosen to act as tent pole. The top two reasons given by Sally Davies, the chief medical officer, for choosing mental health as the subject of her annual report were sick days lost and the cost to the economy.
I wonder if it would have been considered acceptable to anchor a medical report on heart disease solely in terms of its costs to employers – to headline a news story on cancer treatment with the words “working days lost to cancer”. I suspect not. While economic reporting on various vaguely defined patient groups is certainly becoming prevalent, I believe both medical professionals and news editors would feel compelled to include a more patient-based approach when reporting on what a friend has astutely called “X-rayable diseases”. I certainly hope they would not dream of telling the nation on the first page of the report what percentage of “the national disease burden” they form – which is what the CMO does, lumping all mental health issues together. It would be considered inexcusably insensitive.
Coping with mental illness can include feelings of self-blame, inadequacy and failure. It did for me, and does for many people I know. The economic commoditisation of human pain is dangerously close to victim-blaming. Such an approach can send the destructive message: see how much money you cost everyone, you broken person? Its dark heart is that the state’s only interest in its citizens is as economic units, occasionally broken and in need of quick and efficient repair, in order to slot back into the corporate design. It is not unreasonable to expect Davies to counterbalance this insidious idea by adopting, first and foremost, a patient-centric approach.
Unfortunately this fits into a larger pattern of fostered suspicion. While the actual figures from the Department for Work and Pensions in its latest report on Fraud and Error in the Benefit System estimate overpayment due to fraud at 0.7% of total benefit expenditure, a relentless political and media focus on such fraud has succeeded in conveying the impression that everyone is at it; that the vast majority of conditions that rely partly on the patient’s description of the symptoms – from back pain to ME to depression – are mostly made up. A recent survey by Ipsos Mori for King’s College London revealed that on average people think 24% of benefits are claimed fraudulently; 34 times the real 0.7% figure.
Reporting on mental health issues with reference primarily (and at times exclusively) to economic cost feeds into a nexus of mistrust, blame and confusion. It can very easily be perceived as saying: “This is a real issue, not because mental illness is real, but because it demonstrably costs the economy money. We must act to treat it, not because the patient is as deserving of restorative action as someone with a broken leg, but because it is really inconvenient to employers. We must fund prevention, not because mental illness devastates millions of families across the country, but because it affects growth.”
