On Thursday 7th May 2015, the UK will elect a new government. Mental health has been a surprising issue in the early stages what will feel like a long campaign. Mark Brown examines why this is and what it means.
So, what are we to make of the the foregrounding of mental health in the run up to the General Election of 2015? Chris Naylor of The King’s Fund, writing on January 22nd, summarised much of the political activity around mental health of the opening months of the election campaign, raising the issue of the potential for the gap between rhetoric and reality.
Mental health blogger and tweeter @sectioned_ has drawn together all of the various mental health manifestos of recent months, into one handy blog post and it’s clear from looking at them that there is an ever accelerating sense of jostling for advantage in the run up to the election. All demand that something be done, but most tend to situate that something roundly within the health policy arena or within the agenda of returning people to the workforce. There is little discussion of things like stronger social security safeguards to protect people with mental health difficulties from things like poverty and exclusion and next to no discussion of mental health within the context of other areas of policy, human rights and law. The various manifestos appealing for change broadly reflect the interests of the organisations that drew them up.
But how did mental health arrive so prominently on the agenda? To understand that, we have to understand the interplay between Coalition politics, the major pressure groups and lobbies in mental health and the growth of pubic opinion in favour of positive approaches to mental health.
An uncynical, cynical move
The Liberal Democrats have very few things from their time in Coalition that they can say are uniquely theirs. There’s a number of things that they can say they prevented happening; and a number of things that they can say that they reduced, altered or otherwise modified before they became policy. Few of these give them good, clear, untainted LibDem space. They’ve hit upon mental health as an area where they can add something and receive relatively uncomplicated positive coverage. ’We secured X-million from the Treasury that otherwise have been spent on something else‘ is an achievement that is measurable, concrete and which very few people are likely to describe as a bad thing. In some respects its a way of appeasing the left of their own party, as the Liberal end of the party (Orange Book LibDems) has mostly dominated the party in its recent period.
It’s true that Norman Lamb, LibDem Care and Support Minister and Libdem Deputy Prime Minister Nick Clegg have secured some Treasury money for mental health that might otherwise have gone somewhere else but that is in a situation of reduced overall spending on mental health as a whole.
Of course, any promises and commitments have no validity past the General Election. If it’s promised for post-2015 it’s an aspiration, not a commitment. Which is great for all involved politically, and for less critical campaigners, as its possible to make great talk of principles, growing the idea that we are moving out of the dark ages by sheer volume of discussion. As a lobby it makes sense to grab what wins are possible in mental health by capitalising on the LibDems hunger for a legacy; the need for differentiation; and the need to be the unequivocal good guys is great.
But for all of the noise, the overall political, policy and economic situation hasn’t actually shifted. Mental health is one of the greatest public policy challenges we face. It’s fantastic that the LibDems in government are signaling that they understand the extent to which mental health and mental illness constitute hugely challenging problems, even if their own party doesn’t see mental health as a vote winner (This blog post by Mark Pack is worth a look: “For people to vote Lib Dem on the basis of this policy requires people to believe the Liberal Democrats will implement it – that the party is effective, can be trusted and has a political future.”). My assessment is that its an absolutely cynical non-cynical set of actions, which is exactly what all politics really is. And, of course, the much trumpeted spending is desperately inadequate to achieve the policy end that it talks about.
The Time to Change moment
We are in the midst of something that I’d call the ‘Time to Change’ moment. There have never been more people aware of mental health as an issue. This is a different to previous periods in that this awareness is broadly benign, but it isn’t quite a social justice movement either. More people than ever are ‘getting’ the message that mental health difficulty is difficult, challenging and can throw a spanner in the works of someone’s life. This differs from previous periods of visibility in that Time to Change has reached shallow and broad: more people know a little bit about mental health than ever before, sometimes to the extent that there are two distinct mental health worlds: the world of generalised visibility raising campaigning and the more specific, gristly world of trying to make specific things happen.
The result is that more people than ever have a sense that ‘someone should do something about mental health’. This is generally a good thing, but it tends to be slightly less discriminating and strategic than previous periods where there were strong and specific campaigns for particular things (the last I can think of is the campaign around the amending/ replacing of the Mental Health Act in 2007). This means that any increase in funding or indeed conversation about mental health from Westminster circles will be applauded in an environment where people see the fact that these things are being discussed as a step forward. This ‘Time to Change’ moment has swelled the gallery with people who are easy to please: people who are committed to mental health as an issue without necessarily being committed to following the policy detail of what makes for a good societal response to mental health.
At the same time: increasingly via social media, we are seeing the beginning of what we can call ‘mental health public opinion’. People are finding that their ideas and analysis can and does shift offline events (mental patient costume, Samaritans Radar App). This collective voice is quick to snowball; quick to move to fire and anger. It is volatile; mercurial; and increasingly hungry for change while being despairing that change will come. It wants things to do and it wants things to happen.
This developing, growing, changing group of people are creating a space where mental health change can happen and see themselves as actors not subjects. They want to make things happen using the tools that they have but it’s worth remembering they are not online as campaigners or lobbyists as much as they are online as people.
Of course, money that is new money is great in a situation of systematic underfunding (see Shaun Lintern’s great work for Health Service Journal and Andy McNichol’s great work with BBC and Community Care). The problem is that the Big(small) gesture doesn’t tackle structural issues.
The campaigning charity bind
Over the last five years or so the major campaign charities have found themselves wrong-footed by austerity and by a Coalition with which many individuals and organisations are less comfortable. They’ve adopted a logic dictated by the need to maintain their place at the table ( some would cynically say maintain continued flow of taxation funded contracts, though this is less true now than it was in the New Labour period 1997-2010) that makes them celebrate every new piece of funding news as if it were a stepping stone to the levels of funding they, and many people, are desperate for the Treasury to release.
What exists in terms of specific news is often refracted through the lens of large public or civil society bodies; meaning that it is shaped ‘to meet the needs of our beneficiaries’ or worse ‘to meet the aims of our organisation’. There is a simultaneous ‘writing down to ‘approach (‘we must make this understandable to our beneficiaries’) at the same time as there is a confusion as to what is being provided: information? Guidance? Reassurance?
This leaves much of interest that happens in mental health and the broader policy world taboo, as it is extremely difficult to write or speak about it in a way that does not imply a political or strategic endorsement on the part of the organisation. The broader organisational imperatives of charitable or public organisations makes them reluctant to be seen to be pushing out contentious material or material which represents stories and events as they unfold. Broader organisational aims may think in terms of responses and statements, but this removes much of the information and content required for people with mental health difficulties to widen their knowledge and to keep pace with unfolding and developing stories which concern them.
So, on one hand there is a knowledge gap where individuals are not receiving a continuous stream of interesting and potentially galvanising mental health-relevant material. On the other hand the material they are often receiving has be ‘made safe’ by organisations placing themselves between the unfolding story and people with mental health difficulties; translating unfolding or historic events into messages for donors, policy makers, media or other stakeholders.
There has been some healthy friction betwen the large mental health charities and smaller autonomous campaign groups with no bridges to burn such as Disabled People Against the Cuts and Black Triangle Campaign over their lack of focus on areas such as social security cuts, benefits sanctions and cuts to social care.
The major mental health charities have felt they had their hands tied in broader campaigning as they felt the Coalition was fundamentally opposed to some of the things that their existence relied upon: mainly public contracts and general public sector spending. As organisations situated within a political reality, they needed to avoid a protracted battle with the government which they didn’t trust to play fair. That’s Realpolitik. But the government wasn’t a single party government, it was a coalition. With one junior partner looking to differentiate itself from the other, linked with a need to appeal to people within and without its party who felt that coalition wasn’t the best of ideas, there was grounds for the major mental health charities to help support some quick wins for the LibDems and some money coming into mental health that otherwise would have stayed in the Treasury.
It is also noticable that in the run up to the election, the more critical action by major mental health charities is also picking up pace: witness Mind’s recent amplification of calls for change in the benefits system and their Freedom of Information Act request based research into local authority spending on public mental health.
And in other political news
My sense is that mental health is an area that Labour are less comfortable on, as they are trying to avoid any discussion of increasing spending. Where the LibDems are liberators of the Treasury gold for mental health, Labour are trying to avoid being painted as its pirates. Labour’s focus is on the mental health of children and young people, the easiest sell to the electorate as it is couched in money saved and potential prevented from being squandered. Their record on mental health during the Blair years was one of failing to really grasp the nettle and spending, spending spending but not necessarily on the best or rights things. They’ll be playing up the failings and the underinvestment while making sure to acknowledge their mental health progressive colleagues in the LibDems. It’s worth noting that the one policy that really did broaden the reach of mental health services, the Improving Access to Psychological Therapies programme, was a policy put into action by Gordon Brown after the ‘election campaign that wasn’t’ in 2007 when there was a real political need to show a positive spending action and few costed proposals on the table.
All of the large vested interests in mental health (major charities, royal colleges, trade bodies etc) are currently jostling to make sure that their particular interests are at the heart of the programme for the future government. Mental health is in crisis. Good things can happen in mental health. Both of these things can and are true every single day. New money to solve one problem doesn’t solve problems that don’t have enough old money. Pledges and policies without spending set direction but can’t drive it home. Good things happening don’t also mean that bad things aren’t happening at the same time.
Given the likelihood of another coalition government, parties such as Plaid Cymru, the Scottish National Party, the Green Party, Democratic Unionist Party and others might well have an influence on the final shape of any mental health policy or spending through to 2020.
For better or for worse, Conservative plans and ideas for mental health are for many impossible to divorce from the large scale policies that are their legacy for this Parliament: The Health and Social Care Act 2012 and The Welfare Reform Act 2012. Needing little extra help to claim the spotlight, the other party in the current coalition have been happy to clap approvingly at their junior partners mental health aspirations.
And UKIP doesn’t even have a bloody mental health policy.
Mark Brown is development director of Social Spider CIC. He is @markoneinfour on twitter