Better lives, better minds: rethinking mental health policy

6 Oct 2019


'Madness is doing the same thing over and over again and expecting a different result,' as the famous cliché goes. This is sadly applicable to mental health treatment in the UK, where failing to change the system is not only madness in itself, but is leading to growing levels of mental health problems. The approach currently being taken by the UK to try and solve this problem is to throw more money into the direct provision of healthcare. This has a track record of not working. Policymakers need to acknowledge this, and rethink their strategy. 


Policies increasing the proportion of GDP invested in the direct provision of healthcare have worked wonders for physical health over the past 50 years. The average OECD country has increased healthcare expenditure by over 1.6% of GDP since 2000, and experienced improvements in physical health outcomes, with the death rates for all major physical health problems including cancer, cardiovascular diseases and strokes steeply declining. 


The same, however, cannot be said for mental health.


Despite increased spending on healthcare and advances in medicine, mental health problems are making up an ever-increasing proportion of illnesses across the OECD. The OECD average for deaths per 100,000 population due to mental disorders has risen from 8.5 in 1980 to 28 in 2015. The rise has been particularly stark in the UK where the figure has increased sevenfold, from 9.1 to 67, in the same period.


The problem isn’t that mental health has been ignored, as it is very much on the political agenda. According to NHS figures, £34 billion per year is spent on mental heath treatment, and ministers regularly make statements about mental health policy. Brexit may be sucking up most of the political oxygen, but mental health is one of the few domestic issues that is still breathing.


Between 2013 and 2016 an additional £1.4 billion in real terms was invested in NHS mental health care. Currently, the government is rolling out a £67.7 million digital support system to improve mental health and investing in better support for schools and new models of community-based care.


Despite more resources being allocated to mental health care, the population have experienced a deterioration in their mental health. This suggests that the cause of worsening mental health outcomes is not a lack of healthcare, but more cases of people developing poor mental health. 


Mental health policies should therefore pay more attention to the social determinants of mental health. Generally, mental health problems are the result of the environment that an individual lives and grows up in. These factors include their childhood experiences (especially abuse), income, employment status, level of education, housing condition, and the level of support they receive from their friends, family or wider community. Those who have experienced poverty and trauma are far more likely to suffer from mental health problems - a fact that I don’t think will surprise many readers. 


Therefore, additional spending on social services will be more effective than pumping more money into healthcare. Improving social services will improve people’s lives and, by extension, their mental health. Rather than waiting for mental health problems to develop, and then using healthcare to try and treat them, this approach prevents problems from developing. This approach t treats the causes, rather than symptoms. Rather than condemning people to lives of popping painkillers to numb the pain, the system should be helping people eliminate the causes of their distress. 


The most potent way of doing this would require a radical overhauling of the welfare system. The structure of modern welfare systems restricts the benefit they have for population mental health. All current welfare payments have some element of conditionality, being either means-tested or restricted to a particular demographic group.


Having conditions prevents many individuals from receiving payments that would reduce their financial stress, and alleviate the poverty they suffer - an income that could significantly improve their mental health. Further, conditionality is a process of continual assessment so recipients cannot be certain of a stable income, as their eligibility is at the discretion of civil servants. This leads to situations in which individuals receive different amounts every month, and this precarious living situation also causes high levels of stress. 


I propose that a Universal Basic Income is the best solution to the growing problem of mental health. Guaranteeing every citizen a fixed income that provides enough to ensure a decent material standard of living (what this level should be is another issue) would be a huge step forwards. This payment would enable people to avoid the conditions that lead to poor mental heath due to the social determinants.


People do not waste the money as opponents allege, but use it constructively to live healthier physical and social lives with lower levels of stress. Trials, such as UNICEF’s recent experiment in India, showed that UBI recipients improve their physical health, education and productivity relative to non-recipients. These have a positive impact on all the social determinants, so would be expected to greatly reduce instances of mental health problems. 


I am not claiming that UBI is a panacea for mental health problems. It would be absurd to say that healthcare funding is not important; ideally both healthcare and social spending would be increased in the pursuit of better mental health. However, resources are limited and need to be allocated in the most efficient way possible.


This means reallocating some of our healthcare spending to social spending, or better yet, using the money to establish a universal basic income. 


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