Intended for healthcare professionals

Rapid response to:

Feature Interview

Simon Wessely: “Every time we have a mental health awareness week my spirits sink”

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j4305 (Published 21 September 2017) Cite this as: BMJ 2017;358:j4305

Rapid Response:

Re: Simon Wessely: “Every time we have a mental health awareness week my spirits sink”

We read with interest your recent interview with Simon Wesley titled “Every time we have a mental health awareness week my spirits sink”.1 Wesley suggests that mental health awareness leads to increasing numbers of people engaging services for help in times of crises that are already overstretched.

This argument in part captures a wider culture prevailing within the current discourse on mental health, that the solution to providing support for people in distress lies simply in better funded mental health services.

“Mind the Gap” a Bristol based group of mental health supporters feels there is an onus on those that are working with or advocating for people in distress to move the conversation on from a dichotomous health and illness paradigm. We feel strongly that conversations about emotional health, distress or psychosocial disability may benefit from a different approach. Moreover these conversations should be driven by the people they claim to serve. This is an approach that avoids language of exclusion and that proactively widens our gaze as a society as to who can support us in times of distress or crisis.

Emotional distress is an undeniable aspect of being human. Groups in our society that experience longer term distress often face barriers, including stigma and discrimination that can result in disability that has greater consequences for living a good life than symptoms of any illness can.

As the causes of distress and disability are often located in wider society’s attitudes and actions to people with certain experiences or ways of communicating then so are the solutions. The wider community has a key role to play in supporting those facing challenges with their mental health, and in furthering the narrative that, facing challenges in life and asking for support is not a sign of weakness.

Mental health policy and strategy should not be a fiefdom ruled by mental health services. Our current services have a responsibility to help build capacity within their local communities, putting families and people with lived experience at the centre of driving change rather than an over reliance on exclusively medical or service based approaches.

Nowhere is this more important than in the lives of young people, whose sense of control over their life can be stripped by negative interactions with mental health services. Mind the gap have been working with a number of schools in Bristol to start different types of conversations with young people on mental health and wellbeing. Young people across the city are actively engaging with explorations such as the power of vulnerability as well as examining body image from a wider societal standpoint. From our experience these themes introduce vibrant discussions on mental health while encouraging young people to consider that emotional distress is part of being human and that through adversity we have the opportunity to develop resilience. The young people we work with continue to cite sources of support such as family, teachers, pastoral staff and peers as those they find most helpful. Rarely are services offering the lasting relationships that they feel they need to recover.

By avoiding a narrative of the sole responsibility of experts we have the opportunity to build upon existing capacity that exists within our communities to support young people in crisis. By offering teaching and pastoral staff in schools reflective groups, shared understanding of challenging situations can foster shared solutions that think about a young person in a wider context that just an illness. These professionals demonstrate that schools around the country have experts supporting young people in distress working already on campus. With support they can be even more effective in building lasting and stabilising relationships with young people in crisis.

This does not represent a replacement for direct interactions between young people and their families with mental health professionals when required. However this should be complimentary to support structures in built in our society rather than acting in isolation. The growing focus on mental health in the media is an opportunity to think differently about how we as a society wish to support people in times of need or crisis. The growing anxiety about capacity to support emotional distress and psychosocial disability must be addressed. However the conversations must include all of society to offer wider solutions than just growing mental health services.

1. Arie S. Simon Wessely: “Every time we have a mental health awareness week my spirits sink”. BMJ 2017;358:j4305 doi:https://doi.org/10.1136/bmj.j4305

Competing interests: No competing interests

30 October 2017
Daniel J Cooper
Psychiatry Trainee
Peter McGovern (Psychiatry Trainee) and Clare Short (Consultant Child and Adolescent Psychiatry)
Severn Deanery
Bristol