By Mark Brown

It is the day of the Royal Wedding. Outside the sun is bleaching pavements; toasting polite revellers and making bunting shine like strings of patriotic bandages. The television in the urgent care clinic is playing a football match, the windowless waiting room scuffed and yellow. A father and his daughters converse in German. I sit waiting to be seen. I do not feel much like celebrating.

The nurse takes my pulse, blood pressure, temperature. The GP ask questions, offers reassurance. He looks tired. I look terrified. I'm told I've done the right thing. I'm not a burden, or a fool or overreacting. I am outside again with three quarters of an hour, reassured I am not dying; holding an antibiotic prescription in a white paper bag. The sun is still shining. The revellers in front of the pubs are that much redder of face. The bunting still flies. All of this seems eternal. An unshakable British reality.

The National Health Service is seventy this year. It's as central to British identity as bunting and curry and plantain and people shouting in pub car parks. It is the British people in institutional form: mucking in together, always near a crisis, always muddling through. But above all: always there for each other. Mental health in the NHS has never enjoyed the same level of unity of regard, understanding and purpose. It still remains impossible to imagine being able to take your worries about what's happening inside your head and pop into somewhere on a Saturday afternoon to get them checked out and to have all agree that you'd done the right thing.

The National Health Service is the British people in institutional form: mucking in together, always near a crisis, always muddling through.

We have never been able to quite settle what NHS mental health care should do. The way we treat mental health reflects the dominant ideas of society. It cannot be extricated from politics because people's ideas of what other humans should be and should be able to cope with are political. Mental health within the NHS still has the tang of paternalism; of teaching rather than caring; of instilling values rather than healing wounds.

The NHS reflects our expectations of being cared for, of being looked after when we are in need. It's one of the few remainders of a vision of the future where we were all winning, not just a few. The NHS is our collective vision of a machine that keeps us well. Within the machine, mental health is a cog clogged with fluff and tarnished. Sometimes it works as it should, other times it sticks or misfires.

The NHS is our collective vision of a machine that keeps us well. Within the machine, mental health is a cog clogged with fluff and tarnished. 

We can hang as much bunting as we like on the idea of NHS mental health care, but until we find the collective political will to face forwards into the future, we will only be celebrating a promise that many of those who have lived through mental distress will know was never kept. The NHS is a repository for our nostalgia as much as our vision for the future. We are comforted by its faded glory and promise; we are glad, in our terror and discomfort, that it is still here and has not been lost. We don't have a past for mental health in the NHS to return to.

The NHS works best where we all agree what it should be achieving. In mental health that difficult discussion is yet to come. A growing number of people are ready to accept the possibility the founding of a National Mental Health Service, a new generation for a loved institution.

Until we find the collective political will to face the future, we will only be celebrating a promise that many of those who have lived through mental distress will know was never kept

Like the Royal Wedding, regardless of the trappings of tradition and history, it must be the future which we celebrate and the possibility of change. Until mental health care is part of the pride of our nation and helps people when, where, and how they need it, we are simply waving flags, gulping down rosy visions of the past and cheering to cover up the sound of those suffering now.


Mark Brown is development director of Social Spider and writes for a range of publications on mental health. He is @markoneinfour on twitter.

This blog is part of our NHS 70 series. Take a look at other posts in the series.