11 October 2019

By Sarah Hughes

To campaign or not to campaign? Is that the question?

We are in a new era, and mental health is no longer the silent sister in health policy

When I first started out in my mental health career, mental health campaigns were rare. If I’m honest it felt more like activism in those early days, a sense that we were fighting to get mental health acknowledged. We fought to be taken seriously by policy makers and tried desperately to get services in the community off the ground. In the early 90s mental health absolutely got no airtime; it was spoken about in hushed tones in corners with shame and despair – or worse, with fear and recrimination.

We are in a new era, and mental health is no longer the silent sister in health policy. Phrases like #ItsOkNotToBeOk and #timetotalk are in our national consciousness. Mental health is regularly discussed on prime time television and I’ve written before about celebrity endorsement. How has this happened, bearing in mind we started from zero? Campaigns have contributed to this tipping point – but of course they have not, on their own, brought about the changes we’ve seen over the last decade. I think the shift has come from those with lived experience of mental health difficulty having courage to break the chains of shame and exclusion, sharing their stories in the relentless pursuit of equality. I think it’s the staff who have been working tirelessly every day to provide services, who undertake research and who have been lobbying government and decision makers for decades.

the shift has come from those with lived experience of mental health difficulty having courage to break the chains of shame and exclusion, sharing their stories in the relentless pursuit of equality.

All of these things will happen pre- and post- these special days throughout the year: people and organisations are striving for change every day. There are peaks and troughs in terms of progress; there are days when I simply think ‘why don’t they get it?’ (‘They’ meaning everyone, mostly). I look at campaigns like #WMHD and agree that they are crucial in gaining public support. It’s been important to get the nation talking, to lean in on the things that help push through the stigma roadblock. The success of the campaigns has been that there are now more questions than ever. Someone recently asked me what was happening about prevention; I gave them the talk, they paused and said, ‘but you’re always rattling on about poverty and other stuff, what’s happening about that?’ The answer to this question is much less clear and if I’m honest, much more disappointing. It makes me wonder if mental health campaigns need to move focus, beyond awareness to something else – but what next? I’m not sure we have landed on the answer yet. 

Don’t get me wrong: I’ve really enjoyed my days pushing the awareness messages, I’ve loved talking to people outside of mental health and seeing the penny drop. I respect those businesses who are hosting opportunities for their staff to be more open about their mental health challenges. Dare I say it though, I think we are all ready to go to the next level. If you know me, you won’t be surprised that I am hugely inspired by Extinction Rebellion. I agree that climate change needs radical action – but what would radical action look like in mental health?

children living in poverty are more likely to experience mental illness, people living in unstable housing are at risk of degrading health outcomes broadly and as for the welfare system, it’s simply not delivering the stability to support the concept of emotional wellbeing. Until these things are dealt with, the work is not done.

There is no doubt the campaigns have impact; I feel it, I see it. We are in a time of investment into health services with the most ambitious pledges seen in 30 years since the closure of psychiatric institutions within the NHS, and I believe they will be achieved. But children living in poverty are more likely to experience mental illness, people living in unstable housing are at risk of degrading health outcomes broadly and as for the welfare system, it’s simply not delivering the stability to support the concept of emotional wellbeing. Until these things are dealt with, the work is not done.

This year’s #WMHD is focused on suicide prevention, as it should be. Most people who die by suicide are not receiving mental health treatment, and campaigns that dispel the myths continue to be vital for that reason. Campaigns that give people the skills to know what to do are even better. What we want to see next is an impact on the numbers of people dying: this has to be the ultimate goal and I know that there are many people out there campaigning and lobbying every day for a cross-government action plan. Those departments need to listen more to those people.

Campaigns have brought mental health out of the shadows. The challenge for us now is to equip the nation with the other stuff; the reality about the causes of mental health, the social, biological and political factors

So, what am I saying? I’m saying that the campaigns have been so important: they have created a new sense of solidarity, got people being more honest, forced change within workplaces, brought mental health out of the shadows. They have been the public hooks and levers. They have helped us make an offer to those in power they couldn’t refuse – ‘put mental health on your list or else we shall set the nation on you’.

The challenge for us now is to equip the nation with the other stuff; the reality about the causes of mental health, the social, biological and political factors. We must talk about the things that matter to those who experience mental illness every day, and get the nation fighting poverty and exclusion. We need support to get these issues over the line. We want the government to develop policies that create the conditions for healthy families and communities. And before you ask, no, I don’t have the swanky campaign moniker for this. Help us think about it – what does the nation need to hear next?

Finally, I want to dedicate this blog and all our work to those who are suffering today and every day, to those that work with compassion and commitment in services and beyond, the carers that often feel excluded. We can see you and we know that sometimes these campaigns can feel superficial and irrelevant, but I promise, they are only one part of the puzzle.