liv: cast iron sign showing etiolated couple drinking tea together (argument)
[personal profile] liv
There are two things you should know about this post: I'm writing it as a non-mentally-ill person about issues that don't affect me directly, so please feel free to take with as much salt as you like, or ignore it if you hate that kind of thing. I'm mostly planning to link to the words of people who do have mental illnesses, but I'm bad at writing linkspams without my own commentary. And secondly, it concerns mental illness and some of the worst consequences of that, so it will mention triggering topics including self-harm, suicide, forced treatment and medical neglect / abuse.

So there's been this cute #timetotalk campaign recently, backed by the government and mental health charities. They set February the 5th as a special day for talking openly about mental illness, hoping to combat stigma, and they produced a lot of glossy media and social media stuff encouraging people to have a chat with their friends who are dealing with mental illness and not be afraid to broach the topic.

I've seen many things, both on Twitter and in long-form, pointing out the flaws in this, so I'd like to link to some of the response pieces. The basic idea among many mental health campaigners questions how much good having a friendly chat is going to do? There's all this resource going into this high-profile campaign, and a huge glaring void in funding for actual services run by people with the expertise to actually help people with what can be serious, even life-threatening illnesses.

When [livejournal.com profile] siderea posted this thinky piece about the stigma of mental illness, I somewhat disagreed with it. But the #timetotalk thing is making me revise my rejection of her points. (Even though she's focusing primarily on the US context, a lot of what she says seems applicable here.) It does seem like really clearly the case that:
People with mental illness overwhelmingly seek out mental health care. They are prevented from getting it not by any reticence on their part, but because there isn't enough to go around
At this point there's basically no meaningful NHS based support for anything short of a life-threatening emergency and resources are inadequate even to help people who are in immediate crises and a danger to themselves. And charities and third sector services have suffered extremely damaging cuts. So it's a bit worrying, a bit anti-political perhaps, that we're getting all this rhetoric about how we should make time to chat to our friends about their mental illnesses, but there's absolutely no expert help available for them.

I mean, I've seen my friends, who themselves have serious mental health problems, desperately trying to keep a housemate alive through a huge crisis including multiple, serious suicide attempts. And they're both people with a lot of social capital who know the system well and no matter what contacts they used, what strings they pulled, there was no meaningful help available because the housemate's case wasn't emergency enough. It got to the point where the police ended up being about the most helpful resource available, and really, jailing someone is a very poor last resort to prevent them harming themselves.

Short of that extreme, I know really a lot of people who have spent months or years desperately trying to access any kind of support beyond the prescription of psychoactive drugs (for which the evidence is really poor for sole efficacy not backed up by other forms of therapy). I know at least some people who have refused what threadbare, inadequate help is on offer not because they're afraid of the stigma of being thought "crazy", but because the support available has involved misgendering, cultural insensitivity if not outright racism, and in the worst cases violence. And I'm pretty certain the people most excluded by mental health provision are not known to me, they're the people who are not highly educated and articulate with access to social if not financial resources and a very strong ability to self-advocate.

The other reason the #timetotalk thing is anti-political is because it kind of translated into an official coming out day thing. I have a lot of admiration for people who were able to post on FB or their blogs explaining their mental illnesses. And I am aware of a lot of people with mental illnesses, especially older people, who are extremely grateful to celebrities like Stephen Fry coming out and generally making it more acceptable to talk about mental illnesses than was the case historically. But I am uneasy about putting the burden on the people who actually have mental health issues to deal with stigma and prejudice, it becomes yet another disability tax. And I am extremely unhappy about anything that looks like pressure to come out, there are lots of very good safety reasons (as well as economic and privacy and comfort ones) not to tell the whole internet about your craziness.

I definitely do want to signal-boost [personal profile] rmc28's Time to talk post. She has a really good point about exercise and mental health. Sometimes the stigma isn't against mental illness as such, it's against people doing exercise when they don't have the right body type, or aren't athletically competitive. And of course there are all the issues of access to exercise. And the extremely justified worry that some mentally ill people have that they'll just be fobbed off being told to go for nice restorative walk, which is just an excuse for rationing provision of meaningful medical care, while again, exercise has very poor evidence of efficacy on its own without therapy and / or drugs. The comments discussion on [personal profile] rmc28's post also points out that some people have physical disabilities and illnesses as well as mental illnesses, and assuming that everybody can safely exercise is also disablist.

As an aside, I broadly agree about the This Girl Can campaign also discussed in the post and comments: it's somewhat comforting to have a body positivity campaign that includes people with figures and faces like mine, not just ridiculously beautiful, always white, airbrushed "plus-size" models. But as with #timetotalk it really ignores systematic issues beyond just stigma against women exercising.

I also think everybody should read Holly Matthies' LibDem Voice article about immigration and mental health. The immigration system we currently have here is abusive and traumatizing, and serious commitment to improving mental health nationally would include fixing that, as well as funding mental health services adequately. Not just having happy fun conversations about mental health.

The other major political factor which is bad for mental health is the way that the benefits system is becoming punitive. Living in terror of arbitrary sanctions meaning you can't afford to eat properly (this is an old article, but there's pretty clear evidence that deliberate, politically directed starving of people who don't comply with the system is only getting worse) and risk losing your housing is not good for anybody's mental health. And using benefit reductions as blackmail to force people to accept unsuitable treatments is utterly barbaric.

So yes, combatting stigma against mental illness is a good idea. It's also entirely, terrifyingly inadequate when there is so little help available for people who need it, and when the immigration and benefits system are abusing people who have the misfortune to need support.
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Miscellaneous. Eclectic. Random. Perhaps markedly literate, or at least suffering from the compulsion to read any text that presents itself, including cereal boxes.

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