There is no quick fix in mental health
One hundred years ago, two war-wounded young men met at Craiglockhart War Hospital for Officers in Edinburgh.
Their encounter and the friendship it sparked left an indelible mark on English literature and our perception of the Great War. You don’t have to be a lover of poetry to recognise many of the words of Wilfred Owen and Siegfried Sassoon.
In the Imperial War Museum, a manuscript copy of Owen’s ‘Anthem for Doomed Youth’ containing Sassoon’s handwritten amendments survives as testimony to the extent of the influence one had on the other. The verse that was crafted is embedded in our national psyche.
What is less well known is that Owen and Sassoon’s first meeting place, and the diagnosis and treatment of shell shock which was pioneered there, had a profound effect on our mental health care system.
The First World War was supposed to end all wars. A century later that seems a forlorn hope. And our progress on mental illness leaves much to be desired too. But if we are looking for inspiration in our mission to create a mentally healthy Scotland, what happened at Craiglockhart is still a pretty good place to start.
Shell shock affected healthy young men, the nation’s heroes. It showed that anyone could break down, if placed under enough stress. It showed that mental health could leave scars as deep as the most brutal physical injury. It also suggested that early treatment could prevent the onset of more severe mental illness and that it could include a ‘talking cure’ and keeping patients active.
It sounds familiar, doesn’t it? In today’s money, that’s one in four, parity between physical and mental health, early intervention, talking therapy and even social prescribing. What, you might ask, has taken us so long?
Earlier this year, the Scottish Government published its new 10-year mental health strategy. It is not without its critics but it’s a start. SAMH, whose board I chair, has welcomed its good intention. We have long argued for longer-term thinking.
Whilst our ambition for support is ‘Ask Once, Get Help Fast’, we recognise that transforming our approach to mental health is not a quick fix.
SAMH continues to argue for funding and commitment to realise the strategy’s ambitions. There is no doubting the consensus of aspiration on mental health across the political spectrum. But a consensus of implementation remains elusive.
In May, on one of the happiest days of my 56-year-old life, the day of my wedding in Edinburgh, I had cause to visit a much darker period not so long ago. By the time my now husband and I set the date, I had already agreed to be the keynote speaker at a conference on mental health in Glasgow that morning.
I said I didn’t want to back out of the commitment I’d made to the conference organisers. Luckily for me, my husband is a patient and understanding man!
The title of the conference was ‘Closing the Gap’ and in my contribution, I returned to the summer of 2002 when my world imploded. My experiences of mental health services in London and Edinburgh during that breakdown featured some good intention too.
But by and large, the treatment I received was fragmented and partial. It involved no psychological therapy beyond an assessment which came pretty late in the day. Drugs (this is not an argument against them per se) were both the first and last resort.
A psychiatric hospital provided some basic safety in the form of bricks and mortar but little in the way of human understanding. An admission to hospital after a suicide attempt to this day feels like a stigmatising experience. Social prescribing was nowhere to be seen.
But what might have happened if on the first visit to my GP she had asked what got me out of bed in the morning? A running group rather than a pill, or at least as well as, might have followed. What would have happened if the psychological assessment had resulted in the opportunity for the cause of my distress to be explored with me?
I could go on but the picture is plain enough. The gap could have been closed. I was lucky to have the social and economic capital to make it through. Neither is a panacea, but they offer a layer of protection that improves your chances. The link between mental illness and deprivation is stark.
Scotland has a chance to get this right. We have a dedicated minister, strategic intent and not a slither of an argument about either. We know what we need to do. And there is no shortage of expertise and innovation on hand to be exploited. But we need to be honest about what we are less good at: implementation.
Mental health is having its moment in the sun. But being the cause amongst causes will not be enough to turn the tide. Unless we meet the challenge of implementation head on, it will just make us feel good while things actually get worse. We must do better.