Agenda: Time to rethink the way we respond to the problem of mental health

Antidepressants are routinely prescribed for anxiety as well as, in a minority of cases, for pain, migraine, and so on. Although anxiety and depression are frequently found together, anxiety is, across Europe, more common than depression and every bit as debilitating. NHS mental health services and voluntary organisations, although often doing good work, see only the tip of the iceberg and will continue to struggle as demand inevitably outweighs supply, leading to demoralised therapists faced with the Sisyphean task of "doing something about the waiting list". Next year, the Scottish Government introduces a target of 18 weeks between referral and treatment. While many NHS departments will struggle to meet this target, it is surely unacceptable for highly distressed individuals, having plucked up the courage to go to their GP, to be told that they may wait more four months to receive help. Why are we so unambitious? It is no wonder GPs, faced with unresponsive services, feel they have no option but to prescribe.

However, although mental health services are under-funded and deserving of more resources, the answer is not simply "more cognitive behavioural therapy (CBT)". As a CBT therapist, I can attest to the enormous benefit CBT (and other approaches) can often give an individual but I can also see how often it fails. The Improving Access to Psychological Therapies (IAPT) programme for common mental health problems (essentially anxiety and depression), generously funded by the Government south of the Border, is now, predictably, showing, at best, mediocre outcomes suggesting that this model - significant expansion of mainly-CBT individual therapy provision - is of limited benefit. Similar results were reported in Sweden. One reason for this is that psychological therapies, CBT included, are too often tested in university research centres with "perfect patients in perfect circumstances". They often do not travel well to our communities especially to those who have to struggle daily with simply keeping their heads above water. There is a danger that we are now, too often, pathologising normal emotions, for example clinical depression rather than unhappiness.

It is time to look for more radical models that better fit the complex nature of what is going on in our society. Although anxiety and depression can affect anyone, why are they more common in poorer areas? What keeps stigma alive resulting in many people, especially working-class men, being unable to tell anyone about their distress (and, as a result, often self-medicating with alcohol or drugs)? Why do so many people, offered therapy, fail to attend or drop-out? Why are there so few useful early intervention or preventative strategies available (preferably in primary schools)? Why do we not pay more attention to the serious bi-directional relationship between poor mental and physical health?

There are no easy answers but it seems reasonable to suggest that we should look to develop integrated lifespan models ranging from the individual to population level and that we should stop separating mental health from physical health from social realities and aim to develop better holistic biopsychosocial interventions. Doing so may allow us to reduce social, physical health and mental health costs while improving and even saving lives. Finally, and perhaps most pressing, we must pay more attention to the toxic factors in our society that leads one in seven of our fellow citizens to seek antidepressant medication in an attempt to deal with intolerable distress?

Let us get rid of the artificial divide between people who are "normal" and people who have mental health/illness problems. Let us not assume that it should only be the responsibility of individuals to alleviate their distress. At a time when the nation is asking itself what kind of society in which we want to live, this is an opportune moment to reconsider our approach to mental health.