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Mental Health

I, too, would like to thank the noble Baroness, Lady Neuberger, for initiating this important debate. At the outset I would like to contrast West Africa with this country in several respects. My clinical practice is in West Africa for several months every year with a charity known as Mercy Ships. Many of the patients that my wife and I operate on have been rejected by their fellow countrymen because they are assumed to have some sort of curse. This leads to throwing stones at children with hare lips, cataracts, squints and many other conditions. Women who have been rendered incontinent through disasters in childbirth are completely ostracised by society. Before we adopt too critical an attitude to such behaviour in Africa, it is worth remembering that in this country the all too common attitude towards those with mental ill health can be very strange, to say the least. Even highly intelligent, educated people will use terms like ““nutty””, ““balmy”” and ““bananas”” to describe those who are mentally ill. The same people would never dream of using such language to describe those with heart failure, pneumonia or cancer. Some have tried to explain this inappropriate behaviour in terms of fear or ignorance of mental illness, or that it acts as a kind of protective carapace. The strange thing is that doctors have also used these derogatory terms, but what is even more surprising is that psychiatrists have done the same. A medical student spent an hour carefully assessing a patient in a psychiatric outpatient clinic and then presented the case history to a distinguished psychiatrist, who started laughing. ““What’s the joke?”” asked the student. ““The joke is that he is a psychopath””, was the reply. ““Yes, I know that he is a psychopath””, said the student, ““but what is the joke?””. ““The joke is that there is nothing we can do for him””. The student thought that the consultant’s response constituted what psychiatrists call incongruity of affect, which is a well known symptom of schizophrenia. That was a few years ago, and hopefully things are improving. These things are always difficult to judge, but my impression is that there is now less prejudice and ignorance about mental illness, but unfortunately, as has been mentioned already, recent surveys suggest that tolerance towards those with mental health problems is now lower than it was in 1994, which is very discouraging. A survey of members of the Depression Alliance showed that 79 per cent of them were fearful that revealing their condition at work would be damaging. That is a sad state when one bears in mind how common mental illness is in the population as a whole. As the noble Baroness said, one in four in the nation will suffer from mental ill health during their lifetime and at any time one in six workers will be experiencing anxiety, depression or problems related to stress. Mental ill health is normal in every workplace. We have heard the figures about how much it costs, so I will not repeat them. We have heard the term ““presenteeism””, which I do not like at all. I would prefer to use the Latin phrase, labore sed aeger, which means labouring but ill. The Latin word ““aeger”” covers mental as well as physical ill health. The phrase could be abbreviated to LSA, and would certainly be better than presenteeism. The figures we have heard are probably underestimates because many people present with medically unexplained physical symptoms that are due to mental health problems. These are not recognised by patients themselves or by their doctors. Indeed, these symptoms can be difficult to diagnose. To make matters worse and even more complex, a patient’s symptoms may be due to mental health problems and concomitant physical disease. It is important to state the obvious that, as has already been said, mental illness does not make a person unemployable. There have been many recent examples of this: one in the form of the Norwegian Prime Minister, Kjell Magne Bondevik. My Norwegian friends in Norway said that people were amazed when he admitted publicly his illness and then took six months off, but his openness was so impressive that he was elected for a second term. Such openness is a great inspiration for those with the same condition. Mental ill health can be cut by the good management of staff, and there are several excellent examples. BT, as has been mentioned, has reduced its mental health sickness absences by one-third through its Work Fit programme. There is also good evidence that being in work keeps people healthier, both physically and mentally. Unemployment reduces life expectancy by 10 years, as the noble Baroness, Lady Neuberger, pointed out. Work-related mental stress can be reduced by creating more pleasant working conditions, giving staff more say over how they work, and dealing with bullying. I remember some years ago in a hospital how some secretaries got very angry with the way they were being bullied and mistreated by people who should have known better. I suggested to them that the next time it happened they should just look the guy in the eye and think to themselves, ““Poor chap, he’s not having enough roughage in his diet””. The only problem with this was that it would make the secretaries smile, which sometimes inflamed the situation even more. Managers should be, and are being, trained in how to deal quickly and effectively with these problems and how to get people to take up psychiatric therapies and effective rehabilitation. On the subject of rehabilitation, it is helpful if managers keep in contact with people when they are off sick and help them to return to work earlier. There is no doubt that this is a very neglected subject due to the lack of public awareness, the persistent stigma of mental illness and a lack of training among management. Much needs to be done. The Department of Health’s commissioning of the Sainsbury Centre for Mental Health to tackle stigma and discrimination around mental illness is a welcome development, and I look forward to hearing what more the Minister is going to do.