To Help Mental Health Services, We Have to Reduce the Need for Them

The length of mental health waiting lists have raised questions about how to address the growing number of people in need of mental health support – the solutions lie not in denial of the problem, but in recognising how society impacts our mental health, and preventing mental health problems from reaching crisis point.

Alexa Knight

Director of England at the Mental Health Foundation

When politicians discuss mental health, it’s often one of two topics: the length of NHS mental health waiting lists, or whether some on waiting lists really need support.

As the numbers of people presenting with mental health problems have increased, pressure on the NHS and wider public services have grown. The increasing attention on mental health raises the question: why are so many more people struggling with their mental health, and how can we help them?

Are People Really Unwell?

Let’s be clear: people are not making it up. You do not get on the waiting list for a mental health service unless you are experiencing mental distress. It might be lower level – like persistent sadness, anxiety about social events, or burnout from your job – but these are all valid reasons for seeking support. It helps nobody to ignore these issues, as such problems often worsen over time.

What is true, however, is that greater awareness is prompting more people to recognise their issues and reach out for support – but this is not a bad thing. In both human and pure economic terms, this is good – it is easier, cheaper and reduces suffering to help someone at an earlier stage than to help someone at crisis point. 

This debate has clouded the real conversation we should be having: how do we help the number of people waiting for support? It’s clear that services aren’t coping and that the country is less mentally well. We should therefore be asking what kind of support do people need to not be on these waiting lists, and how can we as a society better provide it?

How Do We Help?

Part of the solution, as lots of mental health organisations will tell you, will be funding services properly. Underfunding has led to mental health services playing catchup. For some people on waiting lists, this will make a big difference.

But to just focus on funding would be missing a key element: why these waiting lists have grown. To understand that, you have to recognise that mental health is not purely down to biological factors.

Instead, our mental health is also influenced by psychological factors (for example, the coping mechanisms, healthy or unhealthy, that we use) and by social factors like our relationships, our housing, and our financial situations. We call these social factors the ‘building blocks of good mental health.’ It seems likely that a reduction in positive social factors over the past 20 years, due in no small part to austerity, the pandemic, and social media’s rise, is driving more people to need mental health support.

As the building blocks of good mental health have been knocked down, our mental wellbeing has got worse, and NHS Talking Therapies – with their long waiting lists – are often the only non-medical solution GPs can give. Yet what else can doctors do for the person who turns up, cold, hungry and sad, living in a damp filled room with no money to spend on a social life, who ticks all the diagnostic criteria for experiencing low mood? That young person will sit on a waiting list.

This can’t go on. We need to change the framework of how we approach mental health, not just by investing in psychosocial support like talking therapies and giving people the tools to understand and manage their symptoms, but by rebuilding the building blocks of good mental health.

Rebuilding the Building Blocks

Some of this requires major political aspiration – projects to guarantee good housing, build better workplaces, alleviate poverty, and address inequalities. If we tackle these social ills, mental health would improve.

However, some of the solutions are more immediately achievable, such as rolling out the evidence-based anti-bullying programmes we know are effective. Bullied children are two and a half times more likely to access mental health services than non-bullied peers, so by rolling out anti-bullying programmes in schools across the UK, we could reduce the pressure on mental health services. These programmes are economically beneficial too, with £7.50 returned in the long run for every £1 spent.

More targeted solutions for at-risk groups are also needed, such as the UK-wide roll out of a ‘Child Payment’ to households with children that claim Universal Credit, as happens in Scotland. Research suggests that £100 weekly payment could result in a 13% reduction in poor mental health for those receiving it – representing 100,000 fewer people who may need to access NHS mental health services.

Neither of these examples directly treat mental health problems, but instead would work towards making the country mentally healthier. With programmes like these, people would be better equipped to take on the societal ills of the 21^st century, more resilient, and happier. Waiting lists would come down as less of us turn to the NHS for support.

Final Thought

The solution to our mental health waiting lists isn’t denial, or acceptance that this is how things need to be, or simply spending to treat the problem. The solution is making society better, and helping us all to get better at dealing with life when it goes wrong.

For more of Curia UK’s analysis on mental health policy, please click here.