Inequality and mental illness: boxed in

First Minister Nicola Sturgeon recently announced £54m is to be ploughed into widening access to mental health services. The headline grabbing move came only days after a nationwide council tax freeze was green-lit for the 9th consecutive year, placing those very services under perpetual strain.

While the extra money has to be welcomed we must also accept it’s a paltry, tokenistic sum. Not least because mental illness is one of the few problems that seems to increase the more money is thrown at it.

In Scotland, one in four (maybe even three) people will experience a diagnosable mental health problem each year.

Anxiety and depression are the most common, but others include schizophrenia, personality disorders, eating disorders and dementia. While medicines for people suffering anxiety are being prescribed less, behavioural disorders like ADHD are becoming more common.  The Scottish Association for Mental Health estimated the total cost, both social and economic, of mental illness in Scotland to be in the region of £10.7 billion for 2009/10.

Perhaps most worryingly, the rate of suicide in Scotland remains higher than that of most of Western Europe (though perhaps declining among males at last).

The figure below measures sense of well-being according to 14 categories (with a maximum score of 70).


Unsurprisingly, those living in poverty have a lower level of mental wellbeing, and visit doctors more often, for conditions such as depression and anxiety. They are more likely to adopt coping strategies that compound their problems, such as alcohol and substance misuse as well as poor lifestyle and diet, more so than those who hail from more well-off back grounds.

The root of the problem

But other than pumping cash into the system as and when required, there is a distinct lack of investigation into the root causes of mental illnesses, despite their ubiquity. Nobody in government really wants to know.

My hunch is that government understands that poverty and mental ill health are linked. So unless you are serious about tackling social inequality then you are resigned to rising mental illness.

Such a lack of policy direction results in random cash injections, like the recent £54m, which will be used to paper over the cracks of a system stretched to absolute breaking point.

With this in mind, isn’t it time we as citizens began facing that reality? Given the fact our elected officials cannot solve this growing problem , because that would require innovation and political courage, what are we going to do about it?

The truth is: the growing mental health problems in Scotland are not over there in someone else’s back yard, but rather, festering on your own door step. Loitering in your fridge. Calling from your bed-side table.

Lurking behind your child’s bedroom door.

Over-hasty medication

I want to make the case that unless you are a child, or suffer from a serious emotional or psychiatric disorder, or have been diagnosed as criminally insane, then you will be far better off staying well away from mental health services in Scotland and, instead, finding other ways to improve your well-being.

But as I have learned, this will be a painful, counter-intuitive process of getting to know your true self; peeling back some of the layers of delusion adopted to quiet that nagging feeling that much of your discontentment in life is down to you and the way you choose to live your life.

Modern life is increasingly challenging and more and more of us are presenting at the GP with what looks like symptoms of mental illness. But how much of our well-being is dictated by forces beyond our control and how much is as a direct result of our own behaviour, thinking patterns and lifestyle choices?

Is depression an external actor that possesses our souls or a menace we inadvertently conjure up through dishonest thinking and dodgy decision making?

In essence, do we make ourselves unhappy?

Culturally, the system is set up to produce a diagnosis. It’s not designed to view your body and mind and lifestyle holistically.  Our mental health system is set up to treat your symptoms.  Doctors do not have time (and are not trained) to diagnose the root causes.

This has led to a culture of hastily medicalising young people and setting them on a path to dependency upon external factors for psychological and emotional stability.

We’ve been led to believe, by a medical establishment too keen to import quick fixes from Big Pharma, that happiness is simply about tweaking our brain chemistry. While this is true to an extent, it takes no account of the fact that every other tenet of modern society is also bombarding that brain chemistry with a physiological onslaught. A sensory overload we have not yet adequately evolved to cope with. A toxic food chain full of saturated fat, salt and sugar, never-ending ads about looking a certain way as well as the more subtle and insidious aspects of life online: gambling, binge entertainment and increasingly violent hard core pornography.

When you throw in the endemic, profit-driven, culture of narcissism and a backdrop of 24-hour advertising, it is easy to understand why so many people feel a constant twang of mental and emotional disturbance from which they naturally seek some relief.

My aching soul

We all know that late-evening pang for some elusive home comfort that lies just beyond our reach.  That feeling that you just need something. Is it boredom or stress that brings it on?  Or perhaps it’s just a habit? Whatever it is, emotional or psychological, it seems to exist over and above our basic human need as an altogether optional plane of our existence.

It’s not hunger but it can manifest as a desire for food. It’s not stress but it feels like we could induce a deeper state of relaxation. Whatever it is, it registers as a subtle cry of internal discomfort, like dull tooth-ache of the soul, which is only answered, for most of us, by some form of regrettable consumption.

The ceaseless demands of modern life and the vast array of comfort blankets we adorn to cope leave even the iron-willed among us feeling over-stimulated and mentally exhausted at times.

Over time this kind of lifestyle, often driven by stress, will lead to deep feelings of angst and confusion.

Your highly caffeinated bladder stirs you inconveniently from a rare afternoon nap. Upon relieving yourself you turn naked to a long mirror. It’s worse than you thought it was going to be. It’s in that moment, unhappy with what you see, that you once again swear off those vices that you believe are constantly undermining your lifestyle objectives. For some it’s the biscuits while others struggle with fizzy drinks or deceptively packaged yoghurts. Then there’s the obligatory tipple at night to quiet the racing mind as you try losing yourself in some form of binge-entertainment – or, God forbid, read a bit of a book.

We tell ourselves this is just how life is but deep down we know we would probably modify most of our behaviour if we could only break the habits. Habits which, having clawed their way back into our waking minds, after a short period of absence, now seem to be conducting the entire orchestra of our thinking. The crescendo overwhelms until we feel capable only of submitting to the cacophony of compulsions.

It’s as if our brains aren’t designed to cope with the things we want to consume. And it’s as if the people who make the things we consume already know this.

You ever go to a 24-hour Tesco for a loaf, have to walk half a mile to the bakery section, only to come out with a crate of Dr Pepper, a share bag of something you have no intention of sharing, an inflatable mattress and matching adjustable bed, scented candles and a pair of stilts…and no loaf?

Ever feel like the shop is logistically designed to mock your willpower?

Overwhelmed by stress, mapped by business

After the inevitable slip we make a vow to start again tomorrow – and we do. But only to resume the self-defeating behaviour at the first sign of stress; a warped sense of entitlement, emerging from a knee-jerk reaction, allowing us to entertain the delusion that we made the choice to go against our better judgement.

Hitting the ‘fuck it’ switch. A way to laugh off the fact we feel truly powerless.

For all of the technological advances and all of the personal freedoms, many privately feel imprisoned by their own impulses and dejected at an inability to regulate their own behaviour.

The part of that story we are rarely told (and rarely want to find out) is the part about our human psyche being mapped by big business and how society has started to look and feel like a psychological obstacle course as a result.

One wonders if our elected politicians can even perceive the problem let alone begin tackling it.  After all, they are but humans with problems of their own. When they are not standing in front of cameras or chairing public meetings they are staring blankly out of train windows into cold wet nights, worrying about what they just said and whether other people like them or not.

Politically, their options are limited in terms of reining in the pantheon of multi-nationals who want to set up shop in your head. Which is why throwing some money at mental health services is a welcome but futile cosmetic gesture, because with their other hand, our elected officials are also handing big business the back-door keys to our collective subconscious.

Which is why, ultimately, the buck stops with you, the consumer formerly known as citizen, to pull your head out of the sand and draw a line in it.

Main image: © Josh Carlisle


  1. Kate says

    I worked in mental health services for quite a few years and have had depression myself. I agree with much of what you say. I especially agree that most of us suffering at the ‘mild to moderate’ end of the mental health spectrum are better looking at our own lives and making changes, if we can, rather than getting involved with mental health services which are increasingly bureaucratic and to my mind, odd. At one end of the scale you’ve got poorly trained mental health workers working horrible hours for low rates of pay and at the other end you have overpaid psychologists and mental health specialists with enormous waiting lists. What would help (a bit) is sensible, free, quickly-accessed counselling – with no hoops to jump through in order to get it. You should be able to walk in off the street for it, no questions. My observation when I worked in mental health was that lots of people seeking help are square pegs in round holes and when the pressure to conform and stay on the treadmill becomes too much, for example if stress at work increases or there is a family illness or bereavement, they turn to their GP and psychotropic medication in order to help keep themselves going. For some people this is OK – it tides them over a tough patch and they get back on the treadmill and keep working towards that pension and paying off that mortgage. This is the way society is geared now. It’s relentless and pretty unforgiving. I think it’s probably always been like that – however over the past twenty years or so I think it has got worse and at the same time I think mental health services have also got worse and less easy for the individual to find.

  2. morag says

    I agree with all if that. And I am not the only one, Scots do not have enough thinkers saying so loud enough to be heard over the jingle of tills in shops designed to fleece parents with stuffed replicasof film and television characters complete with expensive accessories !! It’s really shocking to watch.

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