Post No.: 0421
Whenever we see lots of people experiencing the same problems in or around the same places at the same time – it’s logical and sensible to primarily look for the systemic reasons behind them in society as opposed to primarily blaming individuals and their individual choices. It’s not that individual choices don’t matter but it’s rational and sensible to look for solutions at the public policy level if we have a government that truly cares about its people.
Perhaps the issue is thus how to define ‘lots of people’ – in a population of ~66 million, most would regard 100,000 people suffering from a specific problem a lot, but not 10 people. But is 100, 1,000 or 10,000? Anyway, millions of people suffer from mental health problems of one kind or another each year. And even if one therefore argues that ‘it’s just life’, it doesn’t mean civilised society shouldn’t try to tackle it, like tackling e.g. starvation or cancer.
Limited resources for mental health services sometimes mean that people need to be very ill before they’ll receive any help, but this is counterproductive and not cost-effective in the long-term for problems that generally get more difficult to treat the later the intervention starts. It’s also short-sighted to save on general welfare benefits just to increase the need for mental health services down the line because people are struggling to survive, such as if they go homeless, and the trauma this can present. Current and ex-military servicemen/servicewomen certainly need good access to mental health services for the traumatic experiences they can get exposed to.
Sometimes politicians try to make an increase in public health investment sound like a lot to placate us, but we need to factor in what was already previously promised, the historic under-funding, and adjust for inflation, a rising population and a rising need too. Political parties in power can sometimes be accused of only caring for as long as they anticipate being in power though. And for child mental health services – arguably because children don’t get to vote – resources can be taken away from them in order to bolster services that do support those who can and do vote.
There is some disagreement as to how old a child must be before they can first experience depression. Almost all professionals agree that over 7 years old is sufficient but any younger is disputed. Whatever the case, if a child is feeling more negative than usual, is disinterested in or lacks energy for daily activities, and this has been happening for more than a few weeks, then it’s best to get it checked out. Sad thoughts that sound like suicide ideation must never be ignored. They may be false alarms but the risk of checking a false alarm is lower than the risk of not checking a true alarm.
If a child, or anyone, who is classed as ‘not serious enough’ doesn’t get any help then that could motivate them to cross the threshold into getting a taste for self-harm in order to qualify for help. Help should therefore be proportional rather than emergency or nothing at all, and, once again, prevention or early intervention is more effective and cheaper in the long-run. But instead, there are often long waiting lists and young adults feeling abandoned as soon as they hit the age when they’re considered too old for child mental health services.
Targets don’t help solve the root problems either when resources are already stretched – the standard of care must inevitably drop (and the figures may even become deliberately manipulated) in order to meet unrealistic targets when an adequate increase in resources is not concurrently made available.
Some argue that the label of ‘mental illness’ makes society treat the problem as a ‘symptoms and treatments’ problem rather than a ‘causes’ problem. We should remember that it’s all of it – causes, symptoms, treatments and prevention.
People who don’t have sufficient education in mental health matters often conduct welfare benefit assessments for applicants, which have led to some people committing suicide over being denied help. It can be difficult to empathise with people who suffer from invisible problems unless one has experienced them before or has at least been educated enough about them. Athletes who complete challenges that involve a lot of physical pain and endurance can be crushed by such invisible mental problems, which should give one a clue about how, on a different level, mental health problems can be. (You don’t get a natural shot of pain-relieving endorphins from such mental pains either.)
Mental health practitioners and everyone else working in the field must therefore be appropriately trained and qualified. We must be careful with complex cases such as people with autism as well as depression, or psychopathy as well as suicidal and violent ideation (suicide is more likely to affect those with secondary psychopathy (high anxiety, ‘reactive’ and impulsive antisocial behaviours) rather than primary psychopathy (low anxiety, ‘cold’ with interpersonal-affective deficits) in such cases).
We must be careful about patients who lie to staff about not wanting to self-harm or commit suicide but they will, for some patients can be very difficult or will even try to test staff because they perceive that they’re stopping them from doing what they want to do. We must also be careful about not mistaking people with intrusive thoughts from their OCD as potentially dangerous people in society if they disclose their intrusive thoughts to health services, such as thoughts about abusing children or other people (it’s incredibly rare for anyone with OCD to carry out such thoughts precisely because people with OCD who have such thoughts find them incredibly aversive, sickening and frightening rather than at all tempting). People with mental health disorders must feel safe when they seek help. It’ll exacerbate their conditions if they try but they’re doubted or marginalised from society for doing so.
A doctor prescribing antidepressants rather than exploring why a person is feeling the way they do and addressing those root causes – because they don’t have enough time to give for each patient – can make a patient feel like he/she is being given short shrift; as if told to get lost. Some will also find it unacceptable that the risks of side-effects weren’t completely explained to them. There can be little point in receiving a diagnosis if the right or best kind of help isn’t there.
Post No.: 0369 looked at some of the pros and cons of taking a sensitive approach to different local cultures around the world.
Mental health problems negatively affect the loved ones around the direct sufferers too, such as their carers, friends and families. They can feel scared and powerless, and so carers and the wider families can sometimes need support too. These factors further contribute to the costly knock-on effects in society, socially and economically, of stalling on investing enough resources on addressing mental health problems in society before they grow.
Mental health services and staff can themselves be overwhelmed because of funding and staff shortages. We must be careful not to overwhelm frontline mental health staff because their mental health is at risk too for having to deal day-to-day with a lot of traumatic stories, cases and decision dilemmas with their patients, or for simply being overworked. It’s a rewarding but challenging career.
It’s not easy for, and we should logically not expect, a sufferer of a mental health problem to solve his/her own mental problems alone, because he/she would only have his/her own compromised mind to try to solve the problems of his/her own compromised mind. Such sufferers cannot even always be expected to ask for external help, and in some cases they cannot even be expected to understand that they have a problem e.g. addiction sufferers. It’s like expecting a corrupted computer to use its own corrupted system, on its own without effective external help (usually a human trained in IT), to sort itself out. This is another reason why mental health is logically the responsibility of society as a whole.
If a mental illness sufferer misses an important doctor’s appointment then it’s the responsibility of society because, well, depending on the particular condition and its severity, how can we reasonably expect him/her to remember or to have the courage, discernment or wherewithal to go? It’s an absolute ethical minefield for sure though, to force someone to get or attend help, but if that sufferer does something undesirable as a result of missing an important doctor’s appointment then society must take at least some responsibility for it. Here there’s no clear right answer except with the benefit of hindsight – but we don’t have that benefit before it’s too late for a given individual case. But we can be sensible because, once more, the risk of heeding a false alarm is lower than the risk of ignoring a true alarm.
We cannot realistically save everyone but it doesn’t mean we shouldn’t try. It can enter the world of moral philosophy regarding autonomy and individual liberty over one’s own body and life if someone, after all that’s been offered to them, still wants to end their own life regardless. It’s however not straightforward even if an adult, rather than a child, expresses such thoughts because people’s thoughts, choices and behaviours are complex products of their particular previous and current environments, experiences and surrounding influences too; not just their genetics.
For example, as merely a thought experiment – imagine if there was a closed-off community where everyone born into it was raised with the tradition that they ought to commit suicide at the age of 25 in order to escape all Earthly problems and enter heaven sooner, and then you somehow met one of these people at the age of 24 talking about their individual choice to end their own life on their 25th birthday. Would you really accept that their choice was truly free and unfettered? The same person with the same genes but raised in a different time, place and culture with different traditions may have thought differently. It might be impossible to know for 100% sure without comparing their life with their life in a parallel universe with those counterfactuals – except in this case, it shouldn’t be too hard to imagine that they would likely rather live on instead (unless they became terminally ill perhaps) because most people raised in healthy environments where they aren’t exposed to pressures to commit suicide would rather tackle the problems they face in this life and live on than hasten their own death for an expedited escape.
Really, this applies to everyone’s lives and everyone’s individual views – how will we know how much of our thoughts have been instilled as a product of our circumstances spanning from the time of our conception to now, or were inevitable to us as individuals whatever life we would’ve been born into, lived or experienced? (For instance, would your political or religious beliefs be different if you were brought up by and with different people?)
Why care to intervene in other people’s lives anyway if other people want to harm themselves? Well when we see young people in particular being misinformed and willing to take their own lives because of mental health problems – possibly because they’re (also) being exposed to harmful influences online – then society should care.
Woof. An estimated quarter of the world’s population will experience some kind of mental health problem each given year. The COVID-19 pandemic has only made this worse too. So chances are, like cancer, you’ll know at least someone close to you who suffers or will suffer from a mental health disorder. You can blame individuals for their own problems and expect them to sort themselves out without treating it as a public health issue, but sensibly these are common enough problems to warrant the compassionate attention and care of society as a whole.