Beyond Pills: A Call to Action
I sometimes feel like a cog in the machine of society and unclear about how to make an impact beyond my clinical space; but the Beyond Pills Across Party Parliamentary Group’s report: Shifting the balance to social interventions: a call for an overhaul of the mental health system (May 2024), felt like a call to action.
Sobering Statistics
The report is focused on moving UK healthcare beyond an overreliance on pills by combining social prescribing, lifestyle medicine, and psycho-social interventions, among other things.
It opens with some rather hard hitting statistics:
- 25% of the adult UK population were prescribed psychiatric medication in 2023
- 25% of young people in the UK meet criteria for a mental health diagnosis
- Mental health outcomes, despite substantial investment, have, at best, flatlined over the past four decades and there has been no observable reduction in the rates of mental health disorders.
My Response
I’m saddened by these statistics that suggest too many of society are limited in their ability to live valued lives, particularly as an NHS psychologist and mum of three.
The paper points to a need to move from a system focussed on symptoms to one that identifies and challenges the psychological and social causes. Therein I feel lies the challenge and the cure – and the thing I can have a voice in.
Greater awareness but little impact
As a psychologist I see the daily evidence of the impact of context and how difficult experiences – disadvantage, trauma, poor education, childhood adversity, financial stress – are not distributed evenly across society.
The WHO highlighted how these factors provide the foundation for mental health difficulties to arise and be sustained. Relationship factors such as early trauma, neglect, abuse, loneliness and social media use also playing a role.
In 2017, the UN highlighted the growing consensus that in most cases, mental health problems are understandable responses to life (social, relational and psychological adversities) and are not medical problems to be solved by primarily or solely medical interventions.
Mental health and wellbeing are increasingly on the agenda of our schools, press and social media. We hear ideas around it is ‘ok not to be ok’ and the importance of talking. These feel important. They also closely align with my beliefs and therapeutic mode, Acceptance and Commitment Therapy (ACT). ACT emphasises that pain, grief, disappointment, illness and anxiety are inevitable features of being human.
However, despite the investment and greater awareness and understanding of mental health (I know more is needed), the statistics highlighted above suggest things are not improving. So, what is happening?
Mixed Messages?
I believe that the increasing focus on labelling and medicalisation run counter-productive to the positive consequences of these changes in the understanding of, and increased focus on, mental health. For example, when I see advertisements claiming to stop anxiety, I’m frustrated by the unachievable and inappropriate aims they encourage! I also wonder how this connects with the mainstream medicalised language of mental health diagnosis. I often overhear comments of “I am a bit OCD, I like things neat,” or “He can’t sit still he must have ADHD” and I ask myself ‘Is this helpful?’
Questioning the Status Quo
The Beyond Pills APPG highlight how this medicalisation, although validating for some, can hinder recovery and increase stigma. Labels have also become the key to accessing services, hence the 2-year plus waiting list for assessment and diagnosis.
To tackle this, the report rightly identifies that the government needs to stop medicalisation being the key to receiving care. And, while diagnosis and labels may open the door to receiving input, the wider support families need to cope with these difficulties is not necessarily there on the other side. The label does not give the answer.
Does a focus on diagnosis also miss the point?
What is the function of the behaviour? How is it impacting on an individual’s lived experience? We need to take time to understand the context and the influence of society in terms of expectations about appearance, lifestyle and what it means to be ‘happy’ or achieving and how these influence people’s coping behaviours. Do service pressures, entry criteria and a focus on ‘form filling’ mean we professionals are being pulled into this labelling culture, against the best interests of our clients? Even those who maybe come with a label they wish to confirm?
My role to support change
As a psychologist, I understand that people do the best they can to cope with their, often difficult, lived experiences. Society tells us that it is ok to not be ok, but equally tells us we have a disorder that needs ‘fixing’. How can people make sense of that? If we were able to, as the Beyond Pills paper suggests, move to focussing on psycho-social causes and recognising that distress, pain, difficulty and anxiety are a normal part of our lived experience, we could, as a society, be supported to care for each other better, and understand our feelings rather than medicalise them. Could we have more understanding and connection around us as a whole person rather than a label?
As a psychologist I know that if we fail to understand the context, we fail to see the ‘why’ behind the behaviour. That is the core of my training.
“Everybody is a genius. But if you judge a fish by its ability to climb a tree, it will live its’ whole life believing that it is stupid” Albert Einstein
I want to help society understand the need to focus on people and treat them with compassion and evidence not labels and pills.
