Written by Ella Kenny
Art by Biba Klico
In 2024, one in seven adults find their mental health to be either bad or worse than ever before. That’s despite the fact that spending on psychiatric services has increased by over £4 billion since 2018. So alarming are these spiralling rates of mental illness that the Tory party, against their general commitment to ‘balancing the books’ by cutting spending on public services, have promised to continue funding mental health treatment. But given that increasing funding over the past few years has failed to alleviate the rates of mental suffering, why does the tight Tory purse continue to pour funds into a failed solution? A misdiagnosis has been made — and our nation’s mental wellbeing will continue to deteriorate until the true source is identified.
The conservative misdiagnosis of Britain’s mental health crisis has its origins in a metastasising policy failure that has been progressively weakening the public body for decades. According to James Davies, author of Sedated: How Modern Capitalism Created Our Mental Health Crisis, 1980 was a turning point in the national response to mental distress. Reagan and Thatcher were newly in power, and the third edition of the Diagnostic and Statistical Manual of Mental Disorders was published. It was this version of the internationally influential diagnostic manual that first understood psychological distress not as originating in external circumstances, but as ‘a behavioural, psychological or biological dysfunction in the person’. Across the manual’s list of 265 disorders, one ‘symptom’ appears repeatedly: workplace underperformance. That recurring concept contained a powerful ideological conceit: suboptimal productivity as indicative of personal dysfunction.
For governments that prioritise the productivity of the proles over their own peace of mind, this was an ideal foundation for policy. One need not respond to mental distress by interrogating the system in which it occurs. Rather, mental health policy could protect profits by treating ‘problematic individuals’ with psychiatric medication and/or productivity-focussed therapies, to return them to optimal productivity. Who cares if they still check every other diagnostic box so long as they’re not getting a Personal Independence Payment?
Thus this now-defunct and broadly criticised diagnostic manual became a key political player for decades of Conservative and New Labour rule. Numerous neoliberal regimes have retained the costly view that when the masses inconveniently deviate from the new capitalist project, producers are to blame. But treating mental distress as primarily a productivity concern fails to treat the causes of mental distress — as evidenced by the woeful failures of neoliberal mental health services. Rolled out nationally in 2006, Improving Access to Psychological Therapies is a programme of cognitive behavioural therapy (CBT) focussed on returning the mentally distressed to the workplace. IAPT was readily embraced by both the New Labour government and the subsequent Conservative-Liberal Democrat coalition.
Even during the latter’s brutal programme of austerity, an additional half a billion pounds was committed to IAPT. Since 2015, the Conservatives have further expanded the program by co-locating IAPT staff in DWP Jobcentres. Yet, despite this continual cross-party investment, only two in ten people actually recover as a result of IAPT treatment. Even in terms of its economic objectives, IAPT has resoundingly failed. Now, we’re faced with an ‘economically unsustainable’ rise in mentally ill people ‘parked on welfare’, to quote Sunak — the man pledging to sink further funds into this disastrously ineffective programme.
And the psychological decline associated with these austerity policies is further tied to a material decline in physical wellbeing. DWP figures from the same year showed that over 2,300 Britons died after being assessed to be ‘fit for work’. Stride, Duncan Smith’s successor as Work and Pensions Secretary, has admirably taken up the torch of putting the ‘mean’ and ‘testing’ in means-testing. This March, Stride accused doctors of misdiagnosing ‘serious mental health conditions’ in patients experiencing the ‘ups and downs of life’. What the Tories don’t want to admit is that there’s been an awful lot more ‘downs’ than ups in the lives of working-class Britons recently. In 2022-23, the rate of absolute poverty has risen more drastically than at any point in the last 30 years. Though inequality costs the economy £128.4 billion a year, the UK outspends all other European countries in ‘subsidising the cost of structural inequality in favour of the rich,’ according to a 2023 study. It’s a steep decline from the 1970s, when Britain was among the most equal of the OECD countries. And the evidence is clear that poverty and inequality directly cause and exacerbate mental distress. 2024 House of Commons research found that the suicide rate is almost double in the UK’s most deprived areas. Christopher Ricks of the Commission for Healthier Working Life attributes rising mental illness in young people to the scarcity of decent healthcare, income, and housing in austerity Britain.
Mental health policies centred on pushing people into work will never work — not without first addressing the material causes of psychological suffering. A national mental-distress crisis forms when such policy failures themselves further add to those material causes of distress. Sunak is right in his assertion that ‘good work’ can improve mental health. As ever though, the Tories have fallen at the ‘good’ hurdle. In 2023, over 20% of Britons were in severely insecure work — 600,000 more than in 2022. As for the DWP Jobcentres offering in-house IAPT treatments, their ‘Any Job, Better Job, Career’ policy pushes people into ‘insecure, poor-quality work’, claims the Institute for Public Policy Research. For thousands of Britons, these productivity-or-else policies have gotten them embalmed sooner than employed. Unsurprisingly, forcing the frail and fragile back to the factory exacerbates both their physical and mental burden.
Contrary to the neoliberal diagnosis, the real issue is not personal failing, but structural inequality. To locate the source of Britain’s surging psychological suffering, we need to look not at prescriptive diagnostic manuals, but at material conditions. If we must identify culpable individuals, we should scrutinise those implementing the policies which have plunged thousands into poverty. In his April speech dismissing the mental health crisis as symptomatic of Britain’s ‘sick note culture’, Sunak paid tribute to two titans of Tory tyranny: Sir Iain Duncan Smith and Mel Stride. Under Duncan Smith — whom a British high court declared I can reasonably call ‘Tory scum’ — the DWP launched the draconian Universal Credit system, which introduced demeaning arduous requirements for benefits claimants and significantly weakened social safety nets. In 2015, a study by Oxford and Liverpool Universities pointed to a Universal Credit reassessment for incapacity benefit as having contributed to 590 suicides since its implementation.
Make no mistake. Over the past 14 years, the Conservatives have worked tirelessly to create the material conditions for record poverty and inequality, which have themselves caused record rates of mental suffering. Unscrupulous austerity cuts have directly contributed to both the exponential rise in psychological distress, and the woeful lack of NHS resources needed to treat it. Internal 2022/23 figures indicate that thousands of children have been left languishing for years awaiting mental health support. When mental distress can only be validly understood as a physically disabling ailment, extensive waiting lists for psychological treatment become races to the bottom of physical health. As one friend said of seeking treatment for Borderline Personality Disorder, ‘if you’re not standing there in front of them slitting your wrists or with a noose around your neck, they don’t care.’ This year, a doctor covertly suggested to me that if I declared suicidal intent, I’d secure myself a hospital bed for the night, as opposed to a gurney in an Accident and Emergency hallway. For all the talk of mental distress as pathological illness, it seems that the only circumstance in which your condition counts is one of impending death.
Britain’s mental health crisis is an inevitable result of the contradictions of neoliberalism. The Tories are the architects of this travesty, and their stubborn misdiagnosis of the problem has only further made a mess of it. Given Starmer’s vow that his Labour government would retain Thatcher’s ‘meaningful change[s]’, the capitalist refusal to address the causal links between inequality and mental distress seems set to continue for some time. We must recognise increased rates of depression and anxiety as symptomatic of sustained, structural neglect of the public body. A new treatment regime is needed: radical re-investment in the welfare state and public services. It’s time to treat the disease, not the symptoms.
ELLA KENNY reads English at Magdalen, where her tutor predicted she’d become a 21st century Sylvia Plath
Comments