A New Model of Mental Healthcare

This is a plea to anybody who works in mental health: the psychiatrists, psychologists, CPNs, case managers, social workers, GPs, counsellors and psychotherapists.

It is a plea to anybody in a position of power: politicians, CEOs, celebrities, public servants, journalists, writers, bloggers and influencers.

It is a plea on behalf of all those affected by mental health struggles: the sufferers, their families, their friends, their communities, and our society itself.

We need a new model of mental healthcare. The one that we have doesn’t work.

As someone who suffers from depression and anxiety, and has struggled with abuse, trauma, self-harm, suicidal ideation and an eating disorder, I’ve been involved with the mental healthcare system since I was 16, some 25 years now, and one thing has been true all my life: it is oversubscribed and chronically under-resourced. As a result, it operates on the basis of crisis management. All the money, time and expertise is directed towards the problems so big they can’t be ignored. It is focused on severe mental illnesses, on high-risk individuals, on putting back together people who have been broken apart.

What the mental healthcare system does not do is prevent people reaching a crisis. It does not prevent people succumbing to severe mental illness and becoming high-risk, and it does not prevent people from breaking apart.

For 25 years, I have received the same message dozens of times when I’ve tried to access mental health support: you’re not yet at crisis point. It’s not yet serious enough. Come back when you’re worse, and when it is going to be ten times as difficult to put you back together – and ten times more costly.

So you’re uncontrollably binge eating several nights a week? We’ll only see you when you’re making yourself sick afterwards. So you’re burning yourself with cigarette lighters? When you’re admitted to A&E, we’ll get involved. So you think you’re going to have a breakdown? Well when you have it, let us know, we’ll do something for you then.

You keep thinking of suicide? When you’re on the ledge, we won’t be able to ignore you any longer.

In the meantime, in the absence of psychiatric treatment, the GP throws more and more drugs at me. For 25 years, I’ve been on a cocktail of psychotropic substances: Fluoxetine, Paroxetine, Citalopram, Escitalopram, Sodium Valproate, Carbamazepine, Mirtazapine, Amitriptyline, Zopiclone, Trazodone. I’ve been numbed, sedated; plagued by side-effects.

I’m in my forties, and I haven’t had an unmedicated adult thought.

These drugs have their uses, but they’re nothing more than sticking plasters, sealing over the symptoms while leaving the causes untreated. Without therapy – without addressing the trauma, the thought-processes, the identity issues, the abuse, the pain – they’re kicking the can further and further down the road, so nothing ever gets dealt with. Instead of helping, the current mental healthcare system is an endless deferral of help; that is, until you’re so broken, the journey back to any form of functionality is uncertain at best.

There’s a humane argument for early intervention. A little input at the point you ask for assistance, some psychiatric treatment to help you on your way, the prevention of things escalating to crisis point, could save a world of suffering for people such as myself. I shouldn’t always be saying, ‘How much longer can I stay afloat?’ but ‘Thank God they’ve given me a life raft.’ Happier, more positive, and healthier outcomes are a benefit to individuals and society as a whole. That argument is obvious.

Instead, I’m going to make an economic argument for early intervention, because I know that some of you are already thinking: ‘nice idea, but how do we pay for it?’ Simple. It pays for itself.

Take me as an example: I had a breakdown fourteen years ago, and haven’t worked since. Had I received help when I asked for it, before I had the breakdown, I would likely still be in the workforce. That’s fourteen years that I’ve been on benefits, not earning an income – fourteen years in which I’ve been taking antidepressants and mood stabilisers of one sort or another, paid for by the taxpayer. Intervening before things reached crisis point would have been considerably cheaper than waiting until the crisis occurred.

And even after the breakdown, a small investment to get me the help I needed and back into work could have saved thousands of pounds. I would have required fewer GP appointments. I wouldn’t have had to be under social services. I would have been a net contributor to, rather than drain upon, the public purse.

Now suppose that I do have another breakdown; that I harm myself so severely, I have to go to A&E; that I end up on that ledge. The cost of a little bit of psychiatric help to prevent these outcomes is infinitesimal compared to the expenditure once they do occur, in terms of costs to emergency services, medical treatment, inpatient services, and the much longer, tougher job of putting someone back together who has reached that state of collapse.

The economic side of the argument is even more profound when it comes to suicide. It is reckoned that every suicide costs the British economy £1.7 million, including funeral costs, inquests, use of emergency services, insurance claims and the person’s exit from the workforce (1). Furthermore, for every suicide there are more than six ‘suicide survivors’ that are intimately affected by the suicide, who require counselling, take time off work, and are at substantially increased risk of suicide themselves (2). A small outlay that prevented a suicide – even £100,000 of psychiatric treatment – could potentially save £1.6 million.

Given that there are around 6,000 suicides in the UK each year, these cost the UK economy a total of £11 billion.

A mental healthcare system that spends money preventing people reaching a crisis, that intervenes before a person’s problems have developed into a serious mental illness, that helps them remain in the workforce, and that treats the cause instead of just the symptoms, is far more cost effective than waiting until things have escalated to the point that the person is a risk to themselves and others. We do have the money; we are simply not utilising it efficiently.

A country that invests in its people’s mental health creates a stronger, healthier, more resilient society, better able to withstand and thrive amongst the stresses and unexpected changes of the modern world. A country that only intervenes when someone’s mental health has reached the worst case scenario creates a fractured, pessimistic, alienated society that is less productive, less cohesive, and less able to bring about positive outcomes for individuals or the community as a whole.

The mental healthcare system in this country doesn’t work. We need a new model of mental healthcare, one that is based around prevention and early intervention instead of crisis management. We need a mental healthcare system that helps people get better instead of encouraging them to get worse. And we need a mental healthcare system that provides treatment, help and support to deal with the cause of the problem instead of simply numbing the symptoms with medication.

I’m just an ordinary person. I can’t change the world. I can’t change the way the mental healthcare system is run. But maybe somebody that reads this can.

And maybe one day, I’ll get the help I need.

Thank you.

Richard Cain