“Jobseeker! Can of Strongbow, I’m a mess/ Desperately clutching onto a leaflet on depression/ Supplied to me by the NHS/ It’s anyone’s guess how I got here.” – Sleaford Mods, Jobseeker
In the run up to the 1968 US presidential election- and amidst all the political upheaval, civil rights protests and race riots of the late 1960s- Nixon created a winning campaign focusing on “law and order”, with a promise to be “tough on crime.” (Click here for his iconic ‘The First Civil Right’ advert.)
He argued, against the democratic nominee Hubert Humphrey, that “doubling the conviction rate in this country would do more to cure crime in America than quadrupling the funds for Humphrey’s war on poverty.” And hence the beginnings of the modern american “’Tough on Crime’ movement; .. a set of policies that emphasize[d] punishment as a primary, and often sole, response to crime.”* This continued partly through the efforts of Clinton, who diverted funds from projects investing in deprived communities into increasing policing and prison capacities; the modern legacy of which is the second highest incarceration rate globally, and huge racial and class-based disparities in sentencing (black men are statistically more likely to go to prison than complete high-school**). It’s also made police forces in impoverished, inner-city areas (such as the parts of Baltimore currently rioting over the murder of Freddie Gray) more akin to an “army of occupation”, than anything aimed at protecting citizens from the negative effects of crime.***
‘Tough on Crime’, in the end, was bigger than just an astute political manoeuvre. It changed the lens through which we understand crime, from a socio-economic one which took deprivation, poverty and oppression into account (the legacy of the Great Society) into a moralistic perspective based on the idea of punishment and wrongdoing. The approach to crime suddenly became entirely reactive, which is fine if you think the reason poor people commit more crime is due to something other than the fact they’re poor. Or if you care disproportionately more about punishing crime than stopping it.
In much the same way that 1968 was the year that launched ‘Tough on Crime’, I think 2015 will be remembered in the UK as the year where “Tough on Mental Health” began. The Lib Dems have probably gone the furthest on this, launching their ‘Manifesto for the Mind’ in which they claim that they are the “first party to put equality for people with mental health problems on the front page of our full General Election Manifesto” and promise to make mental health a “top priority in the next parliament.” However Labour also say they will “make mental health the priority it deserves to be” and “ensure that people have access to the treatment and services they need” and the Conservatives seem to think they have already “legislated to ensure that mental and physical health conditions are given equal priority.“
And yet, like the focus by the Nixon campaign on using the criminal justice system to punish the guilty, all three parties centre on treatment (psychiatric or otherwise) as a primary, and often sole, response to solving the social problem of the large numbers of people suffering from poor mental health.
I don’t think this is wrong by itself. I can’t stress enough how chronically underfunded mental health services- particularly young people’s mental health services- are, and the combination of stigma and other factors surrounding mental health mean that the parity with physical health (despite the Tory claim) is nowhere near a reality. However, seeing mental health in the UK solely through an essentially medical lens obscures the ugly reality of inequality and oppression that underlies mental health problems for a large proportion of people who suffer from them. And it also obscures the fact that the three main parties, through cutbacks and austerity-politics, are actively pledging things on their manifestos to make the lives of these people significantly worse. And yes, I’m definitely cynical, but despite the undeniable stigma surrounding mental health, talking about the need to cure ill people is a far safer strategy than addressing thorny political issues such as poverty or class or race.
In a way, however, my overwhelming emotion (apart from anger) is astonishment that they’ve managed to trick people into seeing them as “competing over who cares most about mental health“, given the stark and telling demographics of those suffering from mental illness.
Firstly, take poverty. People from the lowest 20% of household income are three times more likely to have common mental health problems, nine times as likely to have psychotic disorders and 3 times as likely to self-harm than the richest 20%. And no, the ‘Drift Hypothesis’ (i.e. the idea that this is due to the downward class mobility of those suffering with mental health issues) does not even begin to explain the effect. Parental unemployment carries with it a two to threefold increase of onset of emotional/conduct disorder in childhood, and incidence of mental health problems in childhood are 19.6% where the parents have no qualifications, compared to 10.3% when they are educated to A level and 5.4% to degree level (with parental educational status acting as a proxy for class.) The effect of socio-economic status on mental health is complex, but factors related to environmental adversity, such as discrimination, disadvantage (including unemployment) and, most importantly, stress have been imputed.
Secondly, race. Depression in ethnic minority groups in the UK is over 60% higher than in the white population, and the rates of psychosis are also substantially higher, particularly in Afro-Caribbean communities where they are double. (First and second generation Afro-Caribbean immigrants are approximately 9 times as likely to be diagnosed with schizophrenia, despite the rate in Trinidad and Barbados being the same as the UK average.) This has been partly attributed to economic factors of the kind discussed above, but also to the direct impact of racism and discrimination. This study conducted in an South-London finds ‘non-specific increase in psychosis among various groups of ethnic minorities [which] would appear to indicate that common sources of stress on members of ethnic minorities, such as cultural adjustment, discrimination, impact of migration and racism, are … important determinants”, ideas backed up by studies into mental health and ethnic minorities conducted elsewhere.
Thirdly, gender and sexual violence. I’m not going to cite the higher figures of woman diagnosed with mental health conditions here because (unlike people with a low income or those belonging to an ethnic minority) there’s evidence to suggest that women might be more willing to access mental health services than men, which would skew the results. What I am going to cite, however, is a recent study which suggests that 40% of women in mental health services are victims of rape or attempted rape as adults and a shocking 69% have suffered from domestic violence. If you add child sexual abuse, the results are even more pronounced; 37% of participants suffering from depression had been sexually abused before the age of 16, and the links between women developing eating disorders and childhood sexual abuse are also well documented.
Finally, LGBT people. I was unsure about whether or not to include this, as I think the fact that LGBT people suffer from worse mental health than the general population is fairly well known. But for those previously unaware, LGB people have double the risk of suicide, 1.5 the chance of suffering from anxiety or a depressive disorder, as well as a higher rate of deliberate self-harm. Trans* people, who arguably face the worst discrimination of all those under the LGBT umbrella, have even more shocking mental health statistics. 36% of Trans* people surveyed suffer from a mental illness, and 48% of Trans* people under 25 report having attempted suicide. And for anyone who wants to locate the cause of any of those statistics anywhere except a society which has an abysmal track record on both sexuality and gender, just get out.
None of this, however, has any space in the easy rhetoric of providing bigger and better mental health services. Because to acknowledge it would mean acknowledging that our system, as it stands, is breaking people, and that it, not us, is what is profoundly “dysfunctional” (had to get some R D Laing in there somewhere.) A genuine commitment to mental health would entail radical commitments to other things: eradicating poverty, exploitation, sexual violence, racism, xenophobia, sexism, homophobia and bringing a society with genuine educational opportunities for all its members, and the possibility of fulfilment through meaningful employment. Anything else is just putting a band-aid on a bullet wound.
I wrote above that having a predominantly reactive approach to crime is okay if you care disproportionately more about punishing crime than stopping it. However perhaps it’s unfair to say that all the parties are more concerned about being seen to treat mental illness than the underlying causes of it. The Lib Dems, at the bottom of their ‘Manifesto for the Mind’ have a brief section on prevention, the mainstay of which is a “public health campaign promoting the steps people can take to improve their own mental health – the wellbeing equivalent of the “Five a Day” campaign for healthy eating.”
That’s what I like about the song ‘Jobseeker’, the source of title quote of this piece. Because handing out a leaflet about how to use mindfulness skills on your depression to someone who’s lost their job, struggling to make ends meet, feeling guilty and ashamed of having let down those who depend on them, and is additionally subject to the ritualised humiliation of the Jobcentre is actually the kind of thing our government would do. Sorry, I meant does. And will continue to do. For as long as we let them.
(With eternal gratitude to https://twitter.com/xaviercoh for introducing me to ‘Jobseeker’ by the Sleaford Mods. For all the right kinds of reasons.)
**Marc Mauer, Race to Incarcerate. Also see http://www.sentencingproject.org/