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Wednesday, July 1, 1998 Published at 18:28 GMT 19:28 UK

All in the mind: mental health evolves

Attitudes to mental health have changed and so have the problems

The stigma attached to mental illness has gradually been eroded, but the number of people being referred for treatment has grown hugely. Six times as many patients are now being dealt with by the National Health Service (NHS) compared to fifty years ago.

Changes in social attitudes have wrought one of the most radical changes in health care over the last 50 years - in the field of mental health.

Although people still find it difficult to talk about 'problems of the mind', the taboo of mental illness has been broken and they are now much more open than they were in the past.

Mental health charities, therapists and counselling groups have all mushroomed in recent years along with TV chat shows which dissect every aspect of our emotional lives.

The media fascination with mental health has increased awareness that mental illness is very common.

Moreover, people with mental health problems are no longer as likely to be locked away from the public view in Victorian asylums. Many now live in the community.


This increased awareness of mental health has helped to reduce the stigma once attached to it.

[ image: Mental asylums are being closed down]
Mental asylums are being closed down
However, despite all the changes, figures show that there has been a dramatic increase in the number of people being referred to psychiatric services since the 1940s - particularly men and young people.

A recent report by mental health charity Mind shows that six times as many people are referred to psychiatric services in the 1990s as in 1946 - just before the founding of the NHS.

And 65% more are being referred to psychiatric hospitals for the first time.

Greater awareness

This may partly be due to greater awareness of mental health problems, but Mind says modern-day malaises like unemployment (now over three times as high as in the 1940s), homelessness and drugs have a big effect on the nation's mental state, although 1940s Britain had to contend with the aftermath of the second world war.

Another social change has been the rise in people living alone. Mental health workers say people who live alone are more prone to mental illness and the number of one-person households has doubled since 1951.

Men catch up

One of the biggest changes has been the huge increase in the number of men being treated for mental health problems.

[ image: The number of men with mental health probems is rising]
The number of men with mental health probems is rising
Traditionally women, wont to be defined as 'hysterical' if their behaviour strayed from the norm, were the most likely to suffer mental illness.

Many were locked away in the past because they were deemed social deviants, for example, because they became pregnant out of wedlock. But in the last 50 years men have been catching up.

Since the 1940s, the number of men reported to be suffering mental illness has soared by 70%, while the number of women with a mental health problem has risen by 38%.

Again, this may be partly due to the reduced stigma around mental health and to men becoming more open about their emotions.

Young people

But it is worrying to note that the number of young people being admitted to hospital for mental illness has doubled over the last 25 years. The suicide rate for under-25s has shot up by 71% in the last decade alone.

Although the numbers admitted to hospital have risen, the way they are treated has changed. Three quarters of psychiatric patients are treated on an outpatient basis now. The majority in 1946 were kept in hospital. Many became institutionalised. Most of those who stay in hospital now remain there for less than a month.

Judi Clements, national director of Mind - which was founded two years before the NHS - said: "Today's challenge, to government and society, is even greater than it was 50 years ago, with one in four people each year having a mental health problem."

She added that the charity was warning the government not to ignore the need to provide adequate support for people in mental distress in 1946 and it found itself doing the same thing 50 years later.

"For how much longer does mental healthcare have to remain the Cinderella service?" she asked.

Cashflow problems

Underfunding has been the major bone of contention in the biggest political change in mental healthcare in the 50 years of the NHS: the 1990 implementation of the Community Care Act. This followed Sir Roy Griffiths 'Community Care: Agenda for Action' report of 1988.

[ image: The Christopher Clunis case showed the hole in the community care net]
The Christopher Clunis case showed the hole in the community care net
It promoted the replacement of big mental hospitals with smaller scale units in the community for the severely ill and supervised discharge for the less seriously ill.

Although mental health campaigners backed the report's aims of normalising people with mental health problems, they criticised the then Conservative government for going ahead with hospital closures and not putting enough money into community care.

They said it was not a cheap option and would, in fact, cost more than hospital care.

The roots of the Community Care Act can, however, be seen earlier in the development of the NHS.

The 1959 Mental Health Act abolished the distinction between psychiatric and other hospitals and encouraged the development of community care.

Patient rights

Another significant development is the growth in patient rights. The 1983 Mental Health Act set out the rights of people admitted to mental hospitals, giving them the right of appeal against committal.

A recent case in the House of Lords sought to extend those rights to vulnerable people who have been informally admitted to hospital, bypassing the Act.

It failed due to fears that a change would increase the number of people being committed to hospital.

The future

New Labour is expected to unveil its plans for mental health in the next few weeks. It is thought they are likely to involve funding for more in-patient beds. The government is reported to believe that the community care pendulum has swung too far.

Cases such as that of Christopher Clunis, a community care patient who slipped through the net and killed a man, have brought calls for more expert care for the most seriously ill of mental health patients.

In inner city areas, psychiatrists complain of not having enough in-patient beds to offer patients who may be a danger to the public and themselves. And they say it is difficult to ensure patients living in the community take their recommended medication.

The arrival on the mental healthcare scene of a large number of different organisations, such as charities and private organisations, has increased the complexity of this most complicated of fields.

The government is promoting partnerships between the different groups as well as statutory organisations that impinge on the social care field, such as education and housing.

So despite advances in our attitudes to mental healthcare, we now find ourselves facing new problems which demand new solutions.

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All in the mind: mental health evolves

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