In May, the Lancet Psychiatry published an editorial asking for the needs of people living with severe mental illness to be prioritised as a matter of urgency, and not to be set aside for the mental health effects of COVID-19 on the general population.  

"The lives and needs of people who live with mental health difficulties which don’t go away are not a populist cause."

The reality of current mental health policy in the UK is that it is a crowded marketplace with different stakeholders jostling for pieces of a depleted pie (Schools! Early years! Key workers! Mental health at work!). Mental health and social care services, historically the centrepiece of mental health spending, and in urgent need of investment and reform, have been relegated to two bullet points amongst many. 

Six months on, the UK Government has published its Winter Plan for England, “Staying mentally well this winter”. It does not seem to have heeded the Lancet Psychiatry’s request.

The Winter Plan speaks to everyone and no-one: children and young people, frontline workers, carers, students, people who use mental health services, “communities”. In the introduction, the furlough scheme is put on a par with the Loneliness Minister’s letter writing initiative, as two wellbeing policy initiatives from the UK government. One, an income protection scheme to the tune of 43 billion GBP and rising; the other, a government partnership with the Post Office and Royal Mail which saw a “Let’s Talk Loneliness” postmark stamped on most letters delivered during Loneliness Awareness Week in June.

This conceptual dilution of mental health within policy speaks to wider shifts and rifts, and highlights the political affordances and dangers of public mental health narratives.  

We are witnessing in real time attempts to capture the mental health significance of the pandemic, to narrativize it, and to politicise it. Mental health is being talked about as a “tsunami”, a “rising tide”, and a “fire”. The pandemic is not a war, although the linguistic tropes around it abound.  There are attempts to relay a collective, global experience of mental ill-health or distress, when the political decisions and actions made in the wake of the pandemic have been crafted from the logics and contingencies of national and regional contexts. Certain experiences and voices have been foregrounded as the consequence of political interests and alliances. Others are being left behind.

Proxy narratives

The commonly held assertion that COVID-19 has been detrimental to the mental health of people in the UK is not only unevidenced, so far; it does political work, most recently weaponised in the fight against lockdown. If mental health is only used as a proxy, we can be sure that it is not the main preoccupation of the authors.  

Preliminary findings from UCL’s study into the psychological and social effects of Covid-19 in the UK do not point to a clear overall picture - but they can and have been used to justify a range of takes from different actors, from the crisis of a nation to the resilience of its people. This is not to say that broad-brush statements about the mental health of the nation and collective mental health - both relatively recent ideas - are inherently false or valueless; only that they do work, and they have real time political consequences.

The push to democratise mental health as something which is shared by all, a collective humanity as it were, in fact only (re)creates new iterations of who is most worthy of support. Taking mental health outside of the preserve of psychiatry has political consequences for those of us, like myself, who have argued for this position. This slippage has made mental health more accessible in public narratives, and yet has done little to address the entrenched gatekeeping of mental health research and the marginalisation of survivor and service user knowledges. 

The lives and needs of people who live with mental health difficulties which don’t go away are not a populist cause, despite compelling evidence of inequality, from the income gap to the mortality gap. They are likely to be side-lined in the coming years, when the material consequences of the pandemic and its aftermath will have a disproportionate impact upon them. We have not yet found a way to counter paternalism on the one hand, and public indifference on the other.

There is a clear generational divide in the UK and beyond, between those who easily weave mental health into their identities and lives, and those who still see it as the preserve of specialists.  Fighting the conceptual collapse of the term mental health with injunctions to speak only of those deemed severely mentally ill is arguably too late. That ship has sailed, for now. The mental health awareness campaigns of the last decade have left their mark; for better or worse, in the UK, we now all “have mental health”. But in a policy setting, this growing dilution of mental health has stretched resources and attention to breaking point. Some people have needs that aren’t met and aren’t even acknowledged – but the majority of oxygen goes to people who policy makers attempt to protect from losing something, rather than people who have already lost and are losing more.

When the first item on a Government policy paper on mental health during a pandemic is an exhortation to empower everyone to look after their mental health and create a Mind Plan, there needs to be a reckoning from all actors in mental health: this was both a consequence of longstanding policy positions, and a collective failure to lobby on behalf of those most marginalised and excluded.