Former Scottish Conservative leader Ruth Davidson recently revealed that she almost did not run for the role in case her mental health history became known. Fearing her ‘shameful secret’ could damage her chances of landing the role, she kept her diagnosis from her university days under wraps. Davidson’s open discussion of her worries has thrust lingering mental health stigma into the limelight, suggesting that, while progress has been made, there is still a lot of work to be done.

In the last decade, many people in the public eye have openly discussed their mental health struggles and a lot of the stigma around mental illness has been challenged. Members of the public may now feel less alone in their struggles and may find it easier to speak to those around them thanks to the openness of these public figures.

Attitudes are changing

Compared to 5 years ago, ‘90% of people in the UK think mental health has a higher public profile 83% of people think it’s more socially acceptable to discuss mental health, and 69% of people are more aware of mental health issues themselves.’

However, at its core, mental health remains an uncomfortable topic for many. Anxiety and depression have become more accepted, but there remains a lot to be done around more severe disorders. For example, an anxious teenager is far more likely to be understood and accepted by those around them than a psychotic person struggling with substance misuse.

Persistent stigma makes it harder to seek help and compounds the existing struggles of living with a mental illness – both due to internal and external stressors.

However, at its core, mental health remains an uncomfortable topic for many. Anxiety and depression have become more accepted, but there remains a lot to be done around more severe disorders. For example, an anxious teenager is far more likely to be understood and accepted by those around them than a psychotic person struggling with substance misuse.

Persistent stigma makes it harder to seek help and compounds the existing struggles of living with a mental illness – both due to internal and external stressors.

Timely interventions

Over half a million people registered with a GP have been diagnosed with a severe mental illness, yet these illnesses remain in the shadows of public discourse. In the case of psychotic episodes, for example, early access to treatment improves patient recovery; if patients felt more able to come forward about their experience and could trust they would not be judged, their overall outcomes would be improved.

Urgent action plays a massive role in achieving positive outcomes – so much so that NICE quality standards state that adults experiencing a first episode of psychosis should start treatment within 2 weeks of referral – yet delivering care in this timeframe is not an easy task. Persistent stigma makes it difficult for people to feel comfortable coming forward for support, resulting in potentially detrimental delays. There are of course also other challenges within the entire healthcare sector at the moment regarding waiting times. Whilst reducing waiting times between mental health referral and treatment is a core component of the Long Term Plan it is equally critical to reducing the time to initial referral by working to dismantle the stigma that may prevent people from seeking help to begin with.

Accessing support

Supporting people with mental illnesses is not just a task for acute crisis services. Wider social care and community services play a key role in supporting mental wellbeing at earlier stages of deterioration, reducing the pressure on acute services while simultaneously making mental wellbeing something that people do not solely think about in moments of absolute crisis.

85% of people agree it’s a good idea to seek counselling or psychotherapy for a problem before it gets out of hand, and 85% of people think it’s important counselling or psychotherapy is accessible to everyone who wants it.

69% of line managers across surveyed UK companies say that supporting employee wellbeing is a core skill, but only 13% have actually received mental health training. The desire for training is there – 35% of line managers reported a wish for basic training in common mental health conditions – but the training itself is still lacking. Providing this training could be a key piece of the puzzle to help build a more resilient workforce and improve overall population health in the future.

A key part of working to challenge this stigma is building a clear picture of its impacts. This includes clear visibility of the time from referral to treatment, the number of people seeking care, the number of people actually receiving it, and the estimated number of people experiencing mental illnesses that are not seeking support. Understanding the scale of this final category will form a key step towards reducing the number of people needing – but not accessing – mental health care.

Mental health stigma persists at different rates in different communities, and it is important that we don’t erroneously assume that progress in destigmatising mental health is equally benefitting everyone. Those in BAME communities, for example, are less likely to seek mental health support early, and thus more likely to end up in mental health crisis care; this can be due to not feeling listened to or understood by healthcare professionals, white professionals not understanding their experiences of racism or discrimination, or not feeling able to seek support from outside of their community. Different communities discuss and support mental health in different ways and it’s important that this is taken into consideration when assessing overall progress.