Mental Health Awareness? I’m Over It

Two weeks ago (yes, it is June, yes, time is exhausting) was Mental Health Awareness Week. The theme of the week was kindness, designed to tie the numerous acts of kindness and flourishing communities that have emerged during the Covid-19 pandemic into the broader idea that kindness can enhance the mental health of individuals and communities alike. 

There is significant scientific evidence that being kind and receiving kindness can be beneficial for our mental health. Volunteering online, checking in with friends and families, dropping some hygienically-baked cake off for a neighbour – all these activities can boost your self-esteem, foster a sense of connection and create a sense of purpose during this mad time. The kindness theme is also designed to emphasise the importance of being kind to yourself by taking a break from social media, dancing around the kitchen or taking a long bubble bath. ‘Now is the time’, the Mental Health Foundation website reads, ‘to re-imagine a kinder society that better protects our mental health’.

It is a lovely idea. ‘Awareness’ and ‘kindness’ are not terms that should be dismissed – my own recovery from anorexia and depression owes much to a growing awareness of the deeper roots of eating disorders, to the kindness of others and to my own attempts to practice self-care. It owes more, however, to my therapy sessions, my dietician, my parents’ ability to send me to a private clinic while I waited three months for an NHS counsellor to become available. It owes more to my daily dose of anti-depressants than it does to a boogie in my bedroom or flowers from a friend. It owes more, in short, to money.

There are two problems regarding the glorification of ‘awareness’ and ‘kindness’ as mental health treatments. The first is a gap in understanding when it comes to what these terms mean, and the second is that both are futile without adequate funding.

In popular discourse, mental health awareness means a chat. It means knowing that at any one time, 1 in 4 people are suffering from a mental health condition, knowing that mental health is something we all have, knowing that it should not be a source of shame. For those suffering acute mental health problems, awareness means something else. I can only speak from my own experience, but perhaps it would be helpful to outline what awareness means to me. 

Every morning, I wake up and consider not taking my medication. I take it. Every meal, I consider not eating enough, or taking a secretive trip to the toilet afterwards in order to purge. I eat enough, and I do not purge. Every time I eat, I calculate the calories I have consumed – and every time I exercise, I calculate the calories I have burned. Every minute of every day, I am aware that my brain is not well, that it has thoughts that seem entirely separate from myself. I am always aware of my anorexia and depression. And I am always aware they may never leave me.

I face a similar disconnect when it comes to how kindness is understood in relation to mental health. The Mental Health Foundation website highlights ‘doing something you enjoy’ or ‘doing something for a good cause’ as ways to practice kindness towards yourself and others. These are, of course, acts of kindness. But when it comes to helping someone going through a mental health crisis, sending them some chocolate or getting them to volunteer should be viewed more as lovely bonuses rather than foundational acts of kindness. When I was ill, self-care involved valuing myself enough to brush my teeth. The acts of kindness I remember are my mum sitting with me while I spent 30 minutes eating a banana, or my counsellor kindly but firmly telling me I was facing hospital admission if I continued to exercise. They were not well meaning gestures – they were critical to my survival and recovery.

The second problem is that no amount of ‘awareness’ and ‘kindness’ is equivalent to sufficient funding. Fears that lockdown will trigger a mental health crisis are well documented, but our obsession with the consequences of Covid-19 risks ignoring that even without a pandemic, NHS mental health services are in dire need of additional funding and support. In December last year, the BBC found that while nine out of ten patients have their first appointment within six weeks of being referred to NHS mental health services, that gap between appointments is growing, with one in six patients waiting over ninety days between their first and second appointment. Schools are increasingly likely to bring in private counsellors to support children who cannot access NHS services, and the scattergun approach to funding has created a postcode lottery when it comes to surviving a mental health crisis. 

We have become so aware that everybody has mental health that we have forgotten that some people have serious mental ill health. In general, talking to a friend is a wonderful way to support your mental health. In the midst of an episode of psychosis, anti-psychotics and paid, professional treatment are critical. In general, playing some happy music and baking a cake is a lovely form of self-care. In the middle of a bulimic binge-purge cycle, cognitive behavioural therapy and nutritional guidance are crucial.

Absolutely, bake that cake. Buy those flowers for your mum, socially distance with a smile. Be kind, be aware. Be aware that these things are not treatments, they are not cures. Be aware that the only way out of our mental health crisis is adequate funding, and know that the negative consequences of austerity are still being felt by those in need of mental health support. Be aware that kindness is not, and never will be, enough. 

Mental Health Awareness Week

Wonderfully, this year’s Mental Health Awareness week coincides with the start of my exam season. The exam period is to mental health what January is to physical health, but instead of a barrage of flu strains, hangovers and chocolate overdoses, the onslaught consists of sleep deprivation and intense pressure to succeed, all within the shadow of ‘your future’, which for four weeks appears to depend solely on how quickly you can scribble down an essay.

Last year, exams pushed me dangerously close to the precipice of a relapse. A return to therapy and an unpleasant few weeks dragged me back to normality, but the wobble made me very aware of how complex my mental health is. While I had predicted heighten anxiety, and possibly a quick spell in the fog of depression, I hadn’t anticipate such a full-throttle resurgence of some anorexic tendencies. This unpredictability defines many people’s experience of mental health conditions and can make everyday life difficult. Someone suffering from generalised anxiety disorder may predict that an exam or job interview would trigger heightened anxiety and they could therefore take steps to manage the situation. However, sometimes the heightened anxiety is present from the moment the person wakes up, with no obvious trigger, making preventative steps practically impossible. 

Over the last few years, attitudes towards mental health have changed markedly, and the taboo is lifting. But while some conditions – such as depression and anxiety – are increasingly escaping the stigma, other mental health conditions are still discussed in hush tones, or simply not mentioned at all. Over the last year, greater attention has been paid to the prevalence of self harm and eating disorders among children and young adults, and advocates such as Bryony Gordon and the Channel 4 comedy Pure have been instrumental in increasing understanding of obsessive compulsive disorder (OCD). But other conditions – such as the other nine diagnosable personality disorders – are yet to be acknowledged and accepted in public discourse.

Charly Clive, star of Channel 4’s ‘Pure’. The programme is based on Rose Cartwright’s real life struggle with Pure O, a type of OCD

Mental health awareness is still in its early days, so it is unsurprising that there is a level of universalisation and simplicity that is not always helpful. Triggers are seen as linear – stressful situations trigger anxiety, sadness can spiral into depression and social media pressure triggers eating disorders. Logic follows that if you can avoid these triggers, you can avoid poor mental health. But triggers are individual to the person. Social media is not a huge trigger for me, whereas the possibility of failure is a big old issue which I still struggle with. Stress can trigger depression and sadness can trigger anxiety; usually there is a knot of triggers that are almost impossible to separate. Some conditions do not have triggers – schizophrenia is thought to have a strong genetic element, and people who have body dysmorphic disorder (BDD) are more likely to have another mental health condition such as OCD or generalised anxiety disorder.

This simplification of triggers is also present in attitudes to treatment. Self care is frequently advocated as a way of ensuring everything is hunky dory in the mental health department, while drugs are demonised as a last resort, a temporary measure. I don’t mean to be dismissive of self care. At my worst, self care was cleaning my teeth and getting out of bed; usually, self care is eating my vegetables and an early night. I value self care hugely, but it is not treatment. My treatment is cognitive behavioural therapy (CBT), and taking my anti-depressants. And within my CBT sessions, maybe 5% is discussing my body image and social media; they are unhelpful, but they are not major triggers for a decline in my mental health. Exercise is a fantastic form of self-care, but as someone who has danced around exercise addiction, it is not always suitable. Baking a cake may be therapeutic but it is not always healthy to demolish the whole thing or aggressively feed it to others while not eating a crumb of it yourself. 

My favourite self care expert

In the same way that being white, or cisgender, or wealthy, or male, provides a certain level of privilege, I am conscious that I have a level of ‘mental health privilege’. I have low level anxiety, easily medicated depression and was lucky enough to receive treatment for anorexia very quickly. People with schizophrenia, types of OCD, BDD and other less well understood mental health conditions are frequently misunderstood, misdiagnosed and remain heavily stigmatised. I fit within a socially acceptable idea of mental health, I have relatively predictable triggers and self-care does help with some of my symptoms. But it is important to remember that this is not the case for everyone. We should not kid ourselves into thinking that the stigma surrounding mental health has disappeared. It is not our job to become experts in every mental health condition, but being willing to learn, understanding nuance and acknowledging our own ‘mental health privilege’ can help us move beyond black and white triggers and treatments to a more holistic understanding of mental health.