“There they stand, isolated, majestic, imperious, brooded over by the gigantic water-tower and chimney combined, rising unmistakable and daunting out of the countryside – the asylums which our forefathers built with such immense solidity to express the notions of their day.”
Over 50 years have passed since Enoch Powell made his famous speech on mental health, and since then much is the same and much has changed.
Much is the same: the then Minister of Health wanted fewer mental hospitals and more community provision – or care in the community, as it has become known since. That in turn meant fewer beds: “in 15 years, time there may well be needed not more than half as many places in hospitals for mental illness as there are today,” Powell told his audience.
Reflecting later on the implementation of his policy, he said that not enough resources had been made available to ensure that community care picked up the people who had been moved out of the beds. The same complaint can be heard today. “Over 2,100 mental health beds had been closed in England between April 2011 and last summer”, the New Statesman reported last summer, adding “not to say that the home-treatment, early-intervention arguments aren’t valid” – before going on to complain, almost in an echo of Powell, of a lack of resources.
But much has changed, and not only in terms of language and attitudes. A section of the then Health Minister’s speech was headed “Prospects for the subnormal”. No Minister would dream of using that language now – it was part of the argot of the era – and would vanish beneath a Twitter storm if he did. And no MP then with mental health problems would have thought for a moment of declaring them, as Charles Walker did during the last Parliament, breaking new ground as he did so.
The illnesses themselves also seem different. This tentative language is a nod to the age-old question of what is new, or at least more frequent, and what was unrecognised or simply undiagnosed. In Powell’s day, teenagers with eating disorders, for example, would not have been a priority. But today, David Cameron is to announce that waiting time targets are to be introduced for them. This is an attempt to tackle the postcode lottery problem that is part of the dark side of localism, and against which Liam Fox has long campaigned, on this site and elsewhere.
There are other signs of the times. Downing Street says that one in five new mothers develop a mental health problem at around the time of the birth of their child, that suicide is now the leading cause of death for men under 50 and that – returning to those young people – anorexia kills more than any other mental health condition. Roughly 75 per cent of mental illness in adult life begins before the age of 18, and some 17,000 people a year experience a first episode of psychosis. The Prime Minister will also say, rightly, that too much stigma still dogs mental illness.
There will be debate about whether establishing more targets is right and will work, where personal responsibility starts to be compromised and substance dependency begins to kick in – a matter he will touch upon – and, above all perhaps, about how much of the almost-a-billion-pounds spending of which he will speak really represents new money. He is clearly keen to head off Jeremy Corbyn, who has appointed a Shadow Cabinet Mental Health Minister and who built his first PMQs around mental health provison.
Cameron’s mental health announcements will be made in the context of a wider speech on boosting the life chances of the most vulnerable. This is partly an attempt to get off the subject of the EU Referendum and partly a reworking of his One Nation theme. The first is understandable (unless one believes that government should be a single-issue business) and the second vital. The Party will not get up to the 40 per cent of the vote it will need in 2020, in those Midlands and Northern marginals and elsewhere, by means of narrowcasting on economic security alone.
The Prime Minister will address inequalities of opportunity, early years and education, as well as mental health. That opportunities can never be fully equal isn’t to say that there shouldn’t be more for many people. So he is right to return not only to the Big Society ideals of his early leadership but, in particular, to the aspirational stress of his best Party Conference speech of all, that of 2013, and to the Disraelian themes that suit him best. But he knows that the problems which he wants government to tackle are not so much institutional or organisational as social and cultural.
Britain’s Anglo-Saxon economic model is built on long hours, high migration, small families, service industries, vibrant media, and mothers of young children working in the labour market. Its strengths are rampant employment, at least compared to our European neighbours, and strong growth. Its consequences include many people living on their own – Jeremy Hunt has worried aloud about the “eight lonely funerals” that take place each day – lots of unmarried or uncoupled men, and women who juggle a work-life balance in a way less usual in many other comparable countries.
There is no cure-all solution to these problems – and, in any event, the Rhineland model of capitalism isn’t working all that well, either. But whatever one thinks of Cameron’s proposed parenting classes (also contained in the same speech), family is clearly part of the answer to some of them. Old people who see their children and grandchildren more often are likely to be less lonely. Settled men are less likely to try to kill themselves. Children who have strong relationships with both parents, other family members and their friends are less likely to self-harm.
All this helps to explain why helping families is bound up with improving mental health. Local authorities need incentivising to pick out the best early years support schemes – to support parents right from the start. Government work schemes should be better targeted at men with low educational attainment and learning disabilities.
Public services must get to anorexic teenagers and depressed mothers earlier. Hard-pressed families need a better-balanced childcare policy than the present one, and support for stability through bigger transferable allowances. Cameron has an instinctive feel for all this. Does his most likely successor, the architect of that childcare policy – George Osborne?