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Yes, depression is an illness, but prevention is better and cheaper than treatment

Brendan Martin, 13 August 2014

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The lonely death of Robin Williams has produced a welcome eruption of concern that we should all be kinder and more understanding about mental illness, and treat diseases of the mind as we would diseases of the body.

This has highlighted the scandal that only one in three adult sufferers of anxiety and depression in Britain today receive treatment, with most other countries no better off.

With mental health services suffering even harsher cuts than the rest of the NHS, and the same austerity measures that have produced that trend also leading to more anxiety and depression, the gap between need and support will surely widen further.

Alastair Campbell, the journalist and former spin doctor, summed up the prevailing mood in Britain’s Guardian newspaper today, by commenting that we should understand depression, from which he suffers, as we would asthma, cancer or diabetes.

“There still needs to be a debate about depression as an illness because there is still a lack of understanding that illness is exactly what it is,” he wrote, adding: “Some people get it, some people don’t.”

That is true, and the human case for understanding and treating depression more effectively is reinforced by the economic case, made by Martin Wolf in the Financial Times recently, when he wrote:

“Given the economic costs to society, including those caused by unemployment, disability, poor performance at work and imprisonment, the costs of treatment would pay for themselves. The cost of therapy is also not high: about the same as six months’ treatment of diabetes routinely supplied by health systems today.”

In these confessional times, and to do my bit for destigmatisation, let me add my voice to those that say it is impossible in words to fully capture what depression is like.

I won’t bring you down with details, but I have long thought that Winston Churchill’s revival of Samuel Johnson’s ‘black dog’ metaphor never quite captured my experience, which had more in common with being surrounded incessantly by an angry pack of them.

We sufferers know that the early signs of the ground slipping from under our feet again are invariably accompanied by diminished capacity to prevent the slide. Yet, if we are lucky enough to enjoy the right support and circumstances, some of us do learn how to mobilise our remaining resources at the first sign of renewed trouble, and it’s that knowledge that sets some alarm bells ringing for me about the primarily medical focus of the last few days of commentary.

If we are truly to treat depression and anxiety as we would asthma, cancer or diabetes we must surely be similarly focused not just on treatment but also on prevention. This involves building an enabling and supportive environment to strengthen personal preventative responsibility.

Just as we know that pollution contributes to asthma, we know that mental illness has external triggers, such as workplace stress. Indeed, according to the Mental Health Foundation, not only are more than 90 million working days a year in Britain lost to mental illness, but also “work-related stress is estimated to be the biggest occupational health problem in the UK".

So we need not only to treat mental illness with the compassion and care it is due but also tackle the working environments that can contribute to its causes. We need, indeed, to include in our definition of economic and social sustainability a commitment to regimes and relationships in the workplace that keep stress within the bounds required to prevent it causing illness.

Our compassion must include acceptance that our personal capacities and circumstances vary, and that each of us has responsibility to support each other and ourselves to make the most of them without overloading them.

We must treat every lung cancer patient with the utmost compassion and care, whether or not their behaviour contributed to their illness, but we should not let the tobacco merchants externalise their responsibility. Similarly, while accepting that depression is indeed an illness, and treating it as such, let’s not over-medicalise it and avoid the work-related challenges.

Prevention is better than treatment, as well as cheaper, and that means, among other things, changing how we work, how much we work and how we relate to each other at work.

That in turn means that employers must accept their responsibilities for their work environments, and governments theirs to enable all of us to earn our livings securely and healthily.

  • Brendan Martin is founder and managing director of Public World.
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