Neil O’Brien is co-Chairman of the Conservative Party’s Policy Board, and is MP for Harborough.
“Man must either fall in love with Someone or Something, or else fall ill” – W.H.Auden
Over recent decades more people have reported mental health problems. Between 2000 and 2014, the proportion of young women saying they’d self-harmed rose from 6.5 per cent to 19.7 per cent. This happened despite the fact that on average people’s reported levels of wellbeing steadily rose prior to the pandemic.
As well as the suffering of people with mental health problems, mental ill health has huge implications for government. More people turning up at A&E. More need for mental health services. More issues for police and social workers.
More people claiming benefits because of mental health problems, too. Among Employment and Support Allowance claimants, half now claim for mental and behavioural problems: 950,000 people in May 2020. The share claiming for mental health problems increased steadily until recent years. In 1995, it was just over a fifth (21 per cent) or 572,000 people, rising to 39 per cent by 2005, and 42 per cent by 2008. Among 18-44 year olds, two thirds claim for a mental health condition.
The NHS landmark mental health study finds severe common mental health problems (depression, anxiety etc) increased from 6.9 per cent of adults in 1993 to 9.3 per cent in 2014. Problems are worst among young women.
What’s driving the upward trend? We could start by looking at people’s early lives.
A 2017 NHS mental health survey of children found little difference between those with professional parents and manual workers (one per cent difference) or between the richest fifth of neighbourhoods and the poorest (two per cent).
However, having parents on benefits roughly doubled the proportion of kids with mental health problems. That chimes with what the survey of adults found: unemployed adults are twice as likely to have mental health problems. But unemployment can’t explain the rising trend. High unemployment could have started the ball rolling decades ago, but pre-pandemic we were at record rates of employment.
Among secondary school pupils with married parents 12 per cent reported mental health issues, rising to 27 per cent for children in lone parent households. Between 1979 and 2000, the proportion of households with dependent children which were lone parent households grew from 11 per cent to 25 per cent, and then remained at that level, dipping a bit in to 22 per cent in 2019. That seems likely to have contributed to the rise over the longer term.
A suspect for the most recent trend is technology.
Jean Twenge has chronicled the impact of the smartphone and social media revolution on the generation she dubs “iGen”. Having changed little for years, US surveys show young people’s self esteem dropping off a cliff between 2011 and 2015, around the time smartphones became ubiquitous.
Having varied between 27 per cent and 30 per cent since the mid-1990s, the proportion of girls feeling “left out” suddenly shot up to 40 per cent. That’s no surprise: social media shows us the edited highlights of other people’s lives. The proportion of young people missing sleep and showing depressive symptoms also rocketed.
There’s a well established correlation between heavy social media use and depression – the only question is whether one causes the other. But it’s striking that the creators of this tech often won’t let their kids near it. As Sean Parker, first President of Facebook said: “God only knows what it’s doing to our children’s brains.”
Another cause may be the fraying of the social fabric.
The NHS survey found the risk of mental health problems doubled among those living alone. And the proportion of single person households roughly doubled from 17 per cent in 1971 to 31 per cent in 2011. Looking just at non-pensioners, the proportion of households that were single working age people nearly tripled from five per cent in 1971 to 14 per cent in 2011.
But there’s more to it than living alone. Robert Puttnam charted the dramatic decline of American civic life in Bowling Alone.
Onward’s Social Fabric research shows similar trends here. Membership of a working men’s or social club or a tenants’ or residents’ association are down 25 per cent and 38 per cent since 1993. Church attendance more than halved since 1980. By 2018, communities were half as likely to have a local post office than two decades agom and three quarters as likely to have a local pub. The proportion of people who say they stop and talk with neighbours slipped from 73 per cent to 63 per cent between 1998 and 2018. Group membership seems to have particularly declined among young people – fitting the mental health trend among the young.
Perhaps there’s also something qualitative about changes in the economy not captured by the unemployment rate: Anne Case and Angus Deaton’s book Deaths of Despair looks at this.
They show that US death rates from drugs, drink and suicide among middle aged whites flatlined for graduates, but tripled since the mid 1990s for those without degrees. They note that US wages for non-graduates have stagnated or declined for a long time, while the quality of work for many non-graduates declined.
That drives social decay: with worse prospects, marriage rates collapsed far more than among those with degrees. I’ve written here before about how this is happening in the UK, too. Community participation – from voting to membership of organisations to church attendance – also dropped more among the white working class.
In the UK, wellbeing data shows that unemployment, health and family structure matter most, and of course the three are deeply connected here too. But the UK is different to the US. The share of income flowing to workers rather than owners of capital held up, here while declining in the US. To help low income workers here, we really need to raise our productivity. Nonetheless, there’s a massive warning here.
Many wonder, how much of the rise in reported mental illness is people being more likely to say they’re suffering? That’s unknowable.
There’s a good side to more discussion of mental health. People don’t suffer in silence, are more likely to seek help when they need it, and more likely to be listened to sympathetically.
The risk is that we medicalise the human condition. Theodore Dalrymple charted his concerns that therapeutic culture was being internalised by some people in ways that minimised their responsibility for their own actions.
Liberal US progressors Greg Lukianoff and Jonathan Haidt have explored the way reduced freedoms for children (less play, less work, more paranoid parenting) are interacting with bad ways of thinking which encourage people to feel fragile, threatened and to overemphasise emotional ways of thinking. They’re exploring ways to encourage more resilience.
C.S Lewis wrote that there were four types of love that sustain people: affection, friendship, romance and faith. In different ways, the modern world has chipped away at each.
What should we do about all this? It’s welcome that we’re investing much more in mental health services – children’s health service CAHMS has been overloaded for many years. But we need to tackle the causes too.
The creation of a Minister for Loneliness was important, and through the APPG on Loneliness we’ll shortly suggest ways to build on that. This year, we’re taking action to drive unemployment down with policies like Kickstart, and helping people move up to better jobs with things like the skills guarantee.
But it strikes me that action to support family and community life, often seen as rather “soft” areas of policy, are also vital to taming this growing problem – and the growing burden on the state.