Challenging Stigma and Scepticism in the UK’s Mental Health Crisis
- Anna Todd
- 5 minutes ago
- 5 min read
Britain faces a growing mental health crisis, yet the narrative increasingly blames individuals rather than the conditions that shape their lives.
Earlier this year, Sir Tony Blair attracted attention on a popular YouTube channel when questioning the rise in UK mental health spending. He suggested that a rise in self-diagnosis and a trend in pathologising life’s “ups and downs” were to blame. His comments poignantly capture the scepticism surrounding our current mental health crisis and failed to address the question posed to him: why is the UK struggling more than other countries?
I am a resident doctor working in London (South London and Maudsley NHS Trust), nearing the end of my training in General Adult Psychiatry. At work, I’ve seen how social deprivation and service pressures can worsen mental health and limit recovery. The growing trend of blaming those seeking help is alarming. But I am hopeful that as a profession, we have the skills and insight to set the record straight and influence policy towards better investment.
Anti-psychiatry attitudes thrive in the sphere of misinformation and 'them-versus-us' rhetoric. The overarching purpose of this strategy must therefore be to rebuild trust in and respect for the profession, by communication which outsmarts and connects.
Social inequalities and mental health
With the aim of reducing health inequality in England, the landmark Marmot Review (2010), identified several critical social determinants of health, and subsequently produced policy objectives for “fair society, healthy lives”. These ranged from early childhood support to fair employment conditions. Despite recommendations, the 10 years on review (2020) highlighted that life expectancy had stagnated and, even more concerning, that mortality had increased in some age groups.
Since austerity measures were introduced in 2010, “deaths of despair” for example through drug-poisoning, alcoholism, and suicide had increased, suggesting the toll of a weakened social infrastructure. Childhood poverty has risen and youth centres and transformative initiatives, like Sure Start, have closed. This contrasts with evidence that early investment yields long-term social and economic benefits. To follow on from Tony Blair’s comments, it seems that life’s “ups and downs” are becoming extreme.
In the midst of it, inspiring initiatives such as the Royal Foundation Centre for Early Childhood demonstrates a cross-sector desire for improving children’s early life experiences, and a recognition that such protective factors reduce future mental health problems.
So, why the scepticism, since we’ve seen good evidence and communities aspiring for better? High profile, politicised, and non-expert comments, amid a hot-take and sound-bite culture, can well undermine awareness of the mental health crisis.
Stigma lives on, emerging under the guise of “reasonable concern”. Mental health’s complexity renders it vulnerable to misunderstanding and neglect. Politicians frequently condemn a “sick note culture”, deflecting attention from structural drivers of this crisis. But psychiatry has both an ethical and professional responsibility to address stigma, especially when portrayed as justifiable.
How can we do this?
A strategy to reduce anti-psychiatry narratives
Reclaim the Narrative: Public-facing campaigns should vividly bring to focus these social determinants of mental health in the context of our current crisis. This could occur with memorable statements and storytelling: “Mental health starts at home.. At school.. At work.” Connecting early adversity to current presentations at the NHS front-line can highlight the need for a compassionate and urgent public health approach, whilst resisting the drift towards individual blame.
Language guides for politicians and journalists could prevent the misuse and weaponisation of medical phrases; conflating over-medicalisation with over-diagnosis is allowing mental distress to be trivialised. Distress rooted in social deprivation may not require a traditional medical approach, but the underlying suffering remains valid.
Good care of mental illness, regardless of a diagnosis, requires proper formulation and holistic intervention. Long waiting and reduced funding make this less likely, and without timely assessment, the public may turn to self-diagnosis. This is not a crime, but a symptom of cracks in the system. Psychiatry continues to absorb the consequences of societal ills. This does not make the individual less unwell, nor the crisis less real.
Take Stigma Seriously: For some, the experienced stigma of mental illness is worse than the distress caused by the condition itself, coined “the double blow”. The Lancet Commission on ending stigma and discrimination in mental health described stigma as a barrier to basic human rights. The ethical weight of anti-stigma interventions should be reflected in evidence-based designs and careful application.
Recent research by King’s Business School indicates that the limited impact of major anti-stigma campaigns may be explained by the diversity of public beliefs and styles of thinking. Those that tend to categorise, are more likely to stigmatise and also respond better to physical health analogies for mental health. Emerging research also shows that supporting lived experience advocates to tell their story, and using human connection, is one of the most consistently effective ways to reduce stigma.
Audio-visual campaigns can be co-created with charities and foundations, in the hope that with a strong network and a shared voice comes sustainability and consistency that sticks. Political pleas by celebrities can be far-reaching. For example, Ed Sheeran’s recent letter to the government has prompted reform of music education in schools. Perhaps mental health champions can do the same.
Accountability is a key aspect of this pillar. Trivialising mental distress or framing help-seeking as malingering is becoming commonplace in UK politics and can powerfully undermine any anti-stigma campaign. A task force could monitor media, identify recurring themes and flag high-impact stigmatising rhetoric that requires timely and proportionate response. Once rhetoric is named clearly as stigma, the narrative may become less socially acceptable. Involving psychiatry trainees in anti-stigma interventions could also encourage a generation of doctors confident in advocating and clear in their approach.
Mental Health Dividends: Finally, and perhaps most importantly, there must be a clear demonstration that investing now will pay dividends in the future. Money speaks, particularly during times of fiscal constraint.
The Royal College has already made its “Economic Case for Good Mental Health”. The investment is financially sensible, but can we go further to be heard? Whilst being careful to avoid being partisan, strategy could include scrutiny of where public money actually goes, investigating the cost of out-sourced for-profit private services with poorer outcomes. If this is presented as an economical comparison, is the choice to invest back in our services a more comfortable one?
Rising scepticism toward the UK’s mental health crisis ignores both evidence and undermines public goodwill. Psychiatrists are positioned to lead on an evidence-based response. But this will have greater impact if co-ordinated with other initiatives, charities and foundations that already exist within the network. To cut-through misinformation and a simplistic, divisive rhetoric, communication needs to be smart and provoke empathy.
This piece has received the South London and Maudsley NHA Trust Training Programme - Lade Smith Essay Prize"
