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Onsite psychiatric services for major employers will save them in the long run

Posted on 17 February 2013 | 7:02am

Here is a copy of the debate in today’s Observer between me and psychotherapist Oliver James, arguing for and against major employers providing onsite psychiatric support for their staff.

Alastair Campbell – I was really pleased to see the headline proclaiming “MPs to get mental health clinic in parliament amid rise in depression and anxiety”. I know the general view of MPs is negative but the vast bulk work hard and under real pressure, so it would be surprising if there was not a considerable number of parliamentarians and staff who would benefit from on-site psychiatric support. 
If one in four of us require help for a mental health problem, why should MPs be different? In fact all that the authorities have agreed to is a £25,000-a-year programme of support. Not much, but a step in the right direction. Parliament is a major employer, and in my view every major employer should provide mental health support services for its staff. It is good for the employer, and in the long run will save them resources, and good for staff. Parliament and MPs should be taking a lead in this, whereas in truth often they lag behind, and as so few MPs have spoken out about mental illness, the stigma tends to get reinforced. 

Oliver James – While I respect your campaign to de-stigmatise mental illness and we might agree that the present government needs its head examined regarding its policies, there are three problems with this plan: 
(1) Will it actually make more employees seek help? I know of a major commercial law firm which (like most large corporations) makes psychiatric support freely available to its overworked and affluenza-stricken denizens. The employees avoid it because it would risk the loss of their promotion prospects. 
(2) I am less sanguine about psychiatry than you. Psychiatrists mostly offer pills and other sticking plasters, like cognitive behavioural therapy (CBT). For the commonest problems, depression and anxiety, neither really work. The major part of the effect of antidepressants is placebo; the patient might as well swallow coloured chalk. Meta-analyses show that 18 months after undergoing CBT, there is no difference between people who had it and those who did not. 
(3) Most fundamentally, to which I would love to hear your answer, how likely is it that this measure is going to change the fact that we have twice as much mental illness in the UK (23%) as compared with mainland western Europe (11.5%)? We need to deal with the underlying causes of mental illness, not tinker with the symptoms.

AC On (1), that is because of the stigma, which is why we have to break it down so that people feel as comfortableake sure  talking about mental health as they do physical health. I did a talk at the Bank of England this week and was really impressed they had a resident psychiatrist and I spoke to people who had benefited from her presence, including senior people. 
On (2), I have benefited both from the expertise of psychiatrists and from medication. 
On (3), good point, but again I think this is because we do not treat mental ill health with the seriousness we should, and again because of the stigma. A small clinic in Westminster won’t change much, but changed attitudes by MPs will, and this might help. There was a report this week from the Royal College of Psychiatrists and Royal College of General Practitioners, which said 16% of the burden of disease in our country comes from cancer, 16% from cardiovascular problems, and 23% from mental disorder. Yet cancer and heart care are taken way more seriously than mental illness. 

OJ If the medics have done the business for you, great. But the evidence suggests you are very much the exception. I suppose I do concede a small part of the stigma could be reduced by the wheeze. However, my core point is that the Human Genome Project is rapidly proving that genes play little part in causing mental illness: the huge differences in prevalence between different countries strongly suggests politico-economic and cultural factors are vital. 
There is now also overwhelming evidence that our electro-chemical thermostatic settings result from care during the first six years of our lives and from prenatal factors, putting us at more or less risk. This vulnerability is exacerbated in later life by high economic inequality, excessive materialism and excessive stress on individuality at the expense of collectivism. We need a total rethink of what our society is for – is it the profits of a tiny few or the wellbeing of the majority? The status quo is not only ecologically unsustainable, but emotionally too. A few corporate shrinks is nowhere near enough, a distraction from the real issues.

AC You are absolutely right that the focus of society should be the wellbeing of the majority, and right too that relentless focus on materialism has not delivered happiness. That is exactly why there should be greater emphasis on mental wellbeing, from cradle to grave, and why we should recognise that we all have physical health, some days good, some days less so, and given the mind is the most complicated part of our being, it is the same for our mental health. I agree a few corporate shrinks is not enough and that a change of attitude is called for. But ultimately parliament has to provide leadership, and in this small step it is doing so. I just hope the bigger steps follow – a reversal in the cuts to mental health services, proper investment in school sport, and above all equality of understanding, services and treatment between physical and mental health. And by the way, the medics haven’t cured me, they just helped from time to time. 

OJ Okey dokey, maybe we are not so far apart. Except that I would advocate very fundamental structural changes, not just attitudes. For instance, politicians must grasp the nettle of the importance of early years. Before three, for their brains to flourish, kids need responsive care from someone who knows them well, preferably at home, preferably from a parent or relative. Who is prepared to stand up and say this and put paying for it ahead of things like a new Trident missile system? 
My argument is that we should follow the Austrian model and effectively pay parents to stay at home (often sharing the care). Equally, Thatcherism created massive job insecurity, higher pay for a few with static pay for the majority, and much more atavistic workplaces, with some of the longest working hours in Europe. These are major causes of our higher mental illness prevalence. Addressing these things, the causes, seems a much higher priority than putting shrinks into corporations (or for that matter, schools, which would be the logical next step). I accept that you are trying to live in the world of the possible and you may say that I’m a dreamer. But I’m not the only one. 

Alastair Campbell is an ambassador for the Time to Change campaign. His ebook, The Happy Depressive, is now available in paperback (Random House, £4.99). 
Oliver James is the author of Office Politics – How to Thrive in a World of Lying, Backstabbing and Dirty Tricks, which is now available in hardback (Vermilion £20)

  • Fiona Ferguson

    As a mother who has brought two adopted girls up from age 5and 6 agree with OJ that they need responsible adults to look after them in the early years .The damage was already done in their early years in care , although now lovely girls , Mental health seeds are planted in the first years of a child life and very hard to reverse.Question whether people would use service as they may judged by their employers ,Counselling may be a more practical answer.

  • Dave Simons

    I don’t usually comment on mental health issues on grounds that I don’t feel that I know enough about the subject, apart from having done psychology as part of a degree and having at the same time had need to consult an in-house students’ psychiatrist, which was like talking to a brick wall. However I find myself mostly agreeing with both sides – if they are sides – in the above blog. However in the case of MPs they will not be seen as taking a lead but only in looking after themselves first, and I think the electorate can perhaps be excused for taking a negative view of such hard-working, honest, public-spirited, self-sacrificing MPs as Chris Huhne and umpteen expense-fiddlers.

  • Anonymous

    Daily Wail on Sunday today having a go at JOF (John O’Farrell), as they have to, I suppose, Alastair!

    http://www.dailymail.co.uk/news/article-2279886/My-disappointment-Mrs-Thatcher-didnt-die-Brighton-bomb–Labours-Eastleigh-candidate.html

    Is a spade a spade, is all I ask, Wail on Sunday, is all I have to say.

  • Anonymous

    ..and yes Guido, one did go to a grammar school, albeit up in the welsh hills, with sheep about, with ref. twitter twatting.

    Or am I being paranoid here? : )

    Oh, Harriet! get it now. Yes, one was paranoid, again, as per.

  • Amateur Mummy

    I wonder how many FTSE 100 or public sector organisations provide easy, non stigmatised access to mental health services (and I don’t mean occupational health)? We could learn a great deal from successful elite sport – notably British Cycling – which has a resident mind expert on hand to bring out the best in their ‘work force’.

  • Anonymous

    Role modeling as a Drama on Stage, would be a way forward, with both service users, carers, and care teams involved in taking part to act in a good script written by a scriptor who has walked in a journey along with service users, carers, and care teams, to give a loud message to the MP’s and the public, how difficult it is to understand mental health. The anxiety around WRAG and SUPPORT Groups, the misassessments by ATOS, etc..Yes, mental health workshops, all is there, it is a paper model, a different method instead should be used

  • Anonymous

    Surprised at you Alastair, got to say. The other guy is just making an ultra left wing party political broadcast. Perhaps he might clarify but based on what he says here depression is caused by poverty and inequality and so if we ended those we’d end depression. Nonsense! We should try to resolve poverty and inequality but we shouldn’t expect depression to end when we do.

    Alastair you know fine well from your own experience that absence of poverty does not mean someone cannot be depressed. Yourself, Lincoln, Churchill, Stephen Fry are all paupers are you?

  • David Meikle

    Yes, BUT! I’d be all in favour of having onsite psychiatric services for government or any organisation of critical mass – BUT – as only as a diagnostic service when it comes to the likes of counselling support. Counsellors aren’t one person fits all. they have to make a comfortable fit with their clients and a choice of one or two provided by the organisation would be wholly inappropriate and may even put people off if they have poor or bad experiences.

  • Anonymous

    Think in-house trick cyclists do their job, Dave S – they just ask you set questions to deduce between the lines of your answers if you going to do yourself, or anyone else, in, mainly. Any other details of one’s life they leave for others to sort out.

    But oh yes, they try and find out if you are smoking too much jamaican woodbines, or doing other substances, that is warping your set mind, of course, too.

  • Anonymous

    Yes, seems Hutchings has put foot in mouth in Eastleigh, with reference local schools there. Oh deary deary me.