It’s World Mental Health Day and I Tweeted earlier:
— eChurch Blog (@eChurchBlog) October 10, 2012
Although I have been wading through the slough of despond for weeks now, I always blog to highlight this important day and now the day is almost over, I’ve finally mustered the strength.
This year the theme for the day is “Depression: A Global Crisis” and David Keen alerts us to an excellent animated film produced by the World Health Organization and written, illustrated and narrated, by Matthew Johnstone.
It’s based on the famous metaphor for depression: The Black Dog:
I dragged myself off to Asda today and at the entrance were representatives of my local NHS Mental Health Foundation Trust, raising awareness of their services in celebration of the day.
I signed their Service User Charter and felt that with some small alterations, a few of their promises could be applicable for the Church:
See from your perspective:
Listen and be guided by your personal experience and expertise about your condition and circumstances
Co-operate with you to provide a positive experience of our services Church Services
Excel and improve:
Work in partnership with you to make sure you are involved in the care we provide.
Be positive, encouraging and focused on your strengths
Value and respect you:
Make sure that you feel welcome and safe in our care environments Church
Treat you with respect and maintain your privacy and dignity
Recognise, record and respond appropriately to the individual needs of people from different communities.
Include you, be open and honest
Provide you with information about our services Church services and how they operate.
Keep you up to date with any changes that affect you.
Support you towards recovering or help you live well with an ongoing condition
The “Treat you with respect and maintain your privacy and dignity” is of particular importance to me.
A few years ago I became quite poorly very quickly, and swiftly found myself in a psychiatric unit. As was the norm for me, I didn’t go around the congregation talking to folk about my mental problems, due to stigma and judgement, and so most didn’t know.
Whilst in hospital my wife phoned the pastor and he accompanied her on a visit to me.
Once recovered and able to attend Church, as I entered for the service I noted furtive looks from some of the congregants and folk keeping their distance at coffee.
It took me some time to discover that the pastor had put me on the ‘prayer-chain’ which encompassed almost the entire Church – and even folk outside the Church – rather than a selected few trusted prayer warriors. Every detail of my condition and circumstances had been disseminated on the prayer-chain, including the odd Chinese-whisper.
Nobody at Church asked me if I felt better, nor indicated they were pleased to see me released from hospital. I was treated as if I had some highly infectious unspeakable lurgy. They just kept their distance. It was made clear that I could no longer be trusted to fulfil functions within the Church.
I left shortly afterwards.
Perhaps my personal experiences and the many people who have contacted me over the years with similar stories – and worse – explains why I feel that mental illness stigma is still such a great tragedy within some Christian communities.
On a slightly different note, today we will see the “one in four” meme bandied around. This is promoted by superb mental health organisations that combat stigma and they employ this statistic which posits one in four of us will suffer from mental illness in our lifetime. Some take this further and claim that one in four will suffer mental problems each year.
Recently this stat has been on my mind and although I fully appreciate its usefulness in promoting acceptance of mental illness due to prevalence, I felt it may be overblown.
As you may notice in the animated video above, the distinction is drawn between ‘black dog depression’ and ‘feeling down, sad and blue’. I wondered if this type of distinction had been incorporated within the “One in Four”.
As I thought through and mused on this, the BMJ published a small paper entitled: “One in four” with a mental health problem: the anatomy of a statistic.
As you may not have access to the document here are some of the findings:
Despite a lack of supporting evidence, the claim that one in four people will have a mental health problem at some point in their lives is a popular one. Where does this figure come from, and why does it persist, ask Stephen Ginn and Jamie Horder
“It’s time to talk” is a campaign currently being promoted by Time to Change, a charity whose aim is to change attitudes to people with mental ill health. On the charity’s website a banner tells us: “1 in 4 of us will experience a mental health problem at some point in our lives, but we still don’t talk about it. What are we afraid of?”
This “one in four” figure has also appeared in government speeches and NHS publicationsIt is the name of a short film and the title of a mental health magazine.
Yet it is not always clear to what the figure refers. Time to Change seems to be referring to lifetime prevalence, while a 2010 advertising campaign by Islington Primary Care Trust stated, “One in four people will experience mental health problems each year.” A statement on the Royal College of Psychiatrists’ website reads, “One in four people has a mental health problem,” implying point prevalence.
The evidence base
The number’s origin is unclear. When one of us (SG) contacted a selection of organisations that use “one in four” in their literature, they cited a number of different sources. The earliest seems to be a 2001 World Health Organization report, Mental Health: New Understanding New Hope, which stated, “During their entire lifetime, more than 25% of individuals develop one or more mental or behavioural disorders (Regier et al 1988; Wells et al 1989; Almeida-Filho et al 1997).”
However, none of the three papers cited contains an estimate of 25% lifetime risk. One did not report on lifetime prevalence at all, and the two that did provide a lifetime figure of rather more than 25% (66% for “all [mental] disorders” in New Zealand and 31-51% in Brazil).
Lifetime prevalence of mental disorder seems never to have been estimated in the United Kingdom. In 2007 the annual psychiatric morbidity survey (APMS) estimated a UK prevalence of 23% in the past week. In numerous other countries lifetime estimates are reported as being in the region of 50%.
We are unaware of any evidence that straightforwardly supports a UK lifetime prevalence of 25%. The APMS past week prevalence most robustly supports one in four as a statement of the UK’s 12 month prevalence, but in this case the UK lifetime prevalence would be expected to be much higher.
A 2005 meta-analysis estimated a yearly prevalence of 27% for the European Union (including the UK), but a 2010 update of this work revised this to 38% a year, as a result of including more disorders such as insomnia and attention-deficit/hyperactivity disorder. This highlights the fact that over the years the consensus on what constitutes mental disorder has often changed.
Different population surveys adopt different definitions, and there is no agreement about whether to treat, for example, a phobia such as arachnophobia as “mental illness.” No major study has considered nicotine dependence or male erectile disorder in their calculations, despite these disorders being widespread and listed in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Nicotine dependence is perhaps responsible for more deaths than any other psychiatric disorder.
Furthermore, surveys such as the APMS establish diagnosis in a very different way from how it is discerned clinically. In the clinic, a doctor works from a patient’s presenting complaint, through their history, and on to mental state examination. By contrast the APMS recruited a large representative sample and used a structured diagnostic interview to screen each participant for a range of disorders. Structured interviews involve a patient answering a fixed series of questions taken from published criteria.
Systematic checking of a symptom inventory in this way lacks the benefit of clinical judgment and simultaneously creates a risk of both over-diagnosis and under-diagnosis. Taken literally, the DSM-IV criteria for major depressive disorder would deem many people depressed after bereavement or the end of a relationship. Conversely, a patient’s imperfect recall or lack of insight into their own psychopathology could lead to under-reporting.
The popularity of “one in four”
Despite these drawbacks, why has this figure proved so popular? We would like to suggest some reasons.
Demonstrating relevance: For journalists, quoting a high prevalence of mental disorder helps illustrate the newsworthiness of stories about mental health.
Fighting stigma: The one in four statistic has been used extensively by charities to advocate the interests of people with mental illness. Much of their recent campaigning has focused on attempting to combat stigma and prejudice through providing a more inclusive vision of mental disorder—one in which it is nothing unusual and a threat to everyone.
Not too big, not too small: If the intent is to raise awareness of the burden of mental illness, why do organisations not cite the even higher, and better supported, figures of one in three or one in two lifetime prevalence? We suggest that one in four is high enough to gain people’s attention but not so high that it provokes incredulity, as claims that over 50% of people have had a mental illness indeed have.
The one in four figure for mental illness prevalence is widely quoted, related variously to lifetime, yearly, or point prevalence. The evidence indicates that it is best supported as an estimate of yearly prevalence. However, estimates of the population prevalence of mental disorder should be approached with caution, as the methods used often have shortcomings. It is important that people know that mental illness is common and that treatment of mental disorder is essential, but it is not clear that championing a poorly supported prevalence figure is the way to achieve this.
I agree. The work to de-stigmatise mental illness is vital, but must be achieved using scientifically valid stats; otherwise, the cause may be undermined.
I believe that mental health stigma within the Christian community remains one of the toughest and important challenges facing the Church today.
The Church needs equiping and the ministry Mind and Soul work towards this and they have a solid piece up for World Mental Health Day.
Tags: Mental Health