Introduction: No health without mental health

Let us start with the context. An estimated one in four of us will suffer from a mental health problem at some point in our lives. Of the 2.6 million people claiming long-term disability benefits in 2012, 43% had a mental or behavioural disorder. This huge level of suffering comes at a cost: emotional, social and also financial (in 2012, £105 billion per year, a figure expected to double in the next 20 years).

These statistics come from the Coalition government's 2011 strategy paper No health without mental health (HM Government, 2011; hereafter, NHWMH). The paper focuses on England but recognises that the issues that it addresses resonate across the UK. It lists as ‘vulnerable groups’: children (with one in 10 between the ages of 5 and 16 having a mental health problem that may persist into adult life); women with postnatal depression (experienced by one in 10 mothers); and prisoners, 90% of whom have a diagnosable mental health problem. NHWMH also acknowledges the risk factors for ‘many people from black and minority ethnic [BME] communities’ (HM Government, 2011, p 8). It uses the language of ‘social justice’ and ‘challenging stigma’ and (perhaps reflecting the influence of Wilkinson and Pickett's [2010] seminal text The spirit level) acknowledges that ‘Social inequality of all kinds contributes to mental ill health’ (HM Government, 2011, p 2).

NHWMH, then, links ‘mental health objectives’ to action points, whether ‘under way’, ‘new’ or ‘ongoing’, and the named government department responsible for seeing the objective through to completion. One of the major strands in this strategy is Improving Access to Psychological Therapies (IAPT), with a further investment of £400 million for the New Labour government initiative that purports to offer a choice of psychological therapies for free within the NHS, although NICE, the body authorised to approve ‘evidence-based’ practice across the health field, currently limits this to Cognitive Behavioural Therapy (CBT).

NHWMH pledges that, together, government and professionals will ‘give weight to both mental and physical health … our ambitious aim [is] to mainstream mental health in England’ (HM Government, 2011, p 2). This has every appearance of a sustained campaign at the highest levels to reach a different understanding of ‘mental health’, progressive even in not viewing mental health as mysterious and ‘out there’, but as central to the structures, and spirit, of society.