Dr Antonis Kousoulis
Former Director of England and Wales
This content mentions abuse and violence, depression and personality disorders, which some people may find triggering.
As we celebrate our 70th anniversary in 2019, it is important to reflect on how much the Mental Health Foundation has achieved in 70 years.
We have seen a momentous shift in public opinion of mental health and policy surrounding it, as well as treatment and care of people with mental health problems.
We have focused on the social issues surrounding mental health, taken multidisciplinary approaches, empowered people through co-production, peer support and recovery in the community and allowed our research to inform our work on prevention of mental ill-health.
70 years of our values
Over 70 years, we have not lost sight of our values, which have become firmly embedded in our way of working. We place an emphasis on prevention, including understanding causation and development of mental ill-health.
Moving from a disease-focused model towards a holistic model. The holistic model considers social circumstances and inequalities in public mental health thinking.
Our history highlights how our public health and prevention emphasis has remained strong:
Our inception in 1949 as the Mental Health Research Fund (MHRF), after the Second World War and the foundation of the NHS, was born out of the urgent need to get research funding for mental health.
The Fund was set up by Derek Richter, a neuro-chemist frustrated at the lack of attention mental health research was getting and the disparities between physical and mental health funding. He said at the time:
I am getting tired of this perpetual fight to get small sums of research, when our colleagues working in cancer and TB are almost embarrassed by the money being thrust at them.
Derek was a keen advocate for researching the social causes of mental ill-health, setting up a wartime research laboratory for treating shellshock after the Second World War and writing several humanitarian books. Concentrating on the social determinants of mental health remains our strategic focus today.
In the 1950s, ignorance about mental health meant that there was extreme stigma and fear surrounding it. People with mental health problems were considered ‘lunatics’ and ‘defective’ and were sent off to asylums. ‘Insanity’ was thought to be incurable and there was no incentive to treat it.
Amid this prejudice, stockbroker Ian Henderson partnered with Richter as Chairman of MHRF. Sir Geoffrey Vickers – distinguished lawyer and scientist – later became Chairman of the Fund’s Research Committee.
The first major, multi-disciplinary psychiatric research conference hosted by MHRF took place in Oxford in 1952. It brought together a range of experts from different fields, enabling cross fertilisation of ideas in way that hadn’t previously happened. As Henderson explained:
[MHRF's] outlook is … not wedded to any particular approach to this many-sided subject.
MHRF began to radicalise the system by awarding research grants for mental health for the first time in 1955.
MHRF awarded student psychiatry fellowships and university posts in 1960. This was ground-breaking. For the first time, between the 1950s and 1970s, academic careers in psychiatry were kickstarted where previously it had not been considered a science. Treatment was transferred from asylums in to hospitals, and public visibility of mental health problems increased in a taboo ridden society.
In the 1960s, MHRF also began to influence policy to turn research into practice. Henderson described the motive behind their policy involvement as:
not only to add to the total sum of research, but also to serve as an advisory body concerned with developing the field on a much wider scale.
1972 saw the merging of the Mental Health Research Fund with the Mental Health Trust and, in 1973, a renaming of the newly formed organisation to the Mental Health Foundation.
In the 1970s, we paved the way for modern mental health research by focusing on the day-to-day experience of people living with mental health problems at a time when research was solely laboratory focused. Putting people with mental illness at the centre of our work and learning from them is something that we still do today, by implementing peer-to-peer and self-management strategies that help people to help themselves and others.
In 1974, we opened our Glasgow office, which today has developed a unique and influential role against the backdrop of a country containing some of the world’s most advanced mental health policy. We have helped develop the Scottish government’s progressive approach to mental health improvement and have been tenacious in influencing Scottish policy and leading innovative initiatives. We also run several innovative projects in Scotland, with vulnerable groups like refugees and young mothers.
In the 1980s, we developed mental health research into a viable academic career. There were 49 psychiatry professorships in universities and medical schools compared with two when we started.
We had allocated £1.5 million in research grants by the end of the decade to make landmark discoveries; for example, on the connection between physical and mental health, the cost of mental health problems and the relationship between mental health and brain chemistry.
We were instrumental in developing support for community care and rehabilitation schemes at a time where newly established community services couldn’t cope with demand.
We took steps to increase the influence of people with lived experience in mental health decision making, starting with funding the first service user consultative events in 1985. Following these events, we published a series of important publications and set up some user-led mental health networks, starting with "Survivors Speak Out" (1986) and then in the decades that followed "Knowing our own minds" (1997), "Strategies for Living" (2000) and the "National Survivors User Network" (2003). These publications and networks helped people manage their own mental health and take control of their own lives.
40th anniversary
Our main achievement at our forty-year anniversary mark in 1989 was that we had grown public awareness of mental health, through giving a voice to normal people and their lived experience.
It was also no longer acceptable for mentally ill people to be confined for long periods of time in institutions. We had contributed to a revolution in the care of people with mental health problems, helped to enable the training and practice of professionals in psychiatry and alleviated a lot of outdated fear and misconception surrounding mental illness.
Sir David Plaistow, Chairman and Chief Executive of Vickers plc commented at the time:
The measure of the Foundation's achievement is that for millions of ordinary people the fear, stigma and suffering associated with mental illness is now a thing of the past.
But there was still a lot more to do. Mental illness remained the most neglected area of public health in the 1980s, despite being the most widely suffered of the disease groups. Incidents of mental ill-health were still high. There had been no decline, despite the progress that had been in helping people to better cope with their mental health.
We went into the 1990s with a mission to be the ‘‘authoritative centre of knowledge and expertise that sets out to influence and bring about change.’’
We identified areas for development and spent more money on social research for the first time, to work on the ground with people experiencing mental health problems. We made our first inquiries into community care and mental health experiences of young people and children, which was an area that had not been thoroughly explored before. We recognised that, "intervening effectively yields huge benefits in reducing a number of problems that are of concern to government, school, parents and children."
The extent of the UK’s mental health problem was revealed in the 1990s. One in four people had experienced mental ill-health and shockingly the proportion of NHS expenditure had fallen from 15% in 1958 to just 11% in 1993.1 £72 was spent on a mentally ill person’s care in hospital per day, but only 29p was spent on their care in the community.[1]
Stigma was still prevalent, with people with mental illness being portrayed as ‘dangerous’ in the media. In the face of these challenges, we started to publish key social research publications about everyday mental health experiences. By asking people their opinions about services and treatments, we were able to bring together statistics and facts on mental health in an accessible way for the first time.
The 2000s saw us pioneering our role in promoting good mental health for all - not just those with mental health problems.
Mental health rose up the public agenda. There was concern over the effectiveness and safety of drug treatments and a rising interest in non-medical and self-help approaches following a trend in user-led initiatives. We were embracing medical and non-medical approaches to work most effectively in a holistic way.
We launched a new website in the 2000s described as ‘‘the most comprehensive European resource on mental health’’ which received millions of views. We set up Mental Health Action Week, now called Mental Health Awareness Week in 2001, which took mental health campaigning to scale for the first time.
The theme for the first campaign was friendship and mental health. Mental Health Awareness Week is now in its eighteenth year and annually the campaign gets bigger and the reach gets wider. This year we focused on body image, receiving four times as much media presence as last year. Mental Health Awareness Week is now the UK’s biggest health awareness week.
We released ambitious campaigns in the 2000s that were user-led and reached out to people who were ‘at risk’ but hadn’t yet experienced mental health problems. By encouraging everyone to be concerned about their mental health, we helped to tackle the stigma around ‘otherness’ and paved the way for our successful prevention focus today.
In 2007, we launched The Scottish Mental Health Arts Festival, which is the largest of its kind in the world and is replicated internationally. The Festival engages with artists and communities to celebrate the artistic achievements of people with experience of mental health issues and the link between creativity and the mind.
In the 2010s, we explicitly shifted our strategic focus to mental health prevention at primary (everyone), secondary (those at risk) and tertiary (relapse for those with diagnosed mental health problems) levels.
We recognised that ‘‘a world with good mental health for all is a vision that will take a global movement to achieve. It can only be achieved by a fundamental reassessment of the power of prevention to support mental health’’. Our programmes reach covers England, Scotland, Wales and Northern Ireland.
We set up an office in Cardiff in 2014 which advocates for mental health policy and runs several projects including with older people, school children and single parents. We carry out important research and we offer training to prevent mental distress.
We must continue to drive change today
Our reason for continuing to focus on prevention today is that mental health problems are an ever-growing public health concern. A recent index of 301 diseases found mental health problems to be one of the main causes of the overall disease disability worldwide2 and depression as the leading cause of disability in the world.
Economic costs of mental ill-health
The economic cost of mental ill-health in the UK is grave, at £5.4 billion in 2015, with over 91% of this amount being due to those leaving the labour force entirely.[3] One in six (17%) people over the age of 16 had a common mental health problem in the UK in 2014.[4] The World Health Organization (WHO) estimates that between 35% and 50% of people with severe mental health problems in developed countries - and 76% to 85% in developing countries - receive no treatment.[5]
Inequality between mental and physical health treatment
The inequality between mental and physical health treatment is also a big concern. Current NHS waiting times for mental health services in the UK are often too long, compared with waiting times for physical illnesses. Sometimes, people can be waiting a year or more for therapy, and during this time, their situation can rapidly decline. A report by Young Minds found that three-quarters of young people referred to NHS mental health services waited so long to be seen that their condition had deteriorated by the time they got to a doctor.[6]
More crisis response for mental health is needed
Crisis response for mental health emergencies is often not there. Some hospitals may see people going through mental health crises at A&E, but some won’t. Apart from charity helplines, not a lot of support exists for people who feel suicidal and need immediate help. Life expectancy is also affected. People with severe mental illness also do not live as long as people without. For example, people with schizophrenia and bipolar disorder die on average 10 to 20 years earlier.[7] Suicide is the most common cause of death for men aged 20 to 49 years in England and Wales.[8]
Mental health stigma still exists
Stigma, while not as extreme as when we started, is still widespread. People - especially men who feel pressure to be ‘masculine’ and not talk about feelings - are still afraid to talk openly about their experiences or reach out to get the support they need. 48% of people said they would feel uncomfortable talking to their employer about a mental health problem. 40% of people still believe people with mental ill-health are prone to violence when mentally ill people are far more likely to be the victims of crime rather than the perpetrators.[9]
A survey in 2017 by Rethink Mental Illness found that of 500 hiring decision-makers or influencers, 83% would worry that someone with a severe mental illness would not be able to cope with the demands of their job.[10] According to NHS statistics in 2017, only 43% of all people with mental health problems are in employment, compared to 74% of the general population.[10]
There is also stigma in public services. People with mental health problems were more likely to report that the police had been unfairly compared to the general population.[11-12]
Mental Health Foundation, 2019The challenges are many. But not disheartening. So let us look forward to the next 70 years and embrace this challenge of prevention. And when we achieve the promised progress, we will look back and see that this was our time’s greatest contribution to human flourishing.
Dr Antonis Kousoulis - Director of England and Wales at the Mental Health FoundationLet us look forward to the next 70 years and embrace this challenge of prevention.
Where we’re going next
The recent evidence shows that we still have work to do. MHRF was set up in 1949 to fill a much-needed void in mental health research. Now, in 2019, the Mental Health Foundation is celebrating its 70th anniversary.
In 70 years, we have transformed knowledge of mental health, how it’s caused, treated and prevented. We have helped move services towards the community and away from hospitals and asylums. We have opened the public’s eyes to the need to protect their mental health and prevent problems from occurring and we have set up programmes to help people at all stages of life. Positive steps have been taken towards researching and understanding mental health and there has been vast improvement in mental health services.
However, the numbers of people experiencing mental health problems is rising, waiting times are too long, the economic and social cost is still too high and stigma is still prevalent.
Drive change towards a mentally healthy society
In the coming years, our goal is to drive change towards a mentally healthy society and support communities, families and individuals to live mentally healthier lives, with a focus on inequalities and those at greatest risk. We will keep making the case for prevention and ensure that there is even greater public understanding of mental health and its causes, so that more people practice effective self-management techniques to stop their mental health deteriorating.
Share our work with others
We will generate and share what works, through our co-produced and evidence-based programmes, and provide more breakthrough information on prevention of mental ill-health, so that there is a significant reduction in diagnosable levels of mental ill-health and suicide rates.
Expand our policy and campaigning
We will make sure prevention is considered in all new policy decisions. We will inform and empower people through public engagement and campaigns to enable mentally healthier lives. We hope that as a result of our tireless mission to deliver good mental health for all, more people at risk of mental ill-health will receive necessary interventions and protection, and people will be better able to look after their mental health in a stigma-free environment that allows them to thrive.
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- https://www.mentalhealth.org.uk/sites/default/files/2022-09/MHF-brief-history-60-years-2009.pdf
- Vos, T., Barber, RM., Bell, B., Bertozzi-Villa, A., Biryukov, S., Bolliger, I., …Murray, CJ.. (2013). Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: A systematic analysis for the Global Burden of Disease study. The Lancet, 386(9995), 743–800.
- ONS. (2016). UK Labour Market: July 2016. Retrieved from ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/bulletins/uklabourmarket/july2016 [Accessed 08/09/16].
- The Adult Psychiatric Morbidity Survey (APMS) 2014
- Demyttenaere, K., Bruffaerts, R., Posada-Villa, J., Gasquet, I., Kovess, V., Lepine, J.P., … & Chatterji, S. (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA, 292(21), 2581–2590.
- https://youngminds.org.uk/media/2620/a-new-era-for-young-peoples-mental-...
- https://www.nationalelfservice.net/mental-health/schizophrenia/people-wi...
- https://www.mentalhealth.org.uk/explore-mental-health/mental-health-statistics/suicide-statistics
- https://www.time-to-change.org.uk/sites/default/files/Attitudes_to_menta...
- Rethink Mental Illness 2017
- NHS 2017
- Pettitt, B., Greenhead, S., Khalifeh, H., Drennan, V., Hart, T., Hogg, J., … & Moran, P. (2013). At risk, yet dismissed: The criminal victimisation of people with mental health problems. London: Victim Support.
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