Martin Baggaley pulled no punches last week in his assessment of the dire state of mental health. The Medical Director of the South London and Maudsley NHS Trust said the system was in crisis, inefficient and unsafe. In response, junior health minister Norman Lamb said there was “institutional bias in the NHS against mental health” that he was determined to end. He will have his work cut out for him.
As a society, we seem strangely unwilling to face up to the reality of mental illness. The size of the problem, for one thing, is immense. Around 7m people in England currently suffer from a clinical psychological disorder (primarily depression and anxiety) – far more than the figures for cancer and cardiovascular disease combined. There’s also good evidence that individuals with serious mental health problems have a dramatically higher mortality rate than other people, and three quarters of people with a mental illness receive no treatment of any kind. Yet the proportion of the NHS budget devoted to mental health is just 13%.
Part of the puzzle
We can’t simply blame politicians and policymakers for the marginalisation of mental illness. Virtually everyone goes through periods of feeling very stressed, anxious, or depressed, and yet we’re rarely comfortable talking about these problems. Our reticence is so ingrained that it doesn’t only make us unwilling to acknowledge the scale of distress caused by mental illness; it also deters us from properly exploring the reasons why such problems occur in the first place. And one potentially important piece of the puzzle is gender.
The World Health Organization has said “overall rates of psychiatric disorder are almost identical for men and women”. Perhaps fearing accusations of sexism, most mental health professionals would probably agree. And yet the data seem to present a very different picture.
We analysed the best evidence currently available: 12 large-scale, national epidemiological surveys. And a remarkably consistent picture emerged. In any given year, women appear to experience significantly higher overall rates of psychological disorder than men. The most comprehensive of these surveys – the Mental Health Supplement of the German National Health Interview and Examination Survey – found that 25% of men had experienced a psychological disorder in the previous 12 months; the figure for women was 37%.
This doesn’t mean that mental illness is essentially a female issue. Indeed, certain conditions are more prevalent in men (substance disorders and antisocial behaviour problems, for instance). But women are far more susceptible to the most common types of disorder: depression, anxiety, eating disorders, and sleep problems – hence the imbalance between the genders in overall rates. It’s true, incidentally, that while women are more likely to try to kill themselves, men are more likely to succeed. The method chosen seems to be decisive here: women tend to opt for an overdose, while men use more lethal hanging or firearms.
Women under pressure
So if women are more vulnerable to mental illness than men, the obvious question is: why? Some commentators have argued that the figures are a mirage; women are simply more likely to admit to their problems. But the evidence to substantiate such an assertion isn’t there. And there are many other reasons why women may be disproportionately at risk.
Much may come down to the distinctive social pressures women face today. Increasingly, women are expected to function as carer, homemaker, and breadwinner – all while being perfectly shaped and impeccably dressed.
Given that domestic work is undervalued and considering that women tend to be paid less, find it harder to advance in a career, have to juggle multiple roles, and are bombarded with images of apparent female “perfection”, it would be surprising if there wasn’t some emotional cost. These are challenges that can wear away at the self-esteem of even the toughest individual: and low self-esteem is a well-documented risk factor for psychological problems. We should also remember that women are far more likely than men to have experienced sexual abuse, a trauma often implicated in later mental illness.
However, research into the links between gender and mental health is not plentiful. One wonders whether the topic might receive more attention if it were men that were principally affected; or if the illness in question were physical rather than psychological. Because just as women remain disadvantaged in our society, mental health has always been forced to play second fiddle to its physical counterpart.
But given the distress that psychological disorders cause so many millions of people, and with the numbers affected only likely to grow in the wake of the recession, this is a situation that seems increasingly unsustainable. As Baggaley warned - and he is right - we are at crisis point. But we can’t hope to solve it without looking at some of the issues we like to brush under the carpet, one of which is what leads more women into mental ill health.