Even before Covid, one out of every four of us was on track to personally experience some kind of mental illness. Since 2020 those numbers have skyrocketed. Today, for most of us, mental health is personal.
It is for me. Since I experienced my first psychosis as a 19 year old, my life has veered between terrific highs and terrifying lows. Medically speaking, I’m crazy.
But Covid made me question this. If pretty much everyone in the world can be struck down by mental health problems, maybe it can’t be fixed with meds and therapy alone. Covid left me asking – are we doing this mental health stuff wrong?
Almost every public discussion about mental health assumes the answer lies in the healthcare system. The argument goes something like this: if only there were more accessible doctors, psychologists and hospital spaces, and if only all those services were cheaper, then we would have better outcomes. On its surface, the utter brokenness of the mental healthcare system gives credence to the claim. If you have ever needed urgent mental health care, and let’s face it most serious cases of mental illness are explosive urgent crises, you will be familiar with the Kafkaesque endurance marathon of phone calls and appointment begging required to find help.
I know this. Several years ago in the grip of a psychosis, my GP desperately called around for hours, finally securing a psychiatrist appointment – in four weeks time. Terrified by the delay, he prescribed me so many antipsychotic medications that I put on 10 kgs in two weeks. It worked, sort of. I got through. But too often it doesn’t work. We need better access to specialist healthcare.
But what if this whole solution was a red herring? What if changes to the mental healthcare system, big or small, could never truly address our growing mental illness crisis?
The language around mental health is relevant here. Mental illness and mental health are defined, described and understood as healthcare issues. This might look benign, but it’s holding up a story that isn’t helping.
A healthcare approach subtly but firmly frames mental health as a personal issue, where solutions to mental illness are to be found between patient and doctor. Expert doctors offer help: ‘Hello patient, you say you have anxiety or bipolar, well that’s an illness and I have medical answers.’ Doctors, with the best of intentions, help where they can. This help is in high demand if the astronomical escalation in prescriptions for depression and anxiety medication is any guide.
Mental health is complex and often requires nuanced intervention, like a combination of medication and talk therapy, or even temporary hospitalisation. But no matter what path you take, all individualised healthcare focuses on the same goal. Its aim is to help you – the person living with a mental illness – get back into the world.
But what if ‘the world’ is actually the problem?
If the world is the problem, then framing mental health as a personal healthcare issue has an ideological quality. Like the fairy tales of capitalism that grimly imply that individuals have the freedom to shape our own lives while obscuring hoarding capitalists enforcing a diet of poisoned apples, and a lifelong necessity to turn up to work. A personal healthcare approach tries to convince you that the state of your brain is about you as an individual, and not about the world in which you live.
Like most people who live with a mental illness, for decades I’ve been told by a variety of medical experts that I suffer from chemical imbalances in my brain. This may very well be true. But the problem is that this convenient medical trope utterly obscures the triggers and sources that set off those chemical imbalances. The ‘it’s all about your brain’ narrative is a bait and switch. The triggers that spike, stimulate and exacerbate mental health crises do not neatly reside inside the skulls of a few unlucky individuals, nor can they be compartmentalised into the dynamics of their private lives. Most of the egregious triggers that spark or exacerbate mental illness crises come from public life – where we work, where we learn in school or university, the robotic welfare system, from our life online, or in our community or cultural organisations.
Aggressively competitive workplace cultures, bullying, overwhellming performance goals, a lack of control over how you do your job, excessive supervision, the expectation of 24-7 device-based work, and flat out discrimination, create a pretty perfect petri dish of mental illness stimulants. But today, when someone experiences a mental illness crisis at work, the typical response is to send them off on sick leave (or too often, kick them out the door). Doctors are then left to work with the individual, and provide medication or talk therapy. This is so frighteningly common that I’ll bet you know someone who’s gone through this. We treat these pernicious patterns as remarkable coincidences; as though each case is just another example of wacky brain chemistry at work. Never do we ask – let alone scream – what the fuck are workplaces doing to our brains, and in what way is work feeding the mental health crisis?
Bait and switch.
We have a well-intentioned healthcare sector pleading for resources to help them respond to a mental health crisis that is escalating out of control. Yet the healthcare frame that credentials their advocacy reinforces the assumption that mental illness is a personal medical issue. This private frame averts our collective attention away from the big public systems and broken cultures that are feeding the growing mental illness crisis.
Remember the parable of the ambulance at the bottom of the cliff. People were falling off a cliff and an ambulance was dispatched to treat the injured. But people kept falling. The crisis only ended when someone went up to the top of the cliff and built a strong fence that stopped people falling in the first place. Mental illness will always need healthcare. But you know what it also needs – a strong fucking fence.
If the cultures and expectations of public institutions like work and school are feeding our mental health crisis, then building a strong fence means changing those institutions.
Just to be clear, I am not suggesting that work or school ‘cause’ mental illness. Plenty of conditions, like my own, have long complex foundations. But public institutions do have a choice about how they engage with our mental health. They can choose to be places that embrace brain differences like mental illness and create spaces where everyone can thrive. Or, they can at least try to minimise and mitigate how they trigger stress or depression. Or, they can remain bottom feeders, running business models that chew and churn the psychological health of those they encounter. Right now, whether by choice, disregard or neglect, too many public institutions are sucking us dry. They are why our collective mental health is fucked.
Covid gave us all a lot of quiet time. As I walked the same loop around my suburb everyday for months, my most constructive rumination was that the 25 years I had spent as a professional social change maker might offer some ideas for how we get out of this mental health mess. Up until that point I’d never put my bipolar life and my changemaking careers together. It took a shadow mental health pandemic and limited social contact for me to see that a collective-focused changemaking mindset might build a mental health fence.
There was one phrase from community organising that I kept coming back to: ‘the public dimensions of our private lives.’ I used to work at the Sydney Alliance. In that job, we worked with thousands and thousands of union and community members, and congregants to help them collectively respond to the challenges they faced. Because it was Sydney, lots of people talked about housing. Whether people talked about the stress of paying rent or feeling like they could never afford a home, there was always one thing in common – initially they would describe their stress as a private, personal problem. People felt like failures. They would blame themselves, lamenting that if only they had gone to university or earnt more money that things would be different.
I listened. But as a community organiser, I also pushed them to see things differently. We did research together, learning about the bigger causes of housing stress, uncovering the role of regulation, negative gearing, investment, and the lack of affordable housing supply. These conversations often happened during large listening campaigns where many other people talked about facing similar challenges. As people connected their personal housing struggles to these broader causes and saw how others faced similar challenges, they changed. Seeing the public dimensions of their private lives helped them realise that they weren’t a failure. But more than that, by seeing those bigger causes they saw how they could be changed if they worked together.
Could we take this idea and apply it to mental illness? What if we started talking about the public dimensions of mental illness?
This would be a hard road to climb. The stigma around mental illness is iridescent. Every single person that lives with a mental illness must constantly calculate who they can trust to share their story. I know the pain of having your mental illness weaponised against you; as whispers behind your back or losing your job. But I’ve also learnt that trying to escape public pain by running to the sanctuary of the private world is wishful thinking. Taking personal responsibility through medication, therapy, exercise, diet and sleep are vital, but they will never be enough to build a good life.
I will always move high and low. I’ve spent a long time trying to change myself to fit into the world as it is. My journey has taught me that I need to change the world as it is so it can better fit people like me.
This kind of change doesn’t just help me, nor does it only help the one in four people in your life who live with a mental illness. It helps everyone. My brain is like a canary in the cave. I speed up and stop sleeping when exposed to excessive stress. But what is super-sensitive to me isn’t good for any of us. Most of us struggle with impossible workloads or with education systems made brittle from unforgiving competitive rigidity. Most of us sense that something is wrong, but we struggle to name it. This is the power that comes from seeing the public dimensions of mental health. This collective changemaking mindset lets us see how the painful patterns of anxiety, depression and other serious mental health conditions are not just in our minds – but are triggered by the destructive cultures that dominate too many workplaces, schools and other institutions.
Most powerfully, a changemaking mindset doesn’t just diagnose a problem – it opens a door to say that public institutions can change. If problems are public and shared, then they aren’t just your problem, they are “our” problem. Collective problems are not just something we need to privately grin and bear, they are things we can change. Our collective mental health might be fucked – but we can unfuck it if we turn our thinking on its head and change the institutions that keep triggering the problem.
This is how we build a stronger fence.