Can We Afford Mental Health?

T H E objects of the present paper are threefold: firstly, to take a long, hard look at the concepts of mental health and mental illness; secondly, to subject to critical scrutiny the present-day functions of psychiatry and psychiatrists within the National Health Service; and thirdly, to try and establish the point, that we may never be able to afford a mental health service which is comprehensive in any reasonable meaning of the word. That such a paper should be necessary at all is the result of the fact that psychiatry has been oversold. In the words of Professor Neil Kessel (1963), 'Partly because it has oversold itself, psychiatry has become oversubscribed. It is a mid-twentieth century panacea, and some psychiatrists are far from educating the public otherwise'. It seems to the present author that one of the factors involved in this over-selling of psychiatry has been the emphasis on mental health and mental hygiene, and on attempts to prevent mental illness by social measures. There is obvious attraction about such simple concepts, analogous to the prevention of certain infectious diseases by hygiene, water purification, better standards of food handling etc. It is as if one could cut down the bill for treating mental illness by some simple manoeuvres aimed at persuading people to wash their minds before meals. Another factor which has undoubtedly contributed is the affluence of American society and the growing affluence of our own. Professor Galbraith in his book The Affluent Society has suggested that when consumers have satisfied their more pressing needs for cars, washing machines and refrigerators, they tend to wish to purchase happiness, and turn to the psychiatrist as the most appropriate vendor. This would be a most happy situation for both parties if the psychiatrist could sell what the consumer wants to buy. Unfortunately, there has been a fairly widespread conspiracy of dishonesty so that the psychiatrist seems to promise a cure, and the patient, needing to believe in the psychiatrist's powers, conspires with him to maintain the myth of the efficacy of psychiatric treatment.