08 October 2013

Mental health

Spiked's Tim Black asks lecturer and psychiatrist Joanna Moncrieff  "'Why are there so many more people being given a diagnosis that demands the prescription of powerful antipsychotics?' Moncrieff is quick to answer: ‘That’s an easy one - it’s the pharmaceutical industry.'"

That's probably part of the answer. But as the discussion continues it's clear that societal changes are another, possibly more significant, reason.
The withering of old forms of informal social life, the corrosion of the traditional mechanisms of support and struggle, be they based in politics or faith, [have] left the individual in a potentially more helpless position.
Dr Moncrieff sums it up: 'We’ve become a much more atomised society ... one in which suffering and difficulties are located increasingly not in the social world but in the individual. So previously, if someone was depressed, not happy, not coping with life, that was a social or a family problem. But now it’s the individual that needs to be rectified rather than the system around them.’

I know a lot less than Dr Moncrieff or Mr Black about psychiatry and mental health. But my concern is, I think, relevant. It is that we do not have the institutional structures in place that will identify major causes of suffering as they change over time and then do something to alleviate it. Instead we have institutions whose sole concerns are, essentially, self-perpetuation and self-enrichment; any overlap between achievement of their goals and solution of society's problems is coincidental.

Yes, we have drug companies, whose motives and methods are increasingly at odds with society, but who are powerful lobbyists and capable of influencing the regulatory environment in their favour.

But social atomisation involves more than drug companies: it probably has much to do with town planning, transport policy, immigration policy, government welfare schemes and much else besides. The point is that we do not have incentives in place that will encourage people to investigate these - and other possible - causes and do something about them. The reverse, in fact: our de facto and default targeting of GDP as the greatest social goal, and the short-term interests of corporations and politicians, mean that social atomisation is hardly seen as a problem. Big pharma benefits from depression, after all, and it's certainly not in the interests of powerful corporations to question things like the apotheosis of the car or coercive multiculturalism.

In today's policymaking environment it's more profitable to treat depression, however ineffectually, with pills than to look for long-term, possibly more edifying solutions, that could threaten the narrow interests of corporations and their clients in government. It's highly likely that those corporate interests are doing much to create depression in the first place, and it's even more likely that it's in nobody's interest to find out for sure.

A Social Policy Bond regime would work differently. It would certainly not take today's intitutional structure as a given. It would take a serious look at mental health, depression and social atomisation and construct reliable metrics that could be targeted for reduction. Investors in Mental Health Bonds would themselves benefit by looking at all potential causes of and solutions to problems like depression and doing whatever is required to alleviate them. In doing so, their interests and those of wider society would merge - in stark contrast to today's policymaking world.

No comments: