Mental health services are creaking under the pressure of rising demand

Should we open our minds to new approaches?

December 07, 2022
© Illustration by Ian Morris
© Illustration by Ian Morris

Public attitudes to mental health have transformed, as increasing numbers reject the stigma historically attached to conditions such as anxiety and depression. In 2021, the British Association for Counselling and Psychotherapy conducted a survey of more than 6,000 people and found that, compared to five years ago, 83 per cent think it is more socially acceptable to discuss mental health.

One of the effects of this shift in social norms is that our health infrastructure is creaking under the pressure of increased demand. Simply allowing this degree of need to go unmet is not an economically sound strategy—the annual cost of mental health conditions in the UK is estimated to be almost £118bn, more than public sector expenditure on education in 2021–22.

Covid-19 has only exacerbated the problem. A study in the Lancet medical journal estimated that globally there were around 53m more cases of depression in the wake of the pandemic, a 28 per cent increase from before 2020. Workforce issues are also impacting the availability of mental health services, with calls for more psychiatrists to be trained so that long waiting times can be tackled. Given the resource-intensive nature of many kinds of therapy, what mix of treatments is likely to represent the most cost-effective strategy, given other budgetary pressures?

It has been noted that the flurry of research and development activity in the 1950s and 1980s (which led to the development of antidepressants and antipsychotics) has not been followed by similarly significant breakthroughs in pharmaceutical treatments in recent decades. Yet, at the fringes, we are starting to see new, sometimes controversial interventions being developed as alternatives or complements to existing treatments, such as the use of hallucinogens to treat depression or virtual reality to tackle conditions like post-traumatic stress disorder. Earlier this year, a startup called Clerkenwell Health opened Europe’s first commercial facility for psychedelic drug trials in London, with the goal of making the UK a global leader in the field.

If attitudes to mental health have evolved over recent decades, an even more rapid shift has taken place in our awareness of the impacts of loneliness. In 2018, then prime minister Theresa May launched a loneliness strategy and the UK created a “minister for loneliness” to spearhead change. 

Feelings of loneliness are often linked to early death. The underlying drivers of loneliness are poorly understood, varying significantly between individuals. But long-term trends around the use of digital technologies, remote working and an ageing population point to the need for a sustained policy focus on how to support strong social connections. Identifying the best-evidenced and most affordable interventions will prove a complex task.

Our contributors believe it is time to open our minds to new approaches. Imran Khan argues we need to dislodge political inertia around the potential of psychedelics, while Daniel Freeman argues that virtual reality treatments should feature more prominently in the therapeutic toolkit. To counter the rising tide of loneliness, Alex Smith calls for renewed investment in our social fabric, funded by a levy on automated retail transactions.

This article first appeared in Minister for the future, a special report produced in association with Nesta.