"We're very punitive. That's fed by sound bites about 'hard-working people' and all of that. It's not the only factor, but it feeds the general idea of social unacceptability," says Bogg. "Because actually we all just want to belong somewhere. You can cope with a lot of things if you have something to anchor you. But if everything's falling apart, then what have you got left?"Mental health services don't get their fair share of NHS funding. A 2012 London School of Economics study concluded that mental illness accounted for 23 percent of the NHS's disease burden but got 13 percent of the cash.A 2012 study concluded that mental illness accounted for 23 percent of the NHS's disease burden but got 13 percent of the cash
She received help after six months. But she eventually needed several hospital admissions. There was a young person's unit five minutes from Nikki's house, but it was always full. So Nikki ended up in hospitals up to 30 miles away. It made it difficult for friends and family to visit."When you're ill you need people that you know and love around you to remind you of why you want to get better. When you're sent away you can't really have that," she says.But have services ever been up to scratch or are problems just receiving more attention now?I asked Bogg, who has been a social worker in mental health services for more than 20 years, how the current state of services ranks. "Services haven't always been great but it has got tighter and tighter in terms of what we can offer," she says. "The chance to build up relationships has pretty much gone. Have I known it to be under as much pressure as it is now? No. We see services cut, beds cut, staff cut… everything."Ask people working in or using services why our services have been allowed to be cut back and they tell you that mental health has long been treated as a second-class part of the NHS.For Sir Simon Wessely, chair of the Royal College of Psychiatrists, the inequality rears its head in different ways. General hospitals are full of flowers, but mental health wards are often bare. Some medics still treat psychiatry as a lesser branch of medicine and some mental disorders are dismissed as "not real illnesses." The same bias means mental health services are low down the pecking order when local NHS commissioners carve up their slice of the £97 billion ($145.8 billion) NHS budget.A Royal College of Psychiatrists survey of more than 500 doctors found that 28 percent had sent a "critically unwell" patient home because they couldn't get a bed.
There have been other steps forward. The coalition also introduced the first ever mental health waiting time targets. By this time next year more than half of people experiencing psychosis should get care within two weeks. At least 75 percent of people seeking talking therapies should be treated within six weeks.The government's final budget committed to spending £1.25 billion ($1.9 billion) extra on children's mental health services over the next five years. Proposals have also been floated to ban the use of police cells for mentally unwell teenagers. And mental health seems, for the first time, to be an election issue rather than simply buried in manifesto small print.Ask Kerry and Nikki what the next government should do and both say help needs to be available for people much earlier. Nikki also wants to see mental health lessons taught in schools. Farmer, Wessely, and Bogg all say securing more funding to stop the rot and help services deliver better, earlier support has to be an immediate priority. "A bit of reality" on the damage being wrought by cuts to welfare and social services, which look set to get worse, is well overdue, says Bogg.Will politicians listen? Who knows. But, as Wessely points out, in the past year Nick Clegg has dedicated several speeches to mental health. Ed Miliband became the first party leader, and Jeremy Hunt the first health secretary, to visit the Royal College of Psychiatrists. David Cameron has championed research into dementia. And NHS England's five-year blueprint for the health service features mental health prominently."All of that is symbolic, but it means something. We'd like to see it translated into a real increase in resources for services but it's a start," Wessely says. "In an era when it's easy to be cynical about politicians, let's be clear that the change in the importance given to mental health has been tangible."And you can see it, too. Mental health gets a total of 44 mentions in the three main parties' election manifestos, compared to seven in 2010. It's on the front page of the Lib Dem manifesto, with plenty more inside (33 mentions specifically), including a promise of £500 million ($759 million) a year in extra mental health funding. Labour say they'll increase the proportion of mental health cash that goes to children's services and introduce a new right to access to talking therapies. Meanwhile, the Tories promise better mental health support for pregnant women and people who are out of work.But with most polls forecasting a hung parliament there's no guarantee these promises will survive coalition talks—remember the Lib Dem promise to scrap tuition fees back in 2010? And with all of the parties looking to reduce public spending it also looks like the cuts to welfare and social care that can contribute to mental ill health are set to continue to some extent.Ultimately for those depending on services, the policies and rhetoric need to be backed up—not just with funding but also by those in government taking responsibility for the state of the NHS mental health system that they oversee."At the moment we just keep hearing, 'It's not down to us, it's down to decisions made by NHS commissioners and different groups'," says Kerry. "You can say all the wonderful things you like about mental health but if the money's not there, too much of it is just gimmickry."If you are concerned about the mental health of you or someone you know, visit the Mental Health America website. Follow Andrew McNicoll on Twitter."Clinical commissioning groups have been told to do more on mental health but the standard response is, 'Once we've handled the important issues—A&E, cancer, maternity services—then we'll get to mental health.' That's not parity." —Sir Simon Wessely, chair of the Royal College of Psychiatrists