A silent mental health pandemic

Finishing her term as president of the Royal College of Psychiatrists, Dr Lade Smith has been pushing for urgent change to funding for mental health services provision in the United Kingdom. In an interview on Radio 4’s Today programme this week, Dr Smith highlighted how this silent mental health pandemic is especially severe for children and young people, calling it the greatest threat to their health.

Demand for mental health services

Before introducing Dr Smith, interviewer Emma Barnett described the surge in demand for mental health services by giving some statistics: 4.1 million people sought help from mental health services in 2024 – 2025, which is a 56% increase on the 2.6 million in 2016 – 2017. That figure includes more than 1 million children and young people.

The anxious generation

In an earlier report, Alan Milburn (chair of the government’s young people and work report) suggested we now see a more anxious generation. Although not confined to the UK, the rise of neuro-diversity conditions including autism and ADHD has led to economic inactivity in our 18- to 24-year-olds. This is double or treble the rate of that seen by our European neighbours.

Mr Milburn was clear this can be addressed but was critical of a system that suggests young people diagnosed with a mental health condition are not fit to work.

Employers want to do the right thing

Emma Carter, Chief Executive of Bristol based WestSpring IT, highlighted the impact of long-term absences related to mental ill health. She described how colleagues will often need to pick up the workload from someone who is absent long-term. Describing the situation as a moral dilemma, she suggested employers want to do the right thing, but it’s hard to continue paying someone through a prolonged absence.

There was consensus that extended episodes of mental ill-health can have serious economic and personal consequences for those affected.

One in eight people has a mental illness

Dr Lade Smith gave her opinions on these ideas, stating ‘Mental illnesses are common, and they are disorders of youth. 75% percent of mental illness arises before the age of 24, 50% before the age of 14. Once you’ve survived the infectious diseases of childhood the most likely condition you’ll suffer from as a young person is a mental illness.’

She agreed with Mr Milburn that this is not just a UK problem but is worldwide. ‘One in eight people in the world suffers from a mental illness. That’s over a billion people’

When asked if this has always been the case, Dr Smith replied:

‘Without a doubt there’s been an increase in [the number of mental illnesses] across the world and the WHO (World Health Organisation) have said that since about 1990 there’s been an increase in mental illness. But that coincides with the increase in a number of the social factors that increase the risk of mental illness’

Giving some examples:

‘We know that about 78% of mental illnesses are driven by social factors such as financial insecurity, debt, poverty, and trauma.’

These adverse experiences including abuse and exposure to violence affect children in particular, because they increase the risk of developing mental illness in later life. Dr Smith suggested the upsurge in mental illnesses worldwide is related to increases these factors.

Low spend on health care support

Turning to the UK, Dr Smith said, ‘Mental illness is 20% of the disease burden in the UK but we get less than 9% of the healthcare spend. We know that we can treat mental illness very effectively, particularly in children and young people. So if you treat people quickly, early, particularly when the problem first starts when they’re young, then they won’t become an adult with a chronic relapsing illness, who doesn’t manage to finish school, doesn’t get into university, or doesn’t manage to get into work’. Without the right support they ‘essentially become someone who’s less likely to be able to be productive, to pay into the tax coffers, be economically active.’

Mental health support teams

In response to the comments, the Department of Health and Social Care stated it’s vital anyone struggling is able to access timely help and support. The government is spending an extra £688m in mental health services this year and hiring almost eight thousand additional mental health workers. It is also rolling out mental health support teams to every school and college in England.

Dr Smith replied, ‘We’re really pleased that they’re doing that, but the reality is it’s not quite enough I’m afraid. Even before the pandemic there was an increase in the number of people who needed mental health support, but unfortunately, we didn’t get an increase in the number of people who were available to provide that support. We are under resourced; we don’t have enough staff, we have staffing vacancies of 10-15%, always. That extra eight thousand staff, we need them on top of our actual numbers but each year we’re losing nine thousand staff through retirement and people just feeling burned out, and feeling that they can’t continue. So, we’re not replenishing the staff’.

‘Everyone is overwhelmed, we are literally on our knees and that means you end up with a bit of a postcode lottery’.

Mental health waiting times

Asking how this plays out in the provision of services, Dr Smith asserted its effect on waiting times’. She claimed,  ‘We’ve got children waiting over two years to be seen. If you’re a twelve-year-old child and you’re waiting one or two years because you’ve got a mental health problem, then that’s a sixth of your life.’

‘What happens is that parents will do the best for their children. The child stops going to school, they go to the GP. The GP thinks this is actually something beyond what I can manage. They refer them to Child and Adolescent Mental Health Services and then they sit and they wait, and they wait, and they wait for treatment. And in that time, people don’t just get better. It’s not like infections where your immune system fights them off. If you don’t get treated, things get worse.’

The role of talking therapy

Asking if it’s true that support via talking therapy is now easier to access, Dr Smith suggested, ‘There is greater access for talking therapies but we’re talking here also about severe mental illnesses. Illnesses like bipolar illness, schizophrenia; illnesses that require more specialist inputs like PTSD.’

‘Unfortunately it’s not easy for people to access support for those conditions. It can take up to nine years for someone to receive a diagnosis and treatment for bipolar illness for example.’

‘In that time that person hasn’t been able to function. They’ve dropped out school, they’ve broken all their relationships, they’re ruining their lives and unfortunately if they have got a job they probably dropped out of that job and not understanding why.’

Do we understand the seriousness of this?

‘No, that’s the problem, that’s why it’s a silent pandemic.’

The honest truth of the matter is that we’re not actually funding and investing in our mental health services. Work from Australia shows really well that [if] you invest in mental health interventions for children, young people and their parents, and parents supporting children and young people, the return on that investment is four dollars for every dollar that you put in, within three to five years. So, this isn’t simply about saying spending money. This is about saying investing money so that your return later on is so much greater.’

‘We need to invest in mental health services so that we can be economically productive.’

The difference between mental health and mental illness

Reflecting on the Prince of Wales’ recent comments on Radio 1’s ‘Life Hacks’, Dr Smith suggested ‘there’s a difference between mental health and mental illness. We all have mental health [and] what the prince is talking about is trying to support people to be more resilient and to be able to cope with all the life stresses that might hit us as we’re going thorough. But mental illness, that’s a different matter. That’s when someone has symptoms that are persistent, that are significant, that interfere with them being able to function, that impair their ability to function. In a way that you can have a severe mental illness like bipolar illness but actually have quite good mental health because you’re managing your bipolar’

‘Don’t get those two things mixed up. Because people are talking about mental health all the time, they’re not really thinking about mental illness. Alan Milburn is thinking, what on earth is going on with all these people with this mental illness? It’s because only fifty percent are able to get good care at any one time. If you only fund the services fifty percent, sometimes you’ll get fantastic treatment, sometimes you won’t. But I can tell you what we’re really good at: when you go into crisis, then we can look after you, but we need to be looking after people early.’

You can learn more about Dr Lade Smith’s ‘silent pandemic’ on the Royal College of Psychiatrists’ web site.