Politically defined insanity

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When you ‘know’ that one political ideology, or one system of government, or even just one political leader is so perfect as to be beyond any rational criticism, it’s easy to see that any opposition must be based on some sort of insanity. That was close to being the official doctrine of the former Soviet Union, in which the science of psychiatry was misused to institutionalise anyone mad enough to dissent. On the other hand, maybe the Soviet authorities had a point – it isn’t wholly unreasonable to regard anyone dissenting from the government line in a society where justice is both arbitrary and violent as possibly being a little mad.

There was news yesterday that Republican law-makers in Minnesota have introduced a new bill proposing that ‘Trump Derangement Syndrome’ be officially classified as a mental illness. The reports don’t tell us what treatment is proposed for this new illness, but it’s doubtful that they have any intention of extending the already limited US healthcare system to include medication for a disease which may afflict up to half the population. The prisons probably don’t have enough spaces either.

It couldn’t happen here of course. In the UK, government politicians are more interested in abolishing categories of mental illness than inventing new ones. It does remind us, though, that politicians deciding what is or isn’t a mental illness is a very poor approach to a serious issue.

Some things are best left to doctors

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It is inarguable that the number of people with a mental health diagnosis has increased. It doesn’t follow from that, however, that Wes Streeting is right to claim that there is ‘over-diagnosis’. There are a number of reasons for the increase in the number of people with a diagnosis, including a reduction in stigma for those seeking help as well as a better medical understanding of some conditions. It doesn’t matter whether a health problem is down to physical issues or mental issues (and there's an argument that many mental health issues have underlying physical causes anyway): as a general rule, identifying more sufferers and providing them with the right treatment and support is surely a good thing rather than a bad one. That some people will be misdiagnosed or wrongly diagnosed is inevitable. It happens with all sorts of illnesses, always has and always will. When cases are numbered in the millions, achieving 100% accuracy is an impossible target.

That doesn’t seem to be the understanding of the English Health Secretary, though. He seems to have in mind that there is a ‘right’ number of diagnoses, and that that number is lower than the actual number currently being recorded. His basis for making that assumption is unclear. Maybe he can explain it clearly and succinctly, but he hasn’t done so thus far. It’s hard to avoid the conclusion that his main driver for making the assertion has more to do with the costs than health – both the direct costs of treatment and the indirect costs of lost productivity from people who aren’t working. It isn’t just him: there seems to be an underlying attitude amongst Sir Starmer and his ministers that many of those who are not working due to poor health are lazy lead-swingers who need to be forced into work regardless of the consequences for their health. I doubt that anyone would argue that there are no people at all in that latter category, but there is no evidence of which I’m aware that the problem is anything like as widespread as the government seem to be assuming. By concentrating his attention on mental health issues, Streeting is in danger of reviving the stigma which has taken decades of work to reduce.

He is, of course, only responsible for the English NHS, and his approach doesn’t necessarily have to be replicated here in Wales, although if Labour MPs are dragooned into going along with him, neither is it certain that the approach will not be more widely applied. But any cuts to benefits or to mental health services implemented on the back of dodgy assumptions certainly will affect people here. His wish to eliminate duplication and waste in the NHS is understandable, but saving money by having sweeping diagnoses made by bean counters and politicians rather than by doctors is surely a step too far.

Sharing the magic

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August is generally known in political circles as the silly season; a time when there is a lack of hard political stories to fill the news. Nature, however, abhors a vacuum, and fortunately both the Tories and the Labour Party have people on hand to make vacuous statements to fill the gap. I’m not entirely sure who got there first, Braverman or Streeting, but both seem to have chosen the Bank Holiday Monday as the ideal occasion to put forward their own version of magical thinking.

Streeting, for Labour, promised that patients would be able to see the GP of their choice rather than the one who happened to be in the surgery at the time, although how he plans to co-ordinate the timing of people’s illnesses with the GP’s holidays and days off was left unstated. Probably wisely. Implementing this policy will not, apparently, require any extra resource. Instead, those surgeries meeting the promise will be given extra financial incentives for doing so, and those incentives will be paid for by reducing the cash given to the surgeries who fail to comply. There is a rather obvious logical flaw in the argument: if you’re paying some doctors to provide this service by penalising those doctors who don’t, delivering the ‘promise’ to some people depends, inherently, on not delivering it to others. Still, why bother with mere maths when you can work magic on this scale.

Braverman, for the Tories, promised that police forces will follow all reasonable leads in investigating all crimes, rather than failing to investigate some at all. She also subscribes to the same sort of magical thinking, somehow believing that restoring some of the police numbers cut since her party entered government in 2010 will enable the police to provide a better service than that which they were under-resourced to provide before her party got its hands on government. I’m not sure how politically wise it is to present the days before her party came to power as a policing success story (particularly since it wasn’t), but then political wisdom and Braverman are not really words which belong in the same sentence. It’s also not entirely clear that her promise is any more universally applicable than that coming from Streeting – there will be many who will have at least a sneaking suspicion that suspected crimes allegedly perpetrated by a better class of criminal will remain less than fully investigated.

We probably shouldn’t take anything either of them says too seriously, though. In Streeting’s case, based on recent history, his leader will have reversed the policy within a month or so anyway, and in Braverman’s case she really isn’t expecting to be around long enough to implement anything – it has more to do with the leadership election expected in the wake of the next election. Assuming that the next general election is held in May next year – which is what many observers seem to expect – next year’s silly season could well be devoted to (yet another) Tory leadership election and, in celebration of the season, the silliest candidate might even win.