Down and out in London: The Government should do more to provide support services to those afflicted by mental illnesses

Five years ago, the benefits system enabled Dan Shewan to recover from a debilitating period of depression. Here, he explains why he fears for Britons trying to cope with mental illness today

'Shortly after that fateful Christmas, I sank into a depression so severe that I was unable to work' (Trigger Image/Alamy)

One day, when I was 17, my best friend at the time – let’s call him Alec – suddenly announced that he was moving to the Netherlands. Alec’s elder brother, with whom we would occasionally get high when he had procured some particularly potent marijuana, had been working as a labourer in Haarlem, about 12 miles west of Amsterdam, for the previous six months. It was 1999 and Alec said the Netherlands was experiencing a labour shortage, and that virtually any able-bodied person could find work on one of the country’s many building sites, no questions asked. Alec’s brother was living above a coffee shop, and had told him that he was smoking some of the finest weed he’d ever had, every night, with money to spare.

Alec was already a reasonably heavy drug user before he left for the Netherlands. I, like many teenagers, was certainly open to recreational experimentation. Our drug-taking adventures were lent further momentum by the fact that a scientifically minded friend from school had a talent for making his own LSD and cultivating marijuana plants. He also happened to be our dealer, a demonstration of his keen business acumen as well as his prowess as a chemist. Perhaps, in another life, he could have applied his skills to the pursuit of a cure for cancer, or some other equally useful scientific endeavour.

Sometimes, Alec and I would simply sit and smoke, listening to Pink Floyd LPs for hours in his tiny bedsit. At least once a week, we’d drop ecstasy before venturing out to one of the scant few nightclubs that our dreary coastal town in Lincolnshire had to offer. As a seasonal treat, we would occasionally sample that year’s batch of psilocybin mushrooms, which we hand-picked in a country field about 10 miles from town. When he left for the Netherlands, I found myself lacking a partner in crime. In time, I stopped hitting the clubs, content with a small pipe or the odd joint in the comfort of my home.

The same could not be said for Alec.

It would be another five years before Mark Zuckerberg was to create what eventually became Facebook in his Harvard dorm room, and Alec didn’t have an email address. As such, I neither saw nor heard from my best friend until almost 14 months after he had departed, when he returned home. I learnt through a mutual acquaintance that Alec had moved into shared housing not too far from where we once hung out together and spent countless hours smoking joints and listening to The Dark Side of the Moon. But the young man who returned from the Netherlands was not the same Alec I once knew.

One afternoon, we were sitting in his small living room, facing each other. We said little. Alec was preoccupied with hand-rolling cigarettes, lining them up in a neat row on the coffee table before him, like lines of cocaine. I asked him about what life in the Netherlands had been like, but conversation was virtually impossible. He hardly spoke, content to giggle quietly to himself, occasionally mimicking the revving sound of a motorcycle’s engine, before dissolving into whispered fits of laughter.

Alec and I didn’t see much of each other after that. Something had changed in him during those 14 months: a transformation that had turned my best friend into a stranger. In the subsequent weeks and months, rumours circulated that he had lost his mind, that he was taking potent antipsychotic medications, that he’d spent time on a mental ward.

Some experts believe that the connection between drug use and mental illness is irrefutable. I cannot attest to this one way or the other. I’ve often felt that my teenage drug use was not the cause of my mental illness later in life, but was instead a coping mechanism for problems that were already there. I’ve never been sectioned, but that’s not to say I haven’t experienced my own struggles.

Three days before Christmas Day in 2008, I lost my job. Having finally escaped the seemingly endless succession of positions in telesales in which I had been trapped since moving from Lincolnshire to London a few years earlier, I had secured a technical-support and systems-administration position at a small company that provided IT services to architectural firms across the city. Although I struggled to master the technical complexities of the role, it was ultimately the unravelling of the global economy that sealed my fate. At the end of my probationary period, I was told that the firm had lost four prominent clients during the previous fortnight, and that my contract would not be renewed.

Shortly after that fateful Christmas, I sank into a depression so severe that I was unable to work – a prolonged period of despair that would last almost 19 months. After the initial shock of my sudden redundancy subsided, several weeks passed before I eventually sought help from my GP. He told me I had most, if not all, of the major symptoms of mixed anxiety-depressive disorder – lethargy, difficulty sleeping, excessive worry, pervasive feelings of dread and hopelessness, and a lack of appetite. He prescribed a common antidepressant medication, and sent me on my way.

During that dark time, I barely left my flat in Woolwich. I had my shopping delivered. The thick, grey living-room drapes were never opened. I lived alone, a temperamental house cat my only company. Showering and shaving were major accomplishments. Leaving the building to buy cigarettes felt like a cause for celebration, as if I had just finished a decathlon. At night, I would hear the laughter of people outside, waiting for their pizzas from the Domino’s directly beneath my bedroom window, coming out of the Paddy Power bookmakers next door, or lurching home from the pub nearby, and my heart would start to race.

I was living on benefits during this difficult time. Housing benefits covered my rent. I received Jobseeker’s Allowance, which enabled me to sustain my hermetic lifestyle, albeit through a carefully calculated and practised routine of falsified evidence that I was actively looking for work. I took the strong antidepressant medications that my GP had prescribed, none of which I paid for due to my government-subsidised prescriptions.

Today, this would be very difficult, if not impossible.

According to the Mental Health Foundation, one in four Britons will experience some form of mental illness during the course of a year. Mixed anxiety-depressive disorder is the most common type in the UK, and Great Britain has one of the highest rates of self-harm in Europe, with about 400 cases per 100,000 people. In addition, data from the Office for National Statistics’ Measuring National Well-being programme indicates that rates of mental illness are higher among people not in paid work than among those who are employed. Approximately 23 per cent of Britons who are unemployed experience a mental illness, compared with 15 per cent of those who are working. This evidence suggests that mental illness and unemployment often go hand in hand; two ends of the Ouroboros, a vicious cycle in which financial stability directly affects an individual’s mental health, and places the victim in a situation that makes it difficult to find and retain work without compromising his or her recovery.

Although I had dutifully paid my taxes for many years, I wrestled with the guilt of accepting handouts from the government to survive. Ultimately, though, the thought of returning to work – or even leaving my flat – was simply too much. In the intervening years, reform of the British benefits system has made it even more challenging for people with genuine mental illness to receive the care and financial support they need.

'Leaving the building to buy cigarettes felt like a cause for celebration, as if I had just finished a decathlon' (Alamy) (AA Pix/Alamy)

It’s difficult to determine the number of people in the UK who are unable to work due to the severity of their mental illness, and how this relates to benefits claims. In May of 2013, an estimated 1.75 million people claimed Employment and Support Allowance in the UK. This particular benefit, which was introduced in 2008, was designed to accommodate those who are too ill to work, including those with serious mental illnesses. However, navigating the minefield of the world of benefits claims is an arduous task, even for those to whom showering and leaving their homes poses little fear. Although I would likely have qualified, I didn’t know that Employment and Support Allowance even existed. Too ashamed to discuss my struggles with anxiety and depression with the uninterested and overworked staff at my local jobcentre, I had no idea that there was a viable alternative to living in fear, racked by guilt, claiming Jobseeker’s Allowance. My GP was stretched to the point that all he could do was increase the dosage of my medication, and refer me to a cognitive therapist. After waiting for more than a year for an appointment, I gave up any hope of talking to a mental-health professional. Although support services are available to people suffering from mental illness, my own experiences demonstrate that, in many cases, people are left to fend for themselves, lacking the essential advice and guidance that could ultimately help them to get better.

One of the most difficult aspects of suffering with depression is the feeling of almost suffocating loneliness. Insomniacs, whether depressed or otherwise, can likely relate; the feeling that you’re all alone, that everyone else is fine, and that there is something seriously wrong with you. That you’re damaged. Broken. The cause of this pain, however, often remains tantalisingly out of reach. Although I felt very much alone during those 18 months, I was obviously not, if these statistics are an accurate indication of the prevalence of mental illness in the UK. However, the true scope of mental illness across the nation may be even worse than the official figures suggest.

According to Depression Alliance UK last week, almost half of British adults have experienced depression, significantly more than the one-in-four statistic that is frequently touted as the official figure. Of these individuals, nine out of every 10 have experienced feelings of loneliness or isolation, and found it difficult to share their struggles with those close to them. In addition, approximately 86 per cent of people with depression lacked access to others with the condition, despite the valuable role of peer support in the recovery process.

Emer O’Neill, the chief executive of Depression Alliance UK, says the charity’s recent survey demonstrates that people with depression need to have access to others with the condition to maintain their recovery. “Previous anecdotal evidence from people who access our services indicated a clear need for people to be able to meet online and face to face in local communities to share experiences by doing ordinary things like having a coffee or going for a walk, and just simply reminding each other that they are not alone,” O’Neill says.

I sometimes wonder what would have become of me had I not left the UK and moved to the United States in 2011. Would I have ended up homeless when my housing benefits were stopped? Would a review panel have deemed me “sufficiently” mentally ill to qualify for Employment and Support Allowance? Would I have even been able to cope with the emotional turmoil of subjecting myself to the 13-week assessment period? I never had to confront the answers to these questions, but, for many Britons, these worries are an everyday reality.

Winston Churchill famously described his depression as “the black dog”, a presence that, much like man’s best friend, would follow him around throughout his life. I don’t have a name for my depression, but it has remained faithfully by my side for much of the past decade. Some days are worse than others but, for the most part, a strict regimen of medications and the support of my family have enabled me to keep going.

However, there are nights, when the world is asleep and all outside is quiet, when I am gripped by a powerful fear, one that leaves a bitter taste in my mouth and my skin clammy. During those silent, lonely hours, I find myself bitterly envious of people who can smile and laugh and sing; who can leave their homes and confidently speak in front of others without their chests tightening. I long desperately to be able to appreciate the things I have, and see my problems for what they are. In short, I fantasise about what my life would be like, about who I could be, without my constant travelling companion.

Contrary to the arguments of some, social stigma towards the mentally ill is pervasive, not just in the UK, but around the world. Even the word “depressed” has been distorted, repurposed into a casual synonym for feeling low, a generalisation that is a grave disservice to those who are genuinely afflicted with the condition. Millions of Britons struggle to accomplish the most basic of tasks every single day, and, without the proper support, they are forced to sacrifice mental health for financial stability.

The Government can, and should, do more to provide essential support services to those afflicted by depression and other mental illnesses. The Rand Corporation recently advised the Department for Work & Pensions and the Department of Health to adopt four key intervention pilot programmes to accomplish this. These recommendations include embedding vocational support into primary-care settings; providing greater support to unemployed individuals suffering from mental illness; expanding access to online resources such as mental-health assessments and computerised cognitive-behavioural-therapy interventions; and offering telephone-support services to unemployed people experiencing mental-health problems.

Christian van Stolk, the director of employment, education, social policy and population at Rand Europe, says there is no “one-size-fits-all” solution to the complex issue of improving the employment outcomes of those with common mental-health problems. “To address the issue, we are likely to need a variety of interventions and so the policy options we propose are complementary,” he says. “Where we have the data, the benefits to the Government are estimated to exceed the costs.”

Whether I created my own mental prison through the excesses of my youth matters little to me at this point. The reality I must face is that, like so many others, I have to fight as best I can against the invisible face of an unknowable foe, in a daily battle that, one day, I fear I will lose.

Today, fortunately, is not that day.