If we're talking about mental health more than ever, why are so many patients still dying?

For most of its medicalised history, mental illness has been and out of sight and out of mind problem, its scandals far from public concern. Current events suggest that not much has changed.  On Monday, the Guardian revealed that coroners reports published between 2012 and the beginning of 2018 show that at least 271 mental health patients have died due to failings in NHS mental health care.

These failing included inadequate supervision of someone who was a clear suicide risk; NHS staff ignoring families’ fears that their loved one would take their own life; mistakes with the patient’s medication; and failing “to properly assess the risk that the patient would take their own life.”

Forty five of the cases involved people being discharged too soon or with inadequate care, forty one treatment being delayed, and seventy two poor or inappropriate care.

The response? Despite the Guardian’s best efforts, there have been no mass demonstrations, burning police cars and emergency Whitehall meetings, no barricades built.

The period covered by the Guardian’s investigation covers the single largest expansion in public debate and discussion about mental health the UK has ever seen, begun by the funding of national anti-stigma campaign Time to Change in 2009.

Why, if we are talking about mental health more than ever, do avoidable tragedies still occur? One problem is that, while discussion of mental health has become louder and broader, it is the areas that are most relatable for the general public where that discussion has pooled; in issues of wellbeing and social acceptance, not in the realities of unmet need and of more serious, life-changing, chronic experiences.

In her speech to the Conservative Party Conference in 2017, Theresa May announced an independent review into the Mental Health Act. Yet her speech focussed upon the risk of discrimination that might arise in the use of the powers of the act to detain people against their will—rather than focusing upon any rights to treatment people might have. Like so many campaigns, she focussed on what was relatable, rather than the uncomfortable reality of people’s needs.

Earlier, in 2013, The World Health Organisation (WHO) published “Investing in mental health: Evidence for action.” It explores the “potential reasons for the apparent contradiction between cherished human values and observed social actions.”

The WHO paper suggests that while governments may be fully aware of the individual and community costs of unmet mental health need, they are also aware that to pay for meeting that need would mean removing funds from another, potentially more valued activity. There is always a more pressing issue to resolve, always something more likely to win votes.

Mental health difficulties are not leading causes of mortality in populations. People do not usually die from mental health difficulties in large, definite numbers all at once in a way that pricks the public conscience.

Systemic causes of death and of disability due to mental health are like a glacial apocalypse—something that can only be seen once hundred or thousands of seemingly unconnected events and failings can be aggregated and analysed.

Mental health remains the perfect area for a politician who wishes to be seen to be doing unequivocal good without committing large amounts of public funds, because the reality of things being improved (or not) is hidden for most of the public by complication and institutional process.

In the UK, calls for action in mental health hinge upon two things: calls for money and calls for more research.

Both of these obscure and professionalise the issues at hand. By making them issues for practitioners, planners and researchers, they erode the sense of injustice that is required to push change into action.

Where people do not understand how a system works they are hazy in their idea of what change is needed. It is easy to spin the wheels of change down to a stop in the process of “lessons being learned” and to revert to a kind of corrosive realpolitik stoicism which accepts the reasons for people being harmed without feeling moved to make real change.

For all that many of us love our NHS and the people who work in it, it failed to save people it should have saved. It is likely to continue failing individuals in similar circumstance in similar ways. Individual tragedies are dismissed as extreme and unrepresentative, and statistics as boring and unintelligible.

It hurts us to believe our NHS can work in ways that let people in intense mental health need die. But it will continue until enough of the general public stops pushing such stories to the margins and calls for better.