1 Common misconceptions about mental ill health

FALSE. Mental ill health is not simply the regular ups and downs of life. It creates distress which does not simply go away by itself, but can be managed through effective interventions. While some people who experience mental illness may act in ways that are unexpected or appear different to others, these cannot be generalised. The behaviours or experiences associated with mental illness are not by ‘choice’. Equally, like anyone else, people with a history of mental ill health may make poor choices or behave unexpectedly for reasons that are unrelated to symptoms of their illness. No one would ‘choose’ to have a mental illness. It can sometimes be challenging to relate to the symptoms and personal experiences of people living with a mental health condition, if one has not experienced these for themselves, but this does not mean that their condition is somehow not real.

FALSE. Having a mental health condition does not make a person more likely to be violent or dangerous. The causes of violence are complicated, and mental illness is not a predictor of violence. Few violent acts can be attributed to individuals living with a serious mental illness. The abuse of illicit drugs and alcohol may perpetuate violent crimes. People who experience mental illness are often amongst those who are excluded from communities, vulnerable, and more likely to be victims of violent crime or of self-harm than of violence towards others. The false perception, popularised in the media that people with mental illness are typically violent, unpredictable and dangerous, is amongst the most damaging of stereotypes.

FALSE. Depending on the severity of their condition, living with mental illness does not necessarily mean that a person is incapable of seeking or maintaining employment. They may require additional support or suitable working arrangements provided by employers. Those with more serious conditions may face some barriers.

FALSE. Mental illnesses are complicated conditions that arise from a combination of genetics, biological, social, environmental, life experiences, and other influences and not simply a consequence of parenting. 1 in 5 children aged between 13 and 18 will have a mental illness. Around half of all lifetime cases of mental illness begin before the age of 14. Parents and family members have a major role in support and recovery.

FALSE. Errant, ‘challenging’ or withdrawn behaviour, and sudden changes in mood at school or at home during adolescence are often seen as a sign that a young person is simply ‘acting out’ their frustration at struggling academically or socially. Adolescence is a period of significant physical and emotional change, brain development in particular, so it is important to understand the underlying reasons for changes in mood and behaviour. Mental illness affects people of all ages, including adolescents. Specific criteria for a clinical diagnosis will need to be met, and it is important to distinguish mental ill health from ‘transitional’ teenage behaviour, moving towards adulthood. Up to half of all mental health conditions show first signs before the age of 14. However, it is estimated that up to 20% of those diagnosed do not receive the treatment and support they need.

FALSE. Mental illness is not always a chronic, lifelong condition. People who experience mental illness can recover and lead fulfilling lives, learning to manage symptoms with support and appropriate treatments. Many people living with mental health conditions are able to live, work, learn and participate fully as active and productive members of communities. When treated appropriately and early, some people can recover with no further episodes of ill health. For others, ill health may recur throughout their life, and will require longer-term management to help people live full and fulfilling lives. Counselling can help to avoid reliance on harmful coping strategies like drinking, as well as to help come to terms with life experiences. Often a combination of pharmacological (medication) and psychological (talking) therapies provides the best outcomes. Individuals have different treatment needs; talking with mental health professionals will help to determine the best treatment plan towards recovery from mental ill health.

FALSE. Depression is not inevitable in old age. However, older adults do have a greater risk of depression associated with losing a partner later on in life or as an early sign of other progressive illness (including neurodegenerative diseases and dementia).

FALSE. Ill health, whatever the cause, is not a character flaw or personal weakness. People with mental ill health are not ‘lazy’, ‘weak’ or able to ‘snap out of it’. The stereotype of a clinically depressed person as being lazy, or simply lacking motivation shows a lack of understanding of the condition. Multiple factors contribute towards mental illness, including life experiences, trauma, family history, physical illness or biological factors. It is not entirely clear why some people are more ‘resilient’ to developing mental illness than others after, for example, witnessing a traumatic event, being a victim of a crime, or longer-term exposure to traumatic experiences, such as military conflict, natural disasters or abuse. Not everyone exposed to a traumatic event will experience post-traumatic stress disorder (PTSD) for example, but this is not related to some notional concept of being ‘strong-’ or ‘weak-minded’.

FALSE. If risk factors are known (e.g. exposure to a specific trauma or known biological or environmental stimuli which can trigger mental health problems), then strategies aimed at preventing these would affect mental, emotional and behavioural outcomes in children and adolescents, as well as adults.

FALSE. Many people with a mental illness recover quickly and do not necessarily need hospital care. Others have short admissions for treatment. Improvements in healthcare provision mean that most people can live within the community while receiving the continued care and support they need, without being confined to psychiatric institutions, as was more common in the past. Some people, however, will require long-term specialist hospital care, and sometimes against their will, if they are deemed to be particularly vulnerable or likely to cause harm to themselves or to others, for example.

FALSE. There is a misconception that people who are clinically depressed can simply will away their mood, shake it off, pull themselves together and cheer up. Depression has a biological basis that affects physiological functioning. It’s not as simple as a psychological pick-me-up. Treatments such as cognitive therapy combined with medication can help address the symptoms of depression.