Introduction
With the ongoing war in Ukraine and the sanctions against Russia, prices of fuel, electricity, water, and the rest has been increased, contributing to mental health problems for many individuals and families. Data from the Organization for Economic Cooperation and Development (OECD) indicate that Europe’s mental health care has been neglected and underfunded across the member states. Additionally, the cost of treating these illnesses is high in such countries as Norway, Belgium, the Netherlands, and Finland. Such countries as the UK also spend huge amounts of money on mental illnesses. Data from the Organization for Economic Cooperation and Development According to OECD, the UK spends up to £94 billion annually on mental illness (Boseley, 2018). With these statistics, the country needs to explore the nature and prevalence of mental health, mental illnesses, and mental well-being. A comparison will be made between the UK and the United States from a cultural perspective. Specifically, the comparison focuses on generalized anxiety disorders (GAD) leading to depression. GAD can be described as six or more months of chronic exaggerated worry, tension, or more severe anxiety.
Definitions
According to World Health Organization (WHO) Health is a state of complete physical, mental, and social well-being rather than the mere absence of disease or deformities (WHO 1948). This definition is widely accepted; with this in mind, this definition implies that mental health encompasses more than the absence of mental diseases or disabilities (WHO, 2018).
Furthermore, WHO defines Mental health as a condition of well-being in which an individual recognizes their potential, can cope with everyday stresses, works, and contributes to their community (WHO, 2018). Such is a healthy mind, and Mental illness is a disorder that impairs one’s cognitive, emotional, or social capacity and is diagnosed by a medical expert (NHS, 2022).
Anxiety disorders
The Case of the UK VS USA
A report published by the House of Commons Library estimates that 1 in 6 adults have recently experienced such common mental disorders as depression and anxiety (Baker, 2021). In 2020/21, 2.0 million adults and 0.8 million children accessed NHS mental health, autism, and learning disability services. 1 in 6 children between the ages of 6 and 16 has experienced at least one health problem in 2021 (Baker, 2021). This figure has risen from 1 in 9 children in 2017 (Baker, 2021). From a historical perspective, the UK is recording an increasing number of patients with mental health disorders, especially depression and anxiety.
The UK has been dealing with mental health issues for several decades, whose historical developments have been captured by the Mental Health Foundation. In 2019, this organization celebrated its 70th anniversary, where Smith (2019) articulated public opinion and policy surrounding mental health developments. The end of the Second World War and the foundation of the NHS were followed by an urgent need to get funding for mental health. In the 1950s, mental health was largely ignored, which caused stigma and fear since people with mental health were regarded as lunatics (Szasz, 1960). In the 1960s, mental health became an academic discipline, and the 1970s saw advances in mental health research. Academic careers emerged in the 1980s and public awareness was increased in the 1990s. at the onset of the 21st century, the UK started to advocate mental health for everyone, not just those experiencing mental health problems.
A comparison between the UK and the United States can be made by giving an overview of the prevalence and the historical and cultural overview of mental health in the country. The National Institute of Mental Health provides some statistics which indicate that the case of the USA is almost like that of the UK. For example, 1 in 5 adults in the US lives with a mental illness, which totals 52.9 million in 2020 (NIMH, 2022a). However, the records for the US are more elaborate as gender, race, and age classifications are also presented. For example, prevalence is higher among females (25.8%) than in males (15.8%) (NIMH, 2022a). Similarly, the prevalence was higher among young adults (30.6%) than in adults aged 26 to 49 years (25.3%) and those over the age of 50 years (14.5%) (NIMH, 2022a). Some of the differences between the two countries may be caused by demographic differences. For example, an estimated 24.3 million people will have received mental health services in 2021, a figure significantly larger than that of the UK. However, the population in the US is larger than that of the UK.
Anxiety disorder in both countries has been associated with some of the historical developments in the lives of people. For example, the levels to anxiety have been observed to have increased from 2008 to 2018 (Campbell, 2020). This period is characterized by such incidences as a recession, growth of social media, climate concerns, Brexit, and a change of attitude towards disclosing anxiety disorder.
Similar to the UK, GAD is a major mental health problem faced in the United States. In 2020, the prevalence of depression among adults 18 years and above was 21 million, which represents 8.4% of all adults (NIMH, 2022b). Adult females (10.5%) recorded a higher prevalence than adult males (6.2%) (NIMH, 2022b). Racial disparities are also more profound in the United States than in the UK. For example, the prevalence for people who reported two or more races was 15.9% (NIMH, 2022b). Overall, it can be argued that the US faces similar mental health situations.
Historical and cultural perspectives
Historically, society has treated people with mental health conditions as abnormal (ref). For example, In the UK, mental asylum is equivalent to a modern-day psychiatric hospital. The term “asylum” comes from the early (religious) organizations that offered asylum as a means of refuge for the mentally sick people (Science Museum, 2018). Bethlem in the UK is regarded as one of the oldest of such institutions. Many methods were used to treat the mentally sick; a typical of such methods was restraint. Restraints prevented people from injuring themselves or attempting suicide. For example, William Scrivener, a mentally ill patient at the Lincoln Asylum, died of strangling in 1829 after being tied to his bed in a straitjacket and left alone overnight. The incident convinced the Lincoln authorities to abolish all physical restraints and institute a no-restraint policy. Their approach had a significant impact on asylum reform in the 1800s, and it was symbolic of a wider shift in attitudes regarding mental disease and the treatment of mentally ill individuals (Science Museum, 2018). More reforms continued and today we have a meaningful treatment to mentally ill.
The US, on the other hand, resembles the UK in terms of the historical and cultural perspective of mental health. For example, many American cultures also perceived mental health as religious punishment or demonic possession. Additionally, racial minorities are disproportionately affected as statistics show blacks and Hispanics record more mental health cases (MHA, n.d.; Terlizzi & Norris, 2021). Also similar to the UK is the treatment-seeking behaviors of the minority races in the United States (Turner et al., 2018). According to Lu et al. (2021), minority populations face stigmatization which prevents them from seeking treatment. Since the problem was largely ignored, stigma and fear were also associated with mental illness. The main difference is that individuals with mental health used to be subjected to unhygienic and degrading confinement in the US during the 18th century. The history of mental illness in the US is longer than in the UK, especially since hospitals and deinstitutionalization began in the 1840s. Mental health policies emerged as early as 1909 and, in 1979, the National Alliance for the Mentally Ill was formed to offer support, advocacy, education, and research services to people with mental health problems. Today, mental health is a scientific and medical problem addressed through various academic disciplines and healthcare practices.
From a cultural perspective, mental health can be understood as a cultural issue which faces cultural difficulties. For instance, disparities across cultures in the UK mean minority races and ethnicities are disproportionately represented in the prevalence of mental health statistics (Simkhada et al., 2021). Minority populations record higher cases of mental health (Bignall et al., 2020). In the UK, Asian and Black minorities are disproportionately represented (Koodun et al., 2021). Additionally, minority cultures have lower treatment-seeking tendencies (Bhugra et al., 2021). In many cases, Blacks and Asian minorities display these treatment-seeking behaviors (Jacobs & Pentaris, 2021; Arday, 2018). According to Gopalakrishnan (2018), mental health providers tend to work with patients from different cultures from their own. The challenges with culture range from how people perceive mental health issues the nature of therapeutic relationships, treatment-seeking patterns, and issues of discrimination and racism. In the UK, mental health is built on western medicine and research, which means that mental health is perceived as being caused by biological or psychological factors that can be medically treated (Njoku, 2020). This means that a change in perception has occurred, as the traditional views held that mental illnesses were caused by supernatural powers or evil spirits. Therefore, the UK has succeeded in overcoming myths and developed scientific approaches to mental health.
Mental Distress Models- (Anxiety)
Mental distress for example, anxiety disorder, can be explained using multiple models, including behavioral, biological, cognitive, and psychodynamic. According to Srividya et al. (2018), mental health can be described as an indicator of a person’s emotional, psychological, and social well-being. Behavioral models conceptualize mental distress as psychological disorders manifested through overt behavior patterns produced through learning and the influence of reinforcement contingencies. Therefore, the behavioral model is based on the assumption that all maladaptive behavior is acquired through the environment in which an individual lives. This conceptualization often means that psychiatrists prioritize changing behavior instead of identifying the root causes of the dysfunctional behavior (Fritscher, 2021). This approach can be regarded as the major conflict generated by the behavioral model since it can be argued that practitioners treat the symptoms and not the illness itself. Changing behavior means correcting one’s actions without due consideration for what caused the behavioral patterns.
Biological models often focus on genetics and environmental stressors, where a key assumption is that anxiety and other mental health disorders run in families. According to Mufford et al. (2021), the heritability of anxiety disorders ranges between 32% and 67% across all subtypes. Specific genes have been associated with mental distress, with findings across multiple studies backing this observation. Therefore, psychiatrists following the biological model will focus on examining neuroimaging of the brain to establish the neural networks associated with a mental disorder (Clark et al., 2017). The major conflict generated by this model is that it fails to acknowledge the cases where genetics are not the problem. Additionally, the model has not been well-development as compared to others, including the psychodynamic, cognitive, and behavioral models. More research would be needed in this modeling of mental distress since critical answers are yet to be obtained. This model has informed studies, research, practice, and policies across both the UK and the US. In other words, both the US and UK use similar treatment approaches associated with the behavioral model, including modifying maladaptive or ineffective patterns.
Cognitive models are often applied to such mental issues as social anxiety disorders, often associated with younger populations. For example, it is estimated that 90% of social anxiety occurs by the age of 23 years (Leigh & Clark, 2018). The cognitive models are based on the premise that people acknowledge the need to make good impressions on others but believe they come across badly. Anxiety can be described as intense, persistent, and excessive fear and worry about daily situations. From a cognitive perspective, these fears emanate from personal perceptions and expectations within the social setting (Fritscher, 2020). The main conflict generated by this model is that there are cases where anxiety occurs in the non-conscious, which means that anxiety is not necessarily a cognitive problem. Similar to the behavioral model, both the UK and the US use the cognitive model in research, policy, and practice. For example, the UK mental health research community uses the cognitive model to develop a set of best practices in mental health care.
Lastly, the psychodynamic models are derived from psychoanalytic conceptualizations, which include self-psychology, object-relations theory, attachment theory, and ego psychology. The principle in psychodynamic theories is that mental life is unconscious and that childhood experience works with genetic factors to shape adult life (Vinney, 2019; Ribeiro et al., 2018). Other maxims include those symptoms and behaviors that serve multiple functions and that these symptoms and behaviors are determined by complex and unconscious forces. Therefore, it can be argued that these models would raise conflicts when considering such elements as social anxiety, where the forces are conscious as opposed to unconscious. Researchers from both countries focus on this model to develop interventions. Examples in the USA include the University of Colorado Denver School of Medicine. In the UK, researchers also seek to develop lasting and effective therapies.
Experiences and Impact of Mental Disorders
Mental disorders, specifically anxiety disorders, cause detrimental experiences on patients and negatively affect individuals, carers, groups, society, and families. These experiences are similar across the OECD, which means that both the United States and the UK display similar characteristics. The experiences and impacts have been subjected to multiple studies focusing on one or more of these stakeholders. Across the US and the UK, it can be observed that the well-being of individuals can be devastated, especially when they cannot live normal lives (Penaskovic, 2022). The limitations include hospitalization, work disruptions due to sick days, declining workplace productivity, and declining incomes due to job disruptions. For school-going individuals, their academic performance is also devastated. Second, the family is the next group to feel direct detriments of mental disorders, especially when the family members act as carers for the patients. Family caregivers tend to provide care to relatives with mental illness; their experiences range from psychological and emotional distress emanating from observing an individual suffer (Azman et al., 2017). The impacts also include loss of income and work productivity due to the time taken caring for the individual.
Society in the UK and the US is negatively impacted by mental disorders among its members. The social impacts are often in the form of social costs associated with mental health. For example, it can be observed in the UK and the US that higher rates of unemployment, reduced productivity, and higher levels of poverty are all experiences of a society with a greater prevalence of mental disorders. The rationale behind this observation is that more people with mental problems means more individuals that are unemployed. The burden of caring for such individuals is borne by family members and relatives. Economic costs, including hospitalization, therapy, and prescriptions, are expenses that negatively affect the socioeconomic well-being of individuals. Additionally, other family members and relatives may also lose their jobs due to their commitment to caring for the individuals. These social costs are often the basis for developing mental health policies in such countries as the UK. For example, new research reveals that the UK economy suffers at least £118 billion as a result of mental health, which forces the stakeholders to advocate more preventative measures (McDaid, 2022). Overall, society is negatively affected in terms of socioeconomic development.
Lastly, careers are another group of people handling mental health patients. Similar to the family members caring for the mental health patient, the caregivers tend to experience higher levels of emotional distress and stigma associated with observing the suffering of the patients. Additionally, some of the patients may require constant care, which could cause burnout among the caregivers. Therefore, the quality of life of a carer could be detrimentally affected. Carers in the UK and the US record high levels of emotional distress, which emanates from spending time with suffering patients. Additionally, carers across these countries face other difficulties, which include difficult home environments for home caregivers.
Stigma and mental health
Stigma is one of the major problems associated with patients with mental illness. As explained earlier, the cultural issues surrounding mental health in both the UK and the USA included stigma and fear as patients were largely ignored. Today, the main cause of stigma in both the UK and the US is the negative perceptions associated with the condition. More specifically, people perceive mental health patients to be unable to control their problems and are more likely to be violent, criminal, dangerous, and unpredictable. Additionally, people with mental disorders can be considered cowards, difficult to like, and lack willpower (Gaiha et al., 2020). The outcome of these perceptions is that the patients are often sidelined or socially excluded, which causes further stigmatization. The stigma is associated with worsening symptoms and a reduced likelihood of seeking treatment. In other words, stigma can be detrimental to treatment-seeking behaviors and the ability of individuals to recover or respond positively to treatment.
Social inclusion is often considered to be an important human right, including for individuals with mental illness. Similar observations can be made across the UK and the US, especially when issues of race and religion emerge as the key determinants of inclusion. According to Hall et al. (2019), inclusion is also a critical part of recovery from mental illness. Therefore, social exclusion can be detrimental to mental health patients since it inhibits their recovery. Mental health patients may not recover on their own, which explains why most interventions are often patient-centered. Despite the adverse effects on the family and society, it can be argued that the best approach to assisting mental health patients is by offering them social support. In this case, social support becomes a mechanism to avoid stigmatization and speed up the recovery process.
Conclusion
Mental health disorders, especially anxiety and depression, are major health problems across Europe and other developing countries, including the United States. Historical and cultural perspectives have been used to compare and contrast mental health issues in the UK and the United States. The case of other European countries has also been highlighted, indicating that developed countries across Europe have relatively similar incidences and prevalence of anxiety and depression. Models that explain mental distress have been outlined and the experiences and impacts of mental illness on family, individuals, carers, and society. Lastly, the causes of stigma have been described, including the negative perceptions by people. Social exclusion is considered to be a critical barrier to the recovery process among mental health patients.
Reference
Arday, J. (2018). Understanding mental health: What are the issues for black and ethnic minority students at University? Social Sciences, 7(10), 1-25.
Azman, A., Singh, P., & Sulaiman, J. (2017). The mentally ill and their impact on family caregivers: A qualitative case study. International Social Work, 62(2), 1-11.
Baker C, (2021) Statistics on Mental Health.
Bhugra, D., Watson, C., & Wijesuriya, R. (2021). Culture and mental illnesses. International Review of Psychiatry, 33(1-2), 1-2.
Bignall, T., Jeraj, S., Helsby, E., & Butt, J. (2020). Racial disparities in mental health: Literature and evidence review. Race Equality Foundation.
Boseley S, (2018) Guardian Health editor Mental illness cost UK £94billion a year.
Campbell, D. (2020). UK has experienced ‘explosion’ in anxiety since 2008, study finds. The Guardian.
Clark, L., Cuthbert, B., Lewis-Fernández, R., Narrow, W., & Reed, G. (2017). Three approaches to understanding and classifying mental disorder: ICD-11, DSM-5, and the National Institute of Mental Health’s research domain criteria (RDoC). Psychological Science in the Public Interest, 18(2), 72-145.
Fritscher, L. (2020). How cognitive theory Is used in phobia treatment. Verywell Mind.
Fritscher, L. (2021). Behavior modeling for the treatment of phobias. Verywell Mind.
Gaiha, S., Salisbury, T., Koschorke, M., Raman, U., & Petticrew, M. (2020). Stigma associated with mental health problems among young people in India: A systematic review of magnitude, manifestations and recommendations. BMC Psychiatry, 20(538), 1-24.
Gopalkrishnan, N. (2018). Cultural diversity and mental health: Considerations for policy and practice. Frontiers in Public Health, 6(179), 1-7.
Hall, T., Kakuma, R., Palmer, L., Minas, H., Martins, J., & Kermode, M. (2019). Social inclusion and exclusion of people with mental illness in Timor-Leste: a qualitative investigation with multiple stakeholders. BMC Public Health, 19(702), 1-13.
Jacobs, L., & Pentaris, P. (2021). Factors affecting the help-seeking behaviour of Black Asian minority ethnic (BAME) groups for mental health services in the UK: A literature review. Greenwich Social Work Review, 2(1), 156-170.
Koodun, S., Dudhia, R., Abifarin, B., & Greenhalgh, N. (2021). Racial and ethnic disparities in mental health care. The Phahrmaceutical Journal.
Leigh, E., & Clark, D. (2018). Understanding social anxiety disorder in adolescents and improving treatment outcomes: Applying the cognitive model of Clark and Wells (1995). Clinical Child and Family Psychology Review, 24, 388-414.
Lu, W., Todhunter-Reid, A., Mitsdarffer, M., Munoz-Laboy, M., Yoon, A., & Xu, L. (2021). Barriers and facilitators for mental health service use among racial/ethnic minority adolescents: A systematic review of literature. Frontiers in Public Health, 9, 1-16.
McDaid, D. (2022). Mental health problems cost UK economy at least £118 billion a year – new research. LSE.
MHA. (n.d.). Black and African American communities and mental health.
Mufford, M., Meer, D., Andreassen, O., Ramesar, R., Stein, D., & Dalvie, S. (2021). A review of systems biology research of anxiety disorders. Brazilian Journal of Psychiatry, 43(4), 414-423.
NIMH. (2022a). Mental illness. National Institute of Mental Health.
NIMH. (2022b). Major depression. National Institute of Mental Health.
Njoku, C. (2020). The relationship between culture and mental illnesses. Our Time.
Penaskovic, K. (2022). How it works: Hospitalization for mental health. UNC Health Talk.
Ribeiro, A., Ribeiro, J., & Deollinger, O. (2018). Depression and psychodynamic psychotherapy. Brazilian Journal of Psychiatry, 40(1), 105-109.
Science Museum. A victorian mental asylum. (2018).
Simkhada, B., Vahdaninia, M., Teijlingen, E., & Blunt, H. (2021). Cultural issues on accessing mental health services in Nepali and Iranian migrants communities in the UK. International Journal of Mental Health Nursing, 30(6), 1610-1619.
Smith, R. (2019). Our history and future: 70 years of the Mental Health Foundation. Mental Health Foundation.
Srividya, M., Mohanavalli, S., & Bhalaji, N. (2018). Behavioral modeling for mental health using machine learning algorithms. Journal of Medical Systems, 42(88), 1-12.
Szasz, (1960) Mental Health in the past. Web.
Terlizzi, E., & Norris, T. (2021). Mental health treatment among adults: United States. Centers for Disease Control.
Turner, N., Hastings, J., & Neighbors, H. (2018). Mental Health care treatment seeking among African Americans and Caribbean Blacks: What is the role of religiosity/spirituality? Aging & Mental Health, 23(7), 905-911.
Vinney, C. (2019). Psychodynamic theory: Approaches and proponents. ThoughtsCo.
WHO, (2018) Mental Health Definition.
NHS, (2022) Mental illness Definition.
Women Health, (2019) Caregiver Stress.