Warkwickshire LINk invited members to a lecture about wellbeing on February 28th. Around sixty attended, though perhaps not all of us, and perhaps very few, were LINk members. The speaker was Gregor Henderson, who was billed as leading the Wellbeing and Population Mental Health programme at the Department of Health’s National Mental Health Development Unit (NMHDU).
I was interested to compare his approach with the approach in Worcestershire that I heard about in a lecture there in October.
The lecture’s full title was: “Why ‘wellbeing’ matters and why it will have an increasing relevance to healthcare policy & its delivery”.
In the event, the lecture made no specific mention at all of the NMHDU or its programme, didn’t relate in any meaningful way to the approach in Worcestershire, and didn’t directly address either of the two questions in its own title. Even so, I’ll return to those two questions at the end.
The lecture took place at the University of Warwick’s Medical School, in a modern lecture theatre designed to have the acoustic properties of a concrete silo. Actually, it was exactly that — a concrete silo. Doors slammed at the back, making the introductions inaudible to everyone except a few at the very front.
Someone over on the right yelled “Speak up!” and the host shouted back “I’m not mic’d up!” before lapsing again into mumbles. Perhaps she introduced herself, but as I was sitting near the back I have no idea who she was.
The lecturer did have a microphone. He spoke fast, with tremendous fluency and conviction, blending personal anecdote, the occasional joke, quotations and facts with confident assertions. Just a few tiny errors betrayed him.
The first was when he said the wrong word. I can’t remember what word it was now. Something unimportant, like saying “appears” when he should have said “allows” — a word completely out of place, making the sentence meaningless. Any normal speaker would have corrected himself, but this speaker continued without the slightest pause. A little later it happened again with a different word.
He wasn’t aware of what he was saying.
This was a robotic performance, a pre-recorded message to a passive audience.
The content of the lecture is difficult to assess, and that appears to have been deliberate. The parts of the lecture that dealt directly with the subject of ‘wellbeing’ went at a hectic pace. The slides were too packed full to be readable in their entirety. Bombarded with information, it was not easy to make any sense of what was being said.
Other parts of the lecture slowed right down. These parts were easy to take in. But these parts did not deal directly with ‘wellbeing’. For example, one slide was a cartoon comparing investment banking with roulette. Another was a picture of a Scottish lake.
In his introduction the speaker warned that we were about to hear his personal take on things, and that he was not sure about the evidence. Both parts of that statement were misleading. The take on things that he presented was not personal, but a very conventional far-left anti-capitalist point of view in which freedom and wealth are denigrated as the main causes of mankind’s troubles. And the evidence for this point of view is not something that anyone can be unsure about — it plainly and simply doesn’t exist.
Indeed, apparently unknown to this lecturer, there is plenty of evidence for the opposite. For example, the Fraser Institute (an independent research institute) shows in considerable detail in its Economic Freedom of the World report for 2010 that:
Nations that are economically free out-perform non-free nations in indicators of well-being
The host (whoever she was) let the cat out of the bag late in the proceedings when she blurted out her admiration for Cuba, (which comes 177th out of the 179 countries in the 2011 Index of Economic Freedom, and which Gallup puts second from bottom for wellbeing amongst countries in the Americas.).
The lecturer himself was never that explicit, but she had correctly identified his gist. His ideal countries are the Scandinavian ones, because of their high levels of government social spending.
The New Economics Foundation
The details of the lecturer’s view are loosely derived from the work of the New Economics Foundation (nef), a far-left think tank that campaigns against freedom and wealth.
The nef’s approach is to identify well-known social problems — areas in which people are clearly dissatisfied with the way things are — and then to support whichever solutions to those problems would tend to decrease freedom and wealth.
The nef has identified wellbeing (or lack of it) as one of those social problems, and it includes happiness (but not freedom or wealth) in the way it defines wellbeing. From its 2004 paper, A Well-Being Manifesto for a Flourishing Society
Well-being is more than just happiness. As well as feeling satisfied and happy, well-being means developing as a person, being fulfilled, and making a contribution to the community.
The lecturer’s view of wellbeing was less clear. According to him, it is not the same as happiness. (And that’s a shame because some good research into happiness has recently been carried out, and there is now an established body of evidence about practical ways for people to be happier.)
He presented a slide based on the 2008 nef paper, Five ways to wellbeing, but followed it up with that picture of the Scottish lake, saying:
Wellbeing looks a little bit like this for me.
Oddly, though, the tranquil and lonely scene did not express any of the nef’s five actions (“connect, be active, take notice, keep learning, give”), but instead suggested isolation and detachment.
His approach to mental health criticised current thinking in two ways.
First, his view is that mental illness is just the tip of an iceberg of mental unwellness. He showed a graph suggesting that almost everyone is mentally unwell to some extent.
Second, he noted that current treatment for mental illness does not work very well. Even if treatment were universally available, he claimed, it would only work in 40% of cases. His solution to this imaginary problem of widespread and untreatable mental illness is to change the:
…economic consumerist model of production…
At this point he showed a picture of ruined buildings, with the caption “Economic Growth”.
He welcomed the way the present government had incorporated some ideas about wellbeing and social capital in its Mental Health Strategy.
But he seemed to become confused when trying to interpret a graph of social spending per capita versus mortality in various countries. He seemed to claim that more social spending is always better. However, the graph showed that social spending is only associated with improved mortality up to a point. The UK’s social spending is at that point. Above that level of social spending, there is no relationship with mortality, according to the graph.
After spending most of the lecture cataloguing things that some people feel are wrong with Western civilization, there was one packed slide describing what is to be done. It all went so fast that I was only able to write down two of the proposals, though the others were in similar vein:
- Controls over the media and marketing
- Corporate sector constraint
So, with this kind of thing as its punchline, the whole lecture had amounted to nothing more than a standard anti-freedom, anti-capitalist rant.
In a recent debate in the House of Lords, Baroness Murphy, a former professor of psychiatry, criticised the focus on wellbeing in the government’s Mental Health Strategy:
For me, the overarching theme of the strategy represents a misguided, somewhat soft-headed, utopianism focused on well-being and mental good health, as though there were a direct connection between a happy society and reduction in serious mental illness. But there is not.
I suggest that a mental health strategy should focus primarily on those with the most severe disorders, whose lives are so often wrecked by the misery of mental illness. It has to be fit to be translated into measurable outcomes for the commissioning board and turned easily into commissioning intentions by GP consortia.
The lecturer was furious at this, remarking later that “Baroness Murphy just doesn’t get it.” His fury is easy to understand, because Baroness Murphy’s speech was knowledgeable, factual and coherent in a way that his lecture was not. It tore apart the fantasy that wellbeing and mental illness are related, which was the assumption on which the entire lecture rested.
There were about a dozen questions from the audience. The host (whoever she was) seemed to know several of the questioners personally.
The questions were almost all critical of the ideas put forward in the lecture, pointing out the lecturer’s lack of evidence and his over-simplified view of mental illness. His answers were very weak, because he tended to quote multiple sources seemingly at random, quickly straying from the point of the question. His fluent but robotic style of lecturing was unsuited to giving thoughtful replies.
Two questions were particularly revealing. One questioner pointed out that Scandinavian countries, with their high levels of government social spending, had comparable levels of mental illness to the UK. The lecturer fell apart, as if the rug had been pulled out from under him. “Let’s see” he said in desperation, “Let’s try it and see.” (And I wrote down his very words.) The host tried to rescue him by changing the subject to parenting.
The last question of all was even more penetrating. Following up the host’s remark about parenting, someone asked whether fathers can be replaced by society. The lecturer thought this was a very good idea, although, “We haven’t been very good at it.”
The Mental Health Compact Network
This lecture was the first in a series organized by the Mental Health Compact Network. I have no idea what that is, or who it is. I don’t think I ever joined it. I received the invitation through Warwickshire LINk.
If it was not all a mistake, and if I am invited to more of these lectures, I will certainly try to attend. It is always fun to hear extremists put forward their points of view, and always interesting to observe their imperviousness to evidence, logic and criticism.
In conclusion, what of the two questions in the lecture’s title?
Wellbeing matters because it’s a fundamental driver for human activity. People will do things if they think they will be be better off (have greater wellbeing) as a result. But this lecture illustrates how the term ‘wellbeing’ has been used recently to promote a lopsided political ideology — one in which people making themselves better off by being more free and more wealthy are deliberately excluded.
Wellbeing will probably not have an increasing relevance to healthcare policy or its delivery. A few years ago it might have seemed that way, but that part of the lecture’s title is out of date. The role of wellbeing in the current government mental health strategy is limited, is a throw-back to an extreme fringe of the previous government’s ideology, has already attracted criticism, and will not survive when everyone starts to focus on real outcomes in the community.