‘There are ways to tell stories that might spur action, or provide hope’

You've always struck me as a person with a message, keen on creative ways of getting it across. What is that message?

When I started this work, it was about awareness raising, in its most general sense. But raising awareness on its own isn't enough, and sometimes the awareness that we raise can have unintended consequences. 

The narrative that 'It's OK to talk about mental health' has been incredibly helpful. But what we talk about tends to be mental health, not mental illness. We talk about wellbeing, or mindfulness, and we talk about depression and anxiety as the default position. Somewhere along the line, we've lost the 'serious and enduring mental illness' side of things, which can destroy lives. 

If the people driving the conversation are the 'chattering classes' – and I may not have started off chattering class, but that's where I'd put myself these days – then we're the ones who can afford to pay for the therapy, and who can use our sharp elbows to make sure that we get our kids into CAMHS. But there are lots of people without a voice – people with severe mental illness, people who end up in prisons, people who end up without a roof over their heads. Those people get lost.

I also have an enormous reaction to the word 'resilience'. It's only one step removed from 'pull yourself together', for me. This relentless focus gives society the excuse not to look at itself and say, 'We don't house our people properly. We have people who are starving, living in poverty, we have a gig economy which is creating massive amounts of instability for our young people. We have a housing market, which puts houses out of reach.' I'm not a great advocate for the hierarchy of needs, but we have removed the bottom of that pyramid. When you talk to young people these days, they've not necessarily got the tools to articulate how that lack of security impacts their mental health, but it's just hovering – that deep uncertainty about the future.

If the needs are that basic, then if people do reach out to you as a psychological professional, do you feel powerless to do anything at all?

I keep speaking truth to power – which makes me sound very up myself, but it's the only thing that I can try to do. 

When I made a series on child and adolescent mental health, I interviewed the fantastic Sally McManus, from NatCen. And she said, 'Can you make it clear to people that poverty is as much an adverse childhood experience as a bereavement or an abuse?' Messages like that are important. When you're interviewing experts by experience, say around addiction, it shouldn't just be a celebrity whose experience has perhaps been atypical. You need to communicate we know about the population, about society, about the way we are configured, which mean that the odds are stacked more against some people than they are against others. It's hard to talk about people having mental health rights, when other rights don't exist for them.

How does that message go down?

I've had stuff edited out of what I've made. I've had things turned down because they're considered 'too gloomy'. Well, you know, what, life is bloody depressing for a lot of people. And there are ways to tell it, which don't drag the listener down, but which might spur action, or provide hope.

I guess that hope can come from working across systems and agencies. But do mental health professionals effectively become political activists or a signposting service to others, or is there anything that can be helpful to the individual in the face of such challenges?

There's always stuff that can be helpful, but we know what those things are. And this is where the evidence comes in. If you look at a project like Men In Sheds, that's done brilliantly, because it's provided social capital for a group of men who are incredibly at risk of a particular thing, suicide. And if you look at Alcoholics Anonymous, it's got its problems, but there's no doubt that the social cohesion – the feeling of being listened to, and held, and not alone – save lives. So we know about social capital, and we can do stuff around creative health.

One of the things I find really depressing about mental health therapy, be that pharmacological or psychological, is that we don't put enough into prevention. At the moment, young people can't get access to support. That's a time bomb. We know this stuff. We know that most mental illnesses start in late childhood adolescence into young adulthood. And we also know that we can at least mitigate those effects and modify them so they don't become more severe. Why aren't we chucking resources at that? But, crucially, why aren't we following the evidence?

Instead, if you take that example of children and young people, people are rushing into the vacuum with all sorts of solutions. There is no evidence base to show that 'mindfulness in every school' is going to improve the mental health of our young people. We should be spending those resources on a skills-based intervention that we know works, not on one that feels like the right thing to some Guardian journalist. 

That's why it's important to me to get the evidence out there. In this post-truth world people are absolutely convinced they know what's right, based on their experience. That's not to undermine anyone's own experience, but within a variety of experience, there's usually a curve, and there's usually a chunk in the middle. And that's where we should be focusing first, because we've got more chance of reaching more people.

Do you think there's a danger this 'public understanding' of the research, becomes a monolithic view, of what is 'right' and what needs to be understood? Is that why it's important to involve service users in your role, so you're not just trawling the journal articles and deciding what's 'right'?

The public don't often want to hear that research. I absolutely understand why, because some of it is really dry and difficult to get your head around. So take Electro Convulsive Therapy, where there has been a recently published review, in Psychological Medicine. It was a narrative review, with studies mainly from the 1980s, when I'm sure ECT was a completely different experience to what it is now. It's a NICE approved treatment in this country. Nobody denies that there can be memory problems with it as a side effect, and that can be quite severe. But it saves lives and works for very many people. How do you explain, in a 28-minute radio programme, what evidence people should listen to? Evidence often isn't compelling.

You have to use storytelling. When we made the documentary Shocking, we deliberately found the experts by experience for whom ECT has worked, to counteract some of the negative images that people have got about it. But you have to do that from a position where you know that the science is solid. 

That's where you've got Psychology in microcosm though. Because the authors of that Psychological Medicine review will say their science is solid. They wants to analyse the evidence too, they want to go out there and capture the patient experience which they feel hasn't been properly represented. A member of the public who hears this just goes, 'Look, you're all scientists, sort it out!'

I see what you mean, and trying ethically to use the right stories to illustrate the science is quite a balancing act. But I do think that in terms of ECT, for people where it has worked, they don't always have the same motivation to tell their story. They're getting on with their lives, and that might be a period they don't want to revisit.

We'll come back to the storytelling. But the 'biopsychosocial' has been a constant thread in our magazine over the years. It's surely not controversial to say that most things in our lives are biopsychosocial. But in my experience, the 'psychology' side perhaps have more difficulty accepting the 'bio', than those more medically or psychiatrically minded have accepting the 'psychosocial'. Perhaps they feel that when it comes to understanding and treatment, the 'bio' can override all else?

With diagnoses, some people like having something that feels discrete and understandable; other people completely reject that as being too reductionist. For me, the answer has always been 'both, and'. You know, we talk a lot about mind and body. But mind, body and context is really important. If a biological intervention, such as Ritalin for example, has a strong effect over and above anything that can be even vaguely described as placebo, then that's showing you something, particularly if you're triaging data from lots of different sources. 

Maybe people reject the biological because they think if we accept it, we've got to throw the baby out with the bathwater, and not accept the psychological or the social. Or perhaps it's just not a great feeling to think something might just be the sum of a bunch of neuronal firings? But it's interesting, if you look at the history of this stuff… I interviewed Max Fink, the 'grandfather of ECT' as he's known. He's 101 now, and he was talking about in the 1950s, this massive tension between the 'new neurologists' and the psychoanalysts. Huge arguments over which should be the dominant model. And then along came antidepressants, and both of those dominant paradigms fell by the wayside, because that's what everybody was rushing towards. I think we're back to having that discussion that was taking place in the 1950s, but there's more thrown in now. The social has become much more prominent, and quite rightly. But how weird is it, that we try to reduce human beings to some sort of science, you know, be it bio, or psycho, or social? Griffith Edwards used to say about 'the addictive personality', the idea that you could sum up somebody in three words, you couldn't even sum up somebody in a book.

Yes, there's that complexity of it, but it's all so flawed too, everything. You talk about research, and funding, and publication… I'm watching Dopesick at the moment, about America's opioid crisis. You know, people are right to be wary of science, and how drugs have been created and marketed. And then, arguably, you get to the end of it all, and with your example of ADHD, there's no Ritalin available anyway! It's no wonder people are confused. 

And so in your recent inaugural lecture, you talked about the 'messy, scary, frightening stuff' that we tend to avoid. Perhaps in a world that does feel so messy and scary, at least you can tell some illuminating stories about people and their issues.

That's what I hope for. So, self-harm is another example. If you look in the literature, people with borderline personality disorder are the group most likely to severely self-harm. And they are also the patient group that health care professionals seem to least want to have anything to do with: they experience regular stigma. We made a programme called Hurting, and I wanted listeners to understand the utter desperation and misery that people who were self-harming were going through. The compulsion, the mental hold that it had over them. 

We've got such sanitising language for this stuff, and radio or podcasts is a great medium for getting people to listen differently. When you have a voice in people's heads, telling them a story, that's a much more intimate thing. It allows people to tell their stories, in audio diaries for example, and yet still choose how much of themselves they do or don't want to reveal.

How do you measure the impact of that kind of programme?

I can get listener numbers, and I've had emails from cabinet ministers and people in positions of authority after my programmes, saying it was thought provoking and not like anything else they had heard. 

But it's true that the impact of any public engagement is really difficult to measure. Did 'Time To Change' reduce stigma, or was it William and Kate getting involved, or was it just a kind of general switch the public was ready for?

I think just getting something commissioned, when there might be resistance if it's a difficult topic, that feels important. And I get loads of emails from the public – I'm easy to find. Sometimes they give me a hard time, but generally, it's thanks for telling the story. These aren't my short stories. It's about providing a space where people can tell their stories, and then I try to honour their words in the edit.

Given what you were saying about the 'chattering classes', presumably it's also important that alongside BBC Radio Three and Four, those stories also get out through platforms such as Ant and Dec's Saturday Night Takeaway, for example. But my concern with the awareness raising we might see there has always been sure, it's good to talk, but it's often rather a lot for friends and family to actually know how to respond.

I was driving the other day, and I heard somebody on the radio talking about how hairdressers and beauty therapists get training as part of their course about listening to people's distress, and being able to signpost them to help. Everybody's got to be a therapist. But to me, it feels that having destroyed so much of the connectedness in our world, we're legislating for those community relationships which should be organic. And sure, it's good to talk, but it's even better to have access to a properly trained professional. I had a psychotherapist for over 20 years and she just died recently. It's left a massive gap for me. She kept me out of hospital. She prevented me from getting so bad that it might become my only option. So yes, it can be about talking, but talking to the right people.

Do you think your approach to these topics has been influenced by the fact you trained quite late in life?

Not so much my late training, it was probably my experience before then. I was 38 when I started with the Open University, 39 when I went to Goldsmiths. It's made me more fearless. I'm 58. I'm getting to the end of my career. What's the worst that can happen? If I say something, what's the worst anyone can do? If I have to go and live on a hill in Yorkshire, it's not a bad life. 

But also as I've got older, I feel I've got a lot to pay forwards. People helped me out when I was younger, and now I'm in a position where I can do that. I don't have any religion or anything that drives me, but it does feel like karma.

When you're mentoring that next generation, do you have a core principle that you try to pass on?

That you can break the rules. Getting to where I am now, from going back to university at 38, is breaking the rules. I had a picture of Glenda Jackson in my inaugural. At the height of her acting career, she jacked it all in to go and be a jobbing MP. And then shortly before she died, she resurrected her acting career, but not just in any ordinary way… in a fabulously modern queer performance. 

Of course, these things are possible for many of us, but not for all of us. So don't forget the ones that it's not possible for. So pay it forward, remember that you don't have to crap on people to get on, and as Jack Lemmon once said, 'No matter how successful you get, always send the elevator back down'. 

Photo: David Tett