In England, the Social Exclusion Unit’s report on mental health confirms that people from a number of groups find it particularly difficult to access help for anxiety and depression (see Chapter 4 on older people and Chapter 8 on ethnic minorities). In recognition of this, The Big Society was the flagship policy idea of the 2010 UK Conservative Party general election manifesto. The stated aim was to create a climate that empowers local people and communities, building a ‘big society’ that will take power away from politicians and give it to people, and supporting the development of local resources to support people in their community.

This chapter illustrates that collaboration between other organisations in the community outside healthcare (social care providers, public health, housing, local government and the ‘third’ or voluntary sector) is essential to ensure that people with anxiety and depression get access to appropriate help that meets their particular needs, many of which may have a large social component.

Problems with accessing care for anxiety and depression

People who are experiencing anxiety and depression may not access care for a number of different reasons. Firstly, they may not recognise that they have a mental health problem, or do not wish to use the term ‘anxiety’ or ‘depression’. Stigma remains a powerful problem in the community and militates against people recognising and seeking help for depression. Secondly, they may have difficulty in making sense of how the healthcare system operates (i.e., they lack health literacy), and understanding how it can help them. Thirdly, they may or may not actually seek help for symptoms, and fourthly their presenting symptoms and problems may or may not be accurately identified by a health professional (this is usually from a doctor or nurse in primary care). Finally, they may or may not be offered appropriate or acceptable treatment for their problems. Effective treatment for depression and anxiety is still lacking across the world according to the World Health Organization, and even where the evidence exists, such services or interventions may not be available for patients and their clinicians. Many people also have social difficulties, which are inextricably linked with their mental health problems.

‘Social problems’

As we saw in Chapter 1, life events, chronic social stresses and lack of social support play a key part in the aetiology of anxiety and depression. This sometimes leads health professionals to assume that the mental health problems a person is experiencing and describing are simply a ‘reaction’ to social problems, are understandable, and not something that they (the health professional) can do anything to alleviate. This is because they do not think that the person can feel any better until their life situation improves (which may be wrong – they may still benefit from treatment that will help them to manage circumstances and stress more effectively and assist in their recovery). Additionally, they may think that there is nothing they can do to assist a person in actually managing their social problems – which is not entirely true. A key issue in medicine, and in particular in primary care, is the extent of wider social causes of health inequalities, which commonly accompany anxiety and depression and are a legitimate focus for health professionals. Many people with anxiety and depression have complex and sometimes enduring social needs (see Box 12.1). However, research has shown that GPs in the UK often have very limited knowledge of, and poor links with, resources in the community. GPs are most likely to refer people to counselling and specialist advice focusing on financial and housing problems, but much less likely to signpost people to community groups or to agencies that might specifically address other types of problem. Counselling in itself may be unhelpful if the problems that caused, or result from, the anxiety and depression are not in themselves addressed in a practical way.