It is Mental Health Awareness Week in the UK. This year, the Mental Health Foundation has chosen anxiety as its main theme, and I have been reflecting on the very mixed picture around it and the many contradictions that abound.

Source: Mental Health Foundation, used with permission

For example, the media is more sensitive than it used to be about issuing warnings before showing images of violence or sexual abuse or discussing content that alludes to suicide or anything that might trigger a flashback of previous trauma. This is all well and good as far as it goes, but at the same time, we seem to have been unable to stop the increasing number of young children being exposed to real or online violence, bullying, and pornography. Moreover, the big social factors that we know negatively affect anxiety and mental health, such as misogyny, racism, poverty, and inequality, continue or get worse.

Many of the young parents I encounter impress me with their emotional intelligence. They seem to have an understanding of a child’s need to be held and the importance of nurturing a sense of safety in the early years. But childcare in this country is still at a crisis point despite recently announced plans to increase funding, leaving many parents in a desperately anxious position with the cost of living increases, precarious employment, and precarious housing. By the time children start school, many are already showing anxiety symptoms—16 percent of 7 to 16-year-olds reported mental health symptoms in a 2022 survey, and the percentage increases as they age. Levels of anxiety in children in the UK are amongst the highest in Europe.

Our institutions—schools, hospitals, and so many places of work—are riven with unhealthy levels of anxiety. High levels of scrutiny and micromanagement, growing bureaucratic demands on employees to account for their every move, and an increasingly persecutory culture within human resources have become the norm. It is well-evidenced that the one factor in work environments that we know has a positive effect on mental health is a sense of agency and control over one’s working life; in other words, sufficient confidence in one’s own skills and how these fit into the general enterprise, and the sense that one is experienced and trusted to use one’s initiative. Sadly, fewer and fewer organizations seem to understand this or show themselves willing to create the culture that would enable it.

There are, of course, reasons to be optimistic. We talk much more openly than we used to about mental health, which is a good thing, and we have moved forward in our understanding of the issues and the various therapeutic options. But while there has been progress in helping people feel more comfortable talking about anxiety in general, I am not convinced this has made a positive difference to our attitude towards people with the most severe mental health problems. Too many people continue to live in a state of overwhelming fear that is hard to make sense of, let alone put into words: a fear compounded by the stigma they face.

Moreover, after years of underfunding, our mental health services cannot be relied on to offer welcoming, humane care and treatment for such people: men and women with levels of anxiety so engulfing that they are unable to keep their hold on reality, some so mistrustful that they are imprisoned by their social isolation, and others so tortured that suicide seems the best option. A shortage of beds and psychiatrists means that assessment, treatment, and admission are often delayed, and too often, the patients’ problems are exacerbated by being sent hundreds of miles away from home.

So while we congratulate ourselves that we are becoming a society that is in some ways more aware of mental health issues, we need to reflect on our general ambivalence and, in particular, our shameful neglect of those with severe mental health disorders, some of the most vulnerable people in our society.