I have a strange fondness for the London Tube.
When I took stock after my last trip to the city, I realized I had come home with a London Underground T-shirt, hoodie, Christmas ornament, coffee mug and tote bag. (I’ve done my part to try to lessen Transport for London’s funding crisis.) My visit to the London Transport Museum (where do you think I got all the swag?) inspired me to watch a few documentaries about the railway’s 150+ year history.
One of the more sobering things I learned is that a serious mental health crisis has been winding its way through the historic tunnels of the London Underground for decades.
This is manifested in a few different ways. The most tragic example is the number of people who attempt to take their own lives by jumping onto the platforms — typically it’s several dozen each year, but periods of economic hardship have nudged the numbers close to 100 at times.
But the less obvious are the mental health issues suffered by transit workers. During years of working long shifts deep underground, station attendants and drivers not only bear witness to suicide attempts and occasional serious crimes, they have a front row seat to frequent passenger accidents.
The famed “mind the gap” phrase made its debut on the London Underground in 1968 when someone finally realized that an automated message and clear signage was more practical than workers being tasked with constantly warning passengers about the gap between the trains and the platforms.
Since then, Transport for London has boosted its safety measures, as well as launched internal campaigns to raise awareness of mental health issues among its staff. Workers even undergo mental health first aid training to help them assist passengers in distress.
Despite this, passenger suicide attempts as well as accidents have continued. In 2018, there was a 60% rise in the number of sick days taken by Transport for London staff citing mental health problems, specifically high incidences of anxiety, depression and PTSD. In other words, there is still a gap, and attempts to mind it have not been effective.
Now, almost two years since COVID came barreling through our world, we’ve reached a point where mental health issues are no longer relegated to the underground. Worldwide inadequacies in mental health treatment have always been very real, and for too long we’ve balanced precariously on the edge of a dangerous mental health crisis.
The pandemic-inspired surge in mental health issues has become a recorded warning playing on repeat, reminding us that there’s a dangerous treatment gap that warrants the world’s attention.
The WHO has sounded the alarm that increased investment is required on all fronts, including mental health awareness and education, as well as research to identify new treatments and improve existing ones.
More than 30 years after “wonder drugs” like Prozac hit the scene, we still don’t fully understand the underlying pathophysiology behind mental illness and there are still patients with little treatment options. Better drugs may only be one part of the solution, but it’s an important part.
And while the psychiatric drug space has seen a fairly large exodus by major players over the past decade, a handful of strong companies have stayed focused and some promising new companies have come on board. Fortunately, new developments in biomarker research and innovative approaches to treatment may offer light at the end of the tunnel for many struggling patients — but only if pharma stays on track.