Mental Health is NOT Mental Illness - And why this matters.

Mental illness is devastating. Its impact can tear through a life and change its course forever. When I talk about mental illness, I am not talking about having a tough week or feeling overwhelmed. I am talking about conditions that take over your ability to function, to think clearly, to work, to maintain relationships, to trust your own mind or body. I am talking about symptoms that frighten the person experiencing them and severely impact those around them. We are a society that speaks more about mental health than ever before, and yet there remains misunderstanding between mental health and mental illness. The difference matters.

Before anything else, let us acknowledge the reality. According to Mental Health First Aid England:

• 1 in 4 people experience mental health issues each year.

• 792 million people are affected by mental health issues worldwide.

• At any given time, 1 in 6 working-age adults have symptoms associated with mental ill health.

• Mental illness is the second largest source of burden of disease in England. It is more common, more long lasting and more impactful than many other health conditions.

• Mental ill health is responsible for 72 million working days lost and costs nearly £35 billion each year.

These numbers represent lives, families, workplaces, and futures altered. They represent people who fight every day to survive conditions that other people may never see and often never understand.

Mental health and wellbeing is not mental illness.

They are not the same.

We all have mental health that requires nurture and attention throughout our lives, but we do not all live with serious mental illness.

The World Health Organisation defines mental health as a state of well-being enabling us to cope, learn, contribute and make decisions, describing it as a basic human right and essential for socio-economic development. In contrast, the UK government describes severe mental illness as psychological problems so debilitating that the ability to engage in daily life and work is significantly impaired. Schizophrenia and bipolar disorder are commonly referenced in this category.

I often question whether social media has blurred the lines of understanding. Our wellbeing naturally rises and falls with life circumstances, stress and physical health, but fluctuations in wellbeing do not automatically equate to mental illness. Not every difficult period is a diagnosis. And not every experience reaches the threshold of serious mental illness that requires intervention, treatment and long term management.

In 2009, during my first psychiatric admission, I met a friend named Jason. We were both facing diagnoses we did not understand and certainly were not prepared for. It was our first hospital stay, our first experience of being told that what we were living through had names, categories, criteria and serious implications. We bonded through honesty, fear, survival and a need to make sense of the chaos our lives had become.

We spent years talking about what we saw online. The voices trying to raise awareness. The influencers and professionals sharing strategies for mindfulness, self help, managing stress and promoting positive wellbeing. Many of these voices come from lived experience and many intentions are good. Awareness matters. Conversation matters. Hope matters.

But Jason and I often felt unseen in that space. Between us we carried bipolar, schizo-affective disorder, psychosis, generalised anxiety disorder, eating disorder, seizure disorder, major depression disorder and even serotonin syndrome, which is a life threatening medication reaction. We were not talking about mindset shifts or bad days. We were talking about high risk episodes, admissions, serious side effects, treatments that worked and treatments that made everything worse. To survive our diagnoses became the daily work of living.

When you are living with serious mental illness, much of what is spoken about publicly feels very far away from the darkest realities. Mental health charities do an amazing job as do lived experience advocates who are transparent with their intent but there is still a long way to go. The pockets of truth shared by those who have experienced the realities of the NHS, often at its most stretched and imperfect, need greater visibility and stronger support from the wider public. To move forward, we need to keep speaking up. We need to challenge stigma where it exists and question harmful narratives.

If we review the use of language towards specific diagnoses, lets start with the word anxiety, which is used often to refer to normal physiological responses to stress. Feeling anxious does not mean someone has an anxiety disorder. But when anxiety becomes chronic, unrelenting, debilitating and impacts your ability to function, it becomes something else entirely. People can be left unable to work, drive, leave the house or live independently. Panic attacks can feel like life is ending. The thought of stepping outside the front door can become impossible. This is a clinical condition which for many can last a lifetime and requires treatment.

The same applies when people casually say they are “so OCD” because they like things tidy or organised. OCD is not a personality quirk. It is intrusive thoughts that can be terrifying and uncontrollable. I have seen first hand people paralysed by their compulsive thoughts. In hospital, when I stood outside with Jason I used to see a young woman hiding inside near the stair case. One day, when we were out of sight, we watched her reach the outside door looking terrified, check to see if anyone was watching and speedily step up and down the step twenty plus times. We realised it was the only way she would come outside. Some people struggling with OCD cannot function without rituals, or be tormented by impulses to harm themselves that come from nowhere. OCD can feel like suffocation with no escape.

Depression is another area where language matters. Saying you are depressed after a difficult day is very different to clinical depression. Clinical depression is constant. It strips your capacity to think, connect, hope or rationalise. It can lead to coping behaviours that become destructive because anything feels better than the crushing weight of the darkness. Suicide can feel like relief, not fear. For many people experiencing depression, suicide may not feel the most frightening part, it can appear as the only solution. Suicide is a permanent response to something that may be treatable with the right intervention, support and time.

Then there is bipolar disorder. Often misunderstood and often misused in casual language. It is not being 'up and down'. It is a serious mental illness. There are different types, which can present themselves in different ways. Bipolar can potentially destroy lives, causing risk taking, delusion, financial devastation, the breakdown of families, friendships and identity. In my first major episode I rapid cycled from intense mania to suicidal depression with psychosis, then I spent many years in and out of depression with bouts of hypomania. After years of inpatient and outpatient treatment including ECT, I found a place of stability through medication, therapy and lifestyle management. However, I know my system is sensitive to life and its curveballs and I am mindful of this on a daily basis.

The statistics from Bipolar UK show 1 in 50 people in the UK have bipolar. The risk of suicide increases 20 times after diagnosis. It takes on average nearly ten years to receive the correct diagnosis and most people are misdiagnosed more than three times. Only 21% of people with long term mental health conditions are in employment.

Psychosis is a very misunderstood diagnosis, which can form part of several serious mental illnesses, including schizophrenia and schizoaffective disorder. It's impact can be profound and relentless. People often fear psychosis because they do not understand it, and that fear can quickly turn into stigma, ridicule or even responses that feel punitive rather than supportive. Fewer than one in a hundred adults in England experience a psychotic disorder in a given year yet the misunderstanding around these experiences is widespread.

In reality, people experiencing psychosis are far more likely to be victims of violence and harm themselves than to harm others, and suicidal thoughts and behaviour are tragically common in the context of untreated distress, highlighting the terror and vulnerability people face. Jason experienced voices through schizoaffective disorder and psychosis. Medication could silence them or amplify them, which is the unpredictable reality of psychiatric treatment. His voices mocked him, taunted him and encouraged him to end his life. The number of suicide attempts he made goes into the hundreds. I would speak to him both before and after. These conversations were not unusual for us. They were an accepted part of living with serious mental illness. This is the reality many people face silently.

Jason died in 2020. Losing him was devastating. I lost not only one of my closest friends, but my ally in the world of mental health and mental illness. We began our journeys at exactly the same time, navigating first admissions, diagnoses and survival side by side, and that shared understanding created a bond that cannot be replaced. He was the one person with whom I could speak openly about the darkest truths of illness without fear of judgement or misunderstanding.

Many people can talk about feeling low or anxious, but conversations about intrusive thoughts, how medication can affect your body and nervous system, periods of emotional disconnection, or behaviour shaped by symptoms do not always feel safe or welcome. With Jason, there was no need to explain or soften the reality. He understood because he was living it too.

People often sympathise when someone cries but do not always know how to respond when someone presents anger, irritability, racing thoughts or detachment. Yet these can be symptoms of illness just as much as sadness can. I have spent weeks hiding with shame, reflecting on moments that were out of character but symptomatic of a diagnosis. Honest conversations delivered without compassion can cause harm. Words matter.

At the same time, compassion does not mean ignoring concern or removing boundaries. When behaviour feels unfamiliar, overwhelming or worrying, seeking professional support is always the right step. Mental illness requires care beyond understanding alone. Listening, empathising and trying to remain compassionate can feel challenging, and it is not something people should carry on their own. Support from trained professionals is essential, both for the person who is unwell and for those around them.

My experience within the mental ill health community is that conversation is different. When you sit with people who have lived through psychiatric wards, suicide attempts, trauma, recovery programs and crisis teams, you learn that honesty becomes survival. These spaces are raw, open and free from expectation. People are valued for who they are, not how put together they appear. These people are survivors in the purest form.

Online, there is encouragement to share openly, but in reality it often feels only acceptable if the darker parts are edited out. If you are struggling with mental illness, speaking to someone you trust and someone who understands can make a meaningful difference. The mental health community can be deeply compassionate when conversations are allowed the space to be real.

Of course, it is important to be mindful of safety and the space being held, but the idea that talking openly about difficult thoughts or experiences will put them into someone’s head is a myth. For many people, being able to speak honestly about what they are carrying can reduce isolation, ease distress and create opportunities for support. Open conversation, when held with care and responsibility, can be an important part of feeling seen and supported.

I share my lived experience through my work, but I do so cautiously and with clear boundaries. Privacy is protection and stability matters. That balance has allowed me to spend the last sixteen years working across education, healthcare and community settings, speaking with students, professionals, organisations and individuals about lived experience, recovery and reality. My work sits in the space between understanding mental health and understanding mental illness, recognising the distinction while also acknowledging how closely the two are connected.

Mental health can deteriorate into mental illness, and mental illness will always impact mental health. The question is not whether they overlap, but how we respond early, how we reduce harm, and how we create environments where people feel safe enough to speak before things escalate. Prevention, understanding and compassion matter just as much as treatment. So does challenging stigma, reducing fear, and removing the barriers that stop people from seeking help or being accepted once they do.

If parts of this blog feel uncomfortable, it may be worth exploring why. Discomfort can be a doorway to understanding rather than avoidance. Mental illness is not something to fear, but it does require acknowledgement, support and space.

Let us look after our mental health and be courageous enough to understand more about the serious side of mental illness. We need forward movement, and that means bridging the gap between the experiences most people recognise and the ones many people cannot relate to at all. The stories that are harder to hear are no less deserving of space. Just because something feels unfamiliar does not mean it should be feared or avoided. With understanding, things that once felt unrelatable no longer have to feel frightening.

The more we learn, the more we listen, and the more we ask questions without judgement, the more we reduce the isolation so many people feel. This is how we create communities that hold space for the full spectrum of mental health, including the parts that are rarely seen and even less spoken about. Compassion builds connection. Curiosity builds safety. And both build a future where serious mental illness is understood, not feared.

  

If you are affected by anything shared here, please visit recommended support resources.

MIND www.mind.org.uk

SAMARITANS www.samaritans.org 116 123