One of the first encounters Paul Farmer had with the issue of mental ill health was while he was studying at Oxford University. A fellow student experienced what he now recognises was a breakdown, but at the time nobody understood what was happening, or knew what to do. “We were all pretty terrible at responding to it,” he recalls, “including the college. It was still a time when none of us really knew anything about mental health.”
It is also clear to him now that his own mum suffered from severe social anxiety. “She got very anxious around people and much preferred to be in her garden. Looking back, that was her therapy. She was never diagnosed with anything, of course – we all just thought she was a bit shy. But that was always a big part of our lives at home.”
Fresh out of university with his history degree, Farmer landed his first job at a tiny, two-employee organisation in London, the Clerkenwell Heritage Centre. The ambition was to “make Clerkenwell trendy” and Farmer’s role was an eclectic mix of community engagement, social renewal, tourism and fundraising. But crucially, the Centre was a charity, funded by the Margaret Hodge-led Islington Council, and quite by chance Farmer had taken his first step in what would become a remarkable voluntary sector career.
But he knew this wouldn’t be his forever job, and when he saw Samaritans advertising for a press officer, he applied. Notwithstanding his total lack of media skills and experience, he was hired, and became Samaritans’ 17th employee.
“This was really where I started to learn about the craft, and the power, of media and communications,” he says. “One of the things you get from a history degree is the ability to translate huge amounts of information into short bits of content, and to some extent that’s what I’ve been doing ever since, really – being a translator, trying to be the bridge between people’s experiences.”
Farmer was so taken with the Samaritans concept – providing a non-judgmental ear to anyone in emotional distress at the point that they need it – that he also trained as a Samaritans listening volunteer. This was an experience that would come to define his career.
“That was such a privilege, listening to people talk about their lives and their experiences. I’d already had those two personal experiences with mental illness, but this really opened my eyes to the huge scale of the mental health deficit. It was everywhere, and ranged from those with severe clinical conditions to those who had maybe lost someone in their lives or were experiencing less severe problems but felt isolated and had no one to turn to. And it fired up in me a real sense of injustice – why were we, as a society, not paying attention to this?”
At the time, Samaritans was entirely focused on the delivery of its helpline and not a campaigning organisation. But increasingly Farmer wanted to do more to make mental illness better understood and accepted, so after six years with Samaritans he joined the National Schizophrenia Fellowship in the role of public affairs director.
“Once again, it was pure luck – I firmly believe that these things come about more from luck than anything else. Half of this role involved things I knew about – the comms and media side – but the other half was completely new to me – the influencing, advocacy, public policy side. This was where I learned all about those things.”
This job also took him to his first party conference, the 1997 Labour conference in Brighton, where Tony Blair’s new administration was still basking in the early flushes of electoral victory.
“We ran a fringe meeting about mental health and mental illness, and three people turned up – there were literally more people on the panel than in the audience. I remember thinking, OK, this is a task, isn’t it? What a mountain we have to climb.
“It wasn’t that there wasn’t any interest in mental health, but at the time all the narrative around it was steeped in dangerousness, mad axemen, all that kind of thing. There was no sense of it as a cause or a wider social issue.”
Farmer stayed in that job for nine years, and remembers it as a period of struggle, especially against the government’s proposed mental health legislation, but also of positive progress in terms of the first signs of collaboration among organisations in the mental health sector.
“Essentially, that new Labour government did some things that were very good – the National Service Framework for Mental Health and then the NHS Plan, which was definitely a step forward. But we also had this massive fight with them over the Mental Health Bill, which was a very draconian piece of legislation born out of this whole idea of dangerousness.” Charities were worried that the bill would result in more people being detained or forcibly treated.
Greater collaboration
In a bid to improve the bill, over 70 organisations joined forces and formed the Mental Health Alliance, which Farmer chaired. He recalls: “People started to think about how we could work together, which was great because there hadn’t been a history of collaboration. While there were still philosophical differences, people started to see that they could put those aside in the interests of those with mental health problems. And the main thing we discovered we had in common was the government as a common enemy.”
The power of a united voice prevailed, and when the bill was finally passed into law its worst effects were significantly watered down and, crucially, it included a right to advocacy as a core statutory right.
While opposition to the Mental Health Bill occupied much of Farmer’s time in his role, he also experienced the challenges of senior management and oversaw a successful strategic rebrand and name change to Rethink. Then the role of Mind chief executive came up, and in 2006 Farmer landed “the best job in mental health”.
Move to Mind
The National Association for Mental Health, now Mind, was set up immediately after the Second World War, bringing together a number of organisations including the rather alarmingly named National Institute of Mental Hygiene. A user-led and federated organisation from the outset, Mind had a proud history of campaigning and putting the stories of those with lived experience of mental ill health front and centre of its work. At the time Farmer joined, the sector was starting to see the green shoots of greater interest in mental wellbeing as a public health issue, and Farmer saw huge potential for the organisation and the impact it could have.
One of the first things that happened after he joined was that Mind took over the running of the Mental Health Media Awards from a smaller charity called Mental Health Media. The Awards were designed to promote and reward best practice in the depiction of mental health, and played a key role in persuading the news media and programmers to alter their coverage of issues and individual cases.
“In its first couple of years, it was really a self-help group for mental health press officers who needed some peer support,” says Farmer. “But by the time we got to the early 2000s, there were some hints that things were starting to change a bit. A couple of soaps featured mental health storylines, and a few journalists started to be more interested in the subject.”
Some progress was also being seen internationally; for example, New Zealand was running a high-profile awareness campaign called Like Minds Like Mine, fronted by All Black John Kirwan who had come out openly about his own problems with depression and anxiety. Farmer recalls: “It was early days in the New Zealand campaign but it was looking very promising. We started to think that if we could pull together some component parts – some lived-experience activism, a communications campaign, some policy support and, obviously, some money – we might be able to do something about the way that the wider public thinks about mental health. So in my very early days at Mind, we pulled together a coalition, went and got some money from the lottery and Comic Relief, and Time to Change was born.”
Time to Change
Over the next 15 years, the Time to Change campaign ran programmes with employers and schools, supported people with lived experience to share their stories and set up campaign groups, and built relationships with media outlets and celebrities in an effort to rewrite the narrative. When the initial £20m ran out after four years, the Department for Health and Social Care took up the mantle and continued to fund it. Over time, surveys of the public and independent evaluations showed that attitudes and experiences were indeed changing – people with mental health issues were reporting significantly fewer instances of discrimination with respect to friends, family, dating, education, employment, even interactions with the police, and were feeling much more confident to talk about their mental health.
One key moment which signalled that mindsets had shifted came in 2013, when Asda launched a Halloween costume called “Mental patient”, featuring a ragged, bloodstained tunic, a mask and a fake meat cleaver. Outrage from charities was amplified by an outpouring of derision and anger on social media, and within hours the store was forced to withdraw the product and apologise.
Such is the wholesale turnaround in public awareness and attitudes that Mind retired the Media Awards after the pandemic, confident that media reporting of mental ill health has matured sufficiently. But given that the final event in 2019 took place at the Queen Elizabeth Hall on London’s South Bank, attended by Prince Harry and a slew of celebrities, their influence over the preceding 25 years cannot be underestimated.
Getting ministers on the same page was not always straightforward, however. Also in 2013, Farmer resigned from a Department for Work and Pensions panel scrutinising Work Capability Assessments – the process by which officials decide whether people are fit to work. He quit over concerns that the process was not genuine and could not deliver the fundamental reforms that were needed. “It was very difficult, as these things always are when you’re speaking truth to power and the power doesn’t like what you’re saying. But it was exactly the right thing to do, because the review simply wasn’t credible.”
And as it turned out, this high-profile row didn’t do Farmer any harm. Two years later, the Conservative government commissioned him and Jacqui Dyer, the mental health equalities adviser for NHS England, to carry out the Five Year Forward View for Mental Health. This six-month review concluded with the government accepting all 67 recommendations and committing an additional £1bn for NHS mental health services.
Mental health at work
Shortly afterward, Farmer was then commissioned alongside Lord Stephenson, by prime minister Theresa May, to review how employers could better support the mental health of their staff and support employees with mental health problems to remain in their jobs. The resulting Thriving at Work report set out 40 recommendations and proposed six “mental health core standards” for all employers to sign up to, plus enhanced standards for the largest organisations. All the recommendations were accepted by the government, and seven years on mental health is arguably given just as much focus as other aspects of workplace HR, such as health and safety or continuing professional development, particularly among larger employers.
Not surprisingly, Mind walks the walk in the way it treats its own staff. A suite of wellbeing support is available to workers, including counselling services, and during the pandemic the charity topped up furlough pay to 100% for all shop staff who could not work due to lockdowns. Colleagues were also given additional caring leave if they needed to look after others.
While Mind was always a campaigning organisation with users at its heart, it was barely recognisable as the same charity by the time Farmer ended his 16-year stint. Its income had risen from £18m to £70m, and its workforce from 100 to 500, mainly as a result of large funders supporting campaigns and programmes such as Time to Change, Ecominds and Mental Health at Work. In tandem with this, the number of people being supported by local Mind branches increased.
Sustaining progress
Yet, while public and political awareness of, and attitudes to, mental health have shifted dramatically since Farmer’s early days in the sector, and the stigma attached to mental illness has undoubtedly diminished, the battle is far from won. Farmer points to the ill-considered comments from Conservative ministers earlier this year about the UK’s “sick-note culture” as one example of the ease with which such lazy stereotypes can re-emerge.
“Every cause has its chapter where it makes loads of progress, but then suddenly it gets to the next level and you see there is another mountain to climb. If you talk to people who have been prominent in the feminist movement, or the LGBT rights movement, they’ve been through exactly that journey, and I think mental health is there now too. It’s very interesting that the current government is talking about ‘mental health culture’ in a rather derogatory way – it shows there is still work to be done to encourage and support people to think about the issue sensibly.”
That said, he is quietly confident about the gains made so far.
“On the positive side, I do feel that a lot of this stuff is quite embedded now. I think for a long time we were anxious that it might all drift away again – that the progress we’ve made might be derailed. But I don’t think it will, actually.”
He is also hopeful that the general election will deliver change, and a new cohort of policymakers willing to engage positively with the issue of mental ill health. In an ideal world, he would see three advancements: first, a proper, cohesive prevention programme, where people can find the right support for their particular situation as soon as they need it; second, adequate funding for NHS mental health services; and lastly, widespread acknowledgement and understanding of inequality in the context of mental health, and the personalised responses that are required for specific marginalised groups.
Move to Age UK
After 16 years at Mind, Farmer moved into the top job at Age UK, which he also considers to be at least partly a mental health organisation, and where he sees many parallels with his former role.
“I have become increasingly interested in this issue of ageing, partly as a result of my own family experiences – my father died aged 98 and we saw the best and the worst of the system in his care – but also because I am in my late 50s myself. Ageism is so prevalent, but as a society we’re still in denial about it. It doesn’t get anywhere near the attention it deserves. There is so much we need to do, whether on health, finances, or wellbeing. I think there’s an element of cause to it, a bit like there is with mental health. So I want to see if I can make a difference in that space.”
Age UK is about to launch a new strategy co-produced with the charity’s beneficiaries, built on the ambition that every older person is valued and included. Farmer says the next five to 10 years will be critical in ensuring that a sense of value and inclusion is embedded throughout society, and that the contributions of older people are seen and appreciated. He is clearly excited by the challenge.
Age UK is the third federated charity Farmer has worked in (Mind and Samaritans too) and it’s a structure of which he is a big fan. “I like federations because I think they are inherently honest, and really grounded in communities. At our best, we are truly local and truly national, which I think is really powerful.” Although he admits it is demanding: “If anyone asks me how I split my time as CEO in a federated charity, I say that I spend 50% of my time internally, 50% externally, and 50% with our local network.”
Non-executive roles
As well as his impressive executive career, Farmer’s CV of extra-curricular activities runs off the page. He chairs the networking group for CEOs of federated charities, is a commissioner at Historic England, and a non-executive director for NHS Frimley Integrated Care Board. He’s been chair or trustee at Acevo, Lloyd’s Bank Foundation, the Directory of Social Change (DSC) and the Disability Charities Consortium, a member of the BBC Appeals Advisory Committee, and had a seat on various public health groups. And he has completed several sponsorship challenges to raise money for Mind, including running the London Marathon, cycling the RideLondon-Essex 100, climbing Spain’s highest peak, and abseiling down the Orbit in Stratford.
In his trustee roles at Acevo and the DSC, he helped to recruit both Debra Alcock Tyler and Vicky Browning to their CEO roles, and has been a real advocate and mentor for women leaders.
“I really do love this sector,” he says. “And I think that if you have this sense of vocation for what we do, then you have to contribute in ways beyond your day job. It all sounds very altruistic, but the thing is, I always learn something new myself from taking on these roles. So I get plenty out of it too.”
As a campaigner and champion of those with mental health issues, Paul Farmer’s impact has been nothing short of immense. But as well as this, he is an incredibly popular figure both in the mental health arena and the wider charity sector.
Perhaps Mind chair Stevie Spring said it best when she announced Farmer was leaving Mind: “Paul has been an outstanding leader, a passionate champion for people with mental health problems, an agent of positive change and a pleasure to work alongside. Age UK is lucky to have him.”
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