A minister has been praised for “leading by example” after he spoke openly about his experience of agoraphobia, a condition that leads to thousands of hospital admissions every year.
Simon Clarke, the chief secretary to the Treasury, said on Wednesday he would not take part in the traditional pre-budget photo with the chancellor as he is agoraphobic. He said the condition “prevents me from being comfortable in some open spaces”.
Agoraphobia is a fear of being in situations where escape might be difficult or that help would not be available if things go wrong, according to the NHS. It can be a fear of open spaces, travelling on public transport, visiting certain places or leaving home.
Rosie Weatherley, information content manager at the mental health charity Mind, welcomed his openness, saying it was “important when public figures speak out … as it helps to tackle the stigma and lets others know they can also seek help”.
“It also demonstrates [that] with the right support and flexibility, those of us with mental health problems who can work can do our jobs just as well. That’s why employers should do what they can to support staff’s mental health.”
Her words were echoed by Mark Winstanley, chief executive of the charity Rethink Mental Illness, who praised the politician’s openness and applauded him for “leading by example”. He added that despite progress stigma still existed and fear of judgment from employers prevented people from thriving at work.
One agoraphobia sufferer, speaking anonymously to the Guardian, said: “I’m sure Simon Clarke wanted to attend the photo. But by not doing it he was allowing his anxiety levels to remain manageable. If they are high one day, it increases the chance they will be high the next. It is a snowball effect.”
Agoraphobia affects thousands, with NHS Digital figures showing there were 6,445 admissions in 2020-21 in England, up from 5,446 admissions in 2017-18, with a primary or secondary diagnosis of the mental health condition. The vast majority of cases were female (4,593) and those aged between 60 and 69 were most affected.
Jon Van Niekerk, from the general adult faculty at the Royal College of Psychiatrists, said the condition can be triggered or made worse when someone comes under a period of stress.
“I can see how it fits with Simon feeling anxious standing around a lot of people taking photographs at number 10,” he said, adding that he commended him for being “brave and open” about his condition.
Van Niekerk said that during the pandemic those with agoraphobia would have seen treatment delayed, leading to an increase in current referrals, though he noted that the condition has remained fairly stable for the last few years.
“It will be interesting to see what the impact of the pandemic is in the longer term,” he said. “Agoraphobia is very treatable and there is a lot of help out there.”
Agoraphobia is typically treated through medication or cognitive behavioural therapy, which focuses on challenging and changing cognitive distortions and behaviours. Getting people to confront their fears is often used as a means of overcoming them.
Lucy Fyles, 30, became ill with agoraphobia seven and a half years ago when she was 23. “It came about overnight for me and I just stopped feeling like I could cope and very much felt really scared of the unknown and being trapped away from home,” she said, adding that she is severely agoraphobic and virtually housebound as a result.
“I am not completely housebound – but I struggle to do anything normal such as food shopping. I have to take medication to go to the doctors, and I have not been to the opticians for years.”
Fyles said she was working on a psychiatric inpatient unit and had done a degree in psychology before agoraphobia took hold. “I basically lost the ability to cope overnight and suddenly felt loads of self-doubt and I did not feel could keep my patients safe.”
She added that her agoraphobia is atypical in that it appeared so suddenly, whereas usually people start with panic attacks in certain situations that become more ingrained and develop into phobias.
She said she had mixed feelings about Clarke’s revelation, saying she was surprised as it is a condition that is not often discussed. But she said that as someone severely affected by the condition she felt his revelation could bring negative attention. “His revelation only scratches the surface of the condition: lots of us are not just afraid of open spaces and it is a disabling and debilitating condition”.