Dr Benji Waterhouse talks about his mission to demystify mental health

From seasoned healthcare professional to rising stand-up star and author, Dr Benji Waterhouse is as comfortable delivering a punchline as he is a diagnosis. Through comedy and his best-selling book, You Don't Have to Be Mad to Work Here: A Psychiatrist's Life, he’s taken on the challenge of shifting public discourse around mental health. “There is this quite well-meaning conversation right now,” he tells me. “But these do tend to focus on the milder, more palatable end. I wanted to make people more aware of more severe and disabling mental illnesses… things like schizophrenia. As I say in the book, for some people, mindful colouring-in and cold-water swimming isn't going to do a lot.”

Psychiatry remains one of the most misunderstood medical disciplines. With a chuckle, Waterhouse tells me some people even seem a little confused about the difference between a psychiatrist and a psychic. Maybe some of the mythos is fostered by its hidden nature of mental health. “If you're a bone surgeon, for example, then the results are there afterwards for everyone to see. While psychiatry is more internalised. There aren’t obvious results, and there are degrees of healing as well.” Symptoms can significantly impact a patient’s standard of living but are often approached as arbitrary concepts. Mental health research and treatments are very much in their infancy. Innovation can still be limited to simply giving names to clusters of symptoms which lack reliable objective markers. It’s a huge grey area. Although it makes me wonder if this huge unmapped territory is part of the appeal for many practitioners.

“I have a very loving, but slightly complicated, family. I think I went into it hoping that I might get the secret codes to fix them. I can certainly cope with a degree of ‘grey’. There's a lot of that in psychiatry.”

His debut book, which has just come out in paperback, sees the good doctor trace his own journey into the NHS. Packed with an engaging blend of humour and insight, it paints a delicate balance between personal and professional challenges.

Through a comedic lens, this skilful piece of storytelling also offers simple guides to the nuances of the nation’s mental health care provision, while treating even the darkest of anecdotes with sensitivity and pragmatism. It’s as much a well-constructed case for better understanding as it is a medical memoir. While many of his peers have deployed dark humour in the books they’ve authored, Waterhouse refers to even the most troubling case with a more humanistic angle.

“I think the NHS often runs on gallows humour,” he tells me. “…along with strong tea! It does help us cope. And it's not a coincidence that I started stand-up when I started specialising in psychiatry. But, before me, Jo Brand was a psychiatric nurse before moving into comedy. She had a nice gag about laughter being the best medicine, although it doesn't work particularly well for erectile dysfunction. I think I'm generally a warm, caring guy. Although the worry is that you can become overwhelmed, institutionalised and compassion-fatigued when you have too many patients and not enough staff. There’s a danger you can start to see human lives as nuisances on your conveyor belt as you try to get through them all.”

He discusses this, and his decision to start practicing medicine part-time, recognising that burning out was a real possibility, in the book. “I think working full-time in psychiatry isn’t good for anyone's mental health. Going part-time did mean I could do things like sleeping, exercising and having friends. Or calling my mum and doing stand-up. I have a much healthier work/life balance now.”

The journey into comedy started with simply seeing an advert for a comedy course in London. Learning the basics, he entered a few competitions, including So You Think You're Funny? in Edinburgh. From there, “nice stuff just happened”. Early on, he was booked for the legendary Comic Boom in Brighton. “I started getting great gigs like that, and it went on from there.”

While much of his material revolves around his ‘professional life’, it might inform his onstage work in other ways. Both roles can encounter extremes of human behaviour and take a certain kind of tenacity.

“There’s a kind of diligence I learned from medicine and a work ethic,” he muses. “Even though comedy is an art, you can turn it into a bit of science. If I try out a joke three times, and they laugh every time, then that's unlikely to be a false positive. And I'll keep that bit in. I guess both are about a kind of rhythm and routine… and trying things procedurally.”

Now he’s on his first full headline tour, conveniently titled You Don't Have To Be Mad To Work Here, coming to Hove’s The Old Market on Wed 14 May and the Gulbenkian Theatre Canterbury on Fri 30 May. As you’d expect, his comedy leans into the day job, as well as his relationships and own mental health. Arguably the only psychiatrist working the mainstream stand-up scene, you get the feeling he’s taken on the responsibility of addressing preconceptions around his profession.

“You tend to only ever hear about things like schizophrenia on the rare occasion that something goes very, very wrong. Then, it's all over the front pages of the tabloids. Human beings obviously generalise, that's why society has a disproportionate fear of such people. I learnt early in my training that people with that diagnosis are more likely to be victims of violence than perpetrators of it."

"Alcohol and drugs are a far bigger risk factor for violence.  Technically, you’re safer being in a psychiatric patient's home than at a house party.”

Perhaps it’s the fear of the unfamiliar shading our culture’s suspicion of mental health issues. Especially the more profound end of the spectrum. “That's why it's not spoken about as much. That it's so unknown, kind of plays into that. No one can even define or say what exactly any of these illnesses are. They're just modern ways of conceptualising human suffering. The jury's still out on how biological any of these things are. You can't point to any head scan or chemical imbalance.”

Is it even possible to create an exact definition of what mental illness is? So much of it relies on norms. Somewhere amidst the broad range of human behaviour and expression, there is a delineation to be agreed upon before we start thinking about cause or effect. “There is a line in the diagnostic classification manuals, but they're all created by us. So, they're just arbitrary measures of saying: ‘Oh, you have depression…’ if someone's been persistently low for two weeks, their sleep is impacted, their appetite is impacted and they can't concentrate. But if you put that person in front of 10 psychiatrists, they could leave with as many different diagnoses.”

His colleagues at the general hospital would have similar outcomes without the luxury of objective markers they refer to. A fractured foot is definable. Most mental health conditions are a bit more vague. “It's not that psychiatrists are less intelligent or less thoughtful; we just have far fewer clues to aid us in our diagnoses.”  

All this seems poignant at the moment, as many experts are warning of an impending mental health pandemic. The causes could be fallout from Covid and isolation, the toxicity of social media or growing uncertainty in the world, but it’s likely a situation we’re unprepared for. The uncertainty is more than an academic challenge. It's a systemic problem that could impact millions. Mental health accounts for 28% of the overall disease burden in the UK yet receives just 13% of funding. While all working within it are doing their best, the system is a victim of neglect. “We really feel that discrepancy on the front line, when we're having to make brutal triaging decisions. Working out who gets the one precious bed, for example.”

He learned early on that tough choices were part of the job. There was a patient on his ward during training who felt suicidal and was considering jumping out of a bedroom window. They were discharged, because they only lived on the second floor. “I had no idea that we’d be allocating resources according to whether jumping from a certain floor would create a big enough splat. Sadly, that is very much the sort of dark consideration that comes into your calculations.”

In the 1980s, there were around 70,000 psychiatric beds. Today, that number has plummeted to less than 20,000 – despite increasing demand and complexity. Part of the philosophy behind the reduction in capacity is based on the question of how good psychiatric hospitals are for people. In some cases, ward closures are forming part of a new approach and modernisation program. “There’s a move away from an asylum model, where you just indefinitely lock up everyone who you think might be dangerous. We’re moving to something that is, in theory, more humane. You can promote people's liberty and autonomy, and they can live in the community with everyone else. But the problem is that this ‘Care In The Community’ model has not been proportionally paid for.” To be brutal, it’s an underperforming system. But then that could be a label borne by the entire NHS. When Waterhouse started practicing medicine in 2010, people were using metaphors like ‘on its last legs’ or ‘on its knees’. He says he doesn’t know what the next euphemism might be.

“Perhaps the NHS is face-planted into the floor. I think a lot of people feel mental health services are performing inadequately. If you want to call that broken. Well, yeah...”

Despite the pressure, being a doctor has been immensely rewarding. And it has thrown up some hilarious stories. He recounts the perils of endless paperwork. Legally binding forms can be complex if you’re tired.  

It was less than ideal when he was trying to detain someone under the Mental Health Act and put his name in the wrong box. “Luckily, I noticed before it was too late, because that could be a tricky one to wriggle out of. Once you’ve been labelled as someone of unsound mind, there's almost nothing you can say when they come to your door to pick you up.” His boss offered some consolation, suggesting this sort of thing happened all the time. Apparently, when previously working in geriatrics, she handed in a form confirming her own death.

Despite its levity, his comedy does work to add context around the conditions he and his colleagues work under, as well as dispelling any notion his profession is cold or disinclined to help. Ultimately, he wants performances to shift the needle a bit on how we perceive mental health, especially those with more profound issues. “One of the problems with diagnoses is that it’s stigmatising. Society has a certain response to such people. Being isolated can often be as damaging as the condition itself.” There’s a poignant example in his book, which talks about an amiable-sounding chap, whom he’d tried to refer to a community garden. “In his former life, before he became unwell, he was a gardener. The person I contacted was initially really enthusiastic to have volunteers. But, after asking where I was calling from, that cooled off. She started asking if he was ‘safe’ to be around members of the public. Inevitably, he never went because he knew he wasn't really welcome. It slightly broke my heart. One time, I asked him if he'd like to increase the dose of his anti-psychotic medication to quieten ‘the voices’. He said: ‘No, thanks, Doc. Some of the voices are nice, and they keep me company.’”

Waterhouse admits the abilities of psychiatry may have been slightly oversold. Many of the concepts are not as black and white as we’d prefer. More people are being diagnosed and treated than ever before. “Maybe we need to be mindful of what is perhaps a psychiatric problem and what is a problem of living and see everything a bit more holistically. We love the idea of quick fixes and easy answers. That's why people often ask me: ‘What's the secret to happiness?’  It's very simple. All you need is a healthy birth, secure attachment, a relatively happy childhood, no trauma or high resilience, loving friends, a family and partner, fulfilling work, financial security, manageable targets, eight hours sleep, regular exercise, healthy diet, moderate social media, plus or minus antidepressants, therapy and 100% charge on your phone.” Is that even remotely representative of the average modern lifestyle? Increasingly, we live in isolation, only interacting through our phones, eating rubbish food, and doing less exercise. None of these factors has a positive impact on mental well-being.

“It doesn't sound very medical to say: ‘Oh, maybe call your mate, or go for a walk’. But prevention is better than cure, especially in psychiatry. A lot of things are out of people's hands. A lot of what we end up calling mental health problems are, more strictly, social problems. And I think we could address things like poverty and inequality, or crap housing and lack of employment, opportunity and community.” He points out that now we’re at risk of painting too gloomy a picture. People do get better, and it's even more rewarding when they do. “You know, we can't pretend our outcomes are amazing. I certainly get fewer thank-you cards and chocolates than I did when I worked over at the General Hospital. But that's what helps you, keeps you going.” He tells me about an old fable, which particularly resonates. An old man is walking on the beach, where he sees millions of starfish washed ashore by a high tide and a youngster throwing the creatures back into the sea. “He says to the boy: ‘What are you doing?’ The kid says: ‘I'm saving these starfish.’ The old man chuckles and points out there are lots of them and only one of him. What difference could he make? The boy picks up a starfish, chucks it into the sea, and says: ‘I just made a difference to that one…’”

Dr Benji Waterhouse brings You Don't Have to Be Mad to Work Here to Hove’s The Old Market on Wed 14 May and the Gulbenkian Theatre Canterbury on Fri 30 May 2025. His book, You Don't Have to Be Mad to Work Here: A Psychiatrist's Life, is available now.

Find tickets here

www.theoldmarket.com  

www.thegulbenkian.co.uk

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