Highs & Lows

There is a moment at the end of a football match that nobody thinks about, because it is the least dramatic thing that happens all afternoon. A man in the middle raises a whistle to his mouth and blows it, and tens of thousands of people stop feeling what they have been feeling.

That is the subject of this issue. Not the feeling. The stopping.

Every weekend from August to May this country runs the largest voluntary experiment in collective mood alteration available to a nation at peace. Enormous numbers of people agree, in advance and at their own expense, to feel considerably more than the occasion strictly requires. They agree to have their heart rate driven up by the movements of strangers. They agree to grieve over events with no bearing whatsoever on their lives. It is one of the more peculiar things we do, and we do it so routinely that it has stopped looking peculiar.

Then the whistle goes, and it ends, and everybody puts their coat back on and thinks about the car park.

Now remove the whistle. Remove the choice. Remove the fifty thousand other people riding the same arc at the same instant. What is left is not football, and it is not a bad mood. It is a different category of thing entirely, and this issue is about how poorly that difference is understood by people who have only ever known the first kind.

I have spent more time around this subject than most people who write about it, and the thing I keep returning to is not a shortage of sympathy. Sympathy is abundant and it is cheap. It is a shortage of imagination: the genuine inability of someone who has only felt the bounded version to picture the unbounded one. You do not close that with a poster in a staff kitchen.

So this issue does something Momentum has not done before. It argues, and it shows its working. Every figure carries its source, the body that published it, the period it covers and the population it describes. Where the evidence is thin, we say so. Where a number everybody repeats could not be traced to its origin, we say that too, and we leave it out. A publication about mental health that is careless with evidence is just another voice asking to be believed.

Football is the most efficient mood delivery system this country has ever built, and its genius is not the joy. It is the container.

Consider what a supporter is really buying. Not entertainment, which is available more cheaply and more reliably at home. They are buying permission. Permission to feel disproportionately, out loud, in the company of strangers, about something that does not matter, with a guaranteed finishing time.

The scale of the thing is easy to under-feel because it is so familiar.

And it is not a figure of speech. The swing is measurable in the body, and researchers have measured it.

The same effect appears at a scale where it stops being charming. Two studies, in two countries, found the arc in hospital data.

Neither study says football damages hearts. Both say something more precise and more useful: that a shared emotional event, in a large enough population, produces a measurable physiological signature. The feeling is real enough to show up in an admissions database. Remember that when somebody tells you a mood is just a mood.

And on balance the ledger is positive. Among 7,249 UK adults surveyed for the Department for Culture, Media and Sport, attending a live sporting event was associated with higher life satisfaction, a greater sense that life is worthwhile, and lower loneliness. The stadium is not a risk factor. It is closer to a public health asset.

Which brings us to why it works at all. Three conditions hold the whole thing together, and they are worth naming precisely, because the rest of this issue is about what happens when they fail.

• Condition oneIt is chosen. Nobody arrives at a stadium by accident. The supporter decided, in a calm moment and with a debit card, to be put through this.
• Condition twoIt is shared. The person to your left is on the identical arc at the identical instant. No explanation is required from anyone, because nobody present needs one.
• Condition threeIt is bounded. Ninety minutes, plus whatever the fourth official holds up. The end is known before the beginning.

Remove any one condition and the character of the experience changes. Remove all three and you have arrived at the subject of the next section.

Imagine the same tightness in the chest and the same lift, except that you did not choose them, nobody is riding them alongside you, and there is no full time.

This is the distinction the issue turns on, and it is routinely lost. In ordinary speech a mood disorder gets described as sadness, or as moodiness, or as a person being up and down. Clinically it is none of those. It is a disorder of the swing itself: a movement between poles that runs on its own clock, and that clock is slow. Untreated, these are not afternoons. They are seasons.

The word people reach for is bipolar, and they usually mean the high. The high is the part that makes the anecdote. But the depressive pole is where most of the time is spent and most of the damage is done, and it is the pole least likely to be recognised for what it is, because it looks exactly like something else.

Nor is this a rarity, tucked away at the edge of the population where it can be treated as somebody else's problem.

One detail in that survey deserves more attention than it receives. Bipolar disorder screened at 1.7 per cent among men and 2.1 per cent among women, which is close to even. That symmetry is almost absent elsewhere in the same dataset, where common mental health conditions were identified in 24.2 per cent of women against 15.4 per cent of men. Whatever produces that gap in the rest of the field is not producing it here.

It also starts young. The guideline puts the peak age of onset between fifteen and nineteen, and notes there is often a substantial delay between that onset and a person's first contact with mental health services. Hold on to the word substantial. The next section puts a number on it.

A person in a depressive episode presents to a doctor describing depression, because that is what they are experiencing and that is what they came in for.

The highs, if they are moderate, do not feel like an illness from the inside. They feel like a good spell. They feel like being finally, properly well: productive, confident, sleeping less and achieving more. Nobody books an appointment to report that. So the clinician is shown one half of a pattern and treats what is in the room.

That is the mechanism behind one of the more sobering findings in psychiatry, which is the sheer length of time between a person first becoming unwell and anybody correctly naming what is happening to them.

The figure quoted more often in this country is longer still. On World Bipolar Day in 2024 the Royal College of Psychiatrists and Bipolar UK jointly put the average wait between first raising symptoms with a health professional and receiving an accurate diagnosis at nine and a half years.

We are printing both numbers deliberately, and we are telling you the difference between them. The nine and a half years comes from Bipolar UK's own Bipolar Commission survey of 2,458 people who already had a diagnosis, reached through Bipolar UK's channels. That is a self-selected sample, and people who took longer to be diagnosed are exactly the people most likely to join a charity and answer its survey. The 6.7 years is peer reviewed and pooled internationally. Both are worth knowing. Only one is a population estimate. Anyone quoting the larger figure at you without that caveat is not being straight with you.

What is not in dispute is the direction of the error, and it is always the same direction.

There is one more number, and it is the one that should give any reader of official statistics pause. Everything we know about how common this is rests on a screening questionnaire. That questionnaire has a sensitivity of 0.28. It identifies roughly a quarter of the people it is looking for.

The survey says so itself. NHS England publishes the limitation alongside the finding, which is the correct and honest thing to do, and it means the 890,000 on the earlier page should be read as a floor rather than a count. This is what good statistics look like: not certainty, but a number that knows what it does not know.

Nothing in this section is advice, and none of it is a promise. It is a description of where the published evidence currently points, and it is included because the alternative, which is a magazine that describes a problem and then goes quiet, is worse.

The interventions with the strongest evidence base are almost aggressively undramatic. They involve sleep, routine, keeping a record, and other people knowing what to look for.

Start with why a record matters, because it is the cheapest intervention available and the one most often skipped.

Read that second pair of numbers again, because it is the whole diagnostic problem expressed as arithmetic. In bipolar II, the half that gives the condition its name is present in about one week in seventy seven. The half that gets treated as ordinary depression is present in about half of all weeks. Anyone relying on a patient to report the rarer half from memory, years after the fact, in a ten minute appointment, is asking for something close to impossible.

On treatment, the published position is clearer than the public conversation suggests. For long term management of bipolar disorder in adults, the national guideline names lithium as the first line pharmacological treatment, at recommendation 1.7.7 of guideline CG185, published in 2014 and last updated in September 2025.

The stronger finding, and the one least reflected in practice, is that medication alone is not the ceiling.

None of this is a cure and none of it is a guarantee. What the evidence describes is a set of unglamorous things that shift the odds: a record, a correct name, a guideline followed, a therapy added to a prescription rather than substituted for one, and somebody who knows the pattern well enough to notice a change before the person in it does.

There is a version of this argument that appeals purely to decency, and it is true, and it does not move budgets. So here is the other one.

The people most likely to be carrying an unrecognised mood disorder in a workforce are frequently among its higher performers, because the hypomanic phase is productive and because the depressive phase stays hidden behind competence for as long as competence holds out. An organisation that cannot tell the difference between a good spell and a warning sign will read the first as talent and the second as a sudden and inexplicable decline.

The bill for that is now measured, and readers of our first issue will recognise the number.

The return on doing something about it is commonly quoted at £4.70 for every pound spent. We are printing that figure with its own caveat attached, because the underlying evidence review contains interventions that returned a loss as well as ones that returned a great deal more. What the review does show consistently is that organisation wide measures, culture and awareness, outperformed interventions aimed only at individuals already struggling, by roughly six to one against four to one.

Which is the commercially awkward conclusion. The thing that pays is not a counselling number in a handbook. It is a workforce in which noticing is normal, and in which a manager who sees a pattern knows what to do next.

The honest ending to this issue is not that the pendulum can be stopped. It cannot, and a publication promising otherwise would be lying to the people who most need it to be straight with them.

What can change is everything around the swing. Whether it is recognised. Whether it is named early rather than after a decade. Whether the person riding it has a record, a clinician, and two or three people who know what they are looking at. Whether the employer reads the pattern as a warning rather than a personality.

At a football ground the whistle does that work for everybody at once, which is why nobody has to think about it. Outside the ground there is no whistle and no man in the middle. There is only what other people notice, and how quickly.

That is the whole argument, and it is smaller and more ordinary than the subject deserves. Notice earlier. Name it properly. Write it down. Tell somebody who can act.

We publish this magazine because that sequence is not automatic and somebody has to keep saying it. If the pages that got your attention were the ones with the football in them, that was the intention. The stadium is the part everybody already understands. It was only ever here to measure the distance to the part they do not.