This week in a speech at the UN in Geneva, the UN’s special rapporteur for health, Dr Dainius Puras, delivered a report explicitly linking worsening mental health with austerity, inequality and job insecurity. This report is the latest from the UN to highlight some of the human impacts of the austerity project that has characterised the political landscape of the last decade.
Talking to the Guardian, Dr Puras noted that measures to combat inequality, job insecurity and discrimination, would be a much more effective approach to treating mental illness, than the pharmaceutical-based approach that has been taken over the last 30 years.
The UN report highlights inequality as one of the largest obstacles to mental health. The report has a global view and does not mention countries, including the UK by name, however it is impossible to ignore the effects of growing inequalities and poverty when looking at mental health in the UK.
This report’s findings will not come as a shock to anybody that has worked in the field of mental health over the past decade. As early as 2011, mental health charities in the UK were warning that austerity policies and financial stress were factors in rising levels of depression and stress-related health issues.
The relationship between the economy and mental health has been known for some time. In the early 20th century, social scientists first saw how economic crises’ increased suicide rates.
The Global Financial Crash in 2007/08 which sparked austerity measures is now widely associated with worsening mental health. Since the crash the economy has improved, but the prevalence of poor mental health in the population continues to grow.
Austerity and growing inequality
Framed as an economic necessity back in 2010, austerity entailed the radical re-engineering of the social welfare state and devastating cuts to public spending, of which the health and social care system has shouldered the largest burden.
Austerity has widened existing inequalities and driven 14 million people into poverty in the UK. Social cohesion has been reduced along with the safety nets and social capital that allow societies to function effectively. All a natural product of neoliberal policies.
How does this relate to mental health?
The effect of income inequality is clear. Direct social comparisons can increase feelings of shame or failure that can worsen an individuals’ mental health. Inequality also erodes the relationships that exist within society that allow it to function effectively. The social fragmentation this causes can isolate the poorest in society, leaving them more vulnerable to the psychological impact.
“What gets between us and other people are all the things that make us feel ill at ease with one another, worried about how others see us, and shy and awkward in company—in short, all our social anxieties.” – Kate Pickett, co author of the Spirit Level.
Evidence pre–dating austerity found that there was an increased risk of suffering a common mental disorder when living in low income areas. The risk significantly increased among populations living in the most income unequal areas. Put simply, the evidence shows that inequality and poverty can cause and maintain mental ill-health.
The UN special rapporteur noted in his report that since the 2008 financial crash, policies have “accentuated division, inequality and social isolation” which has been bad for mental health and wellbeing.
Mental health, austerity and the NHS
The NHS has been hit by austerity on two fronts. The health service has faced huge budget cuts which has meant reduced services, longer waiting times and staff shortages. On the other side, increasing poverty and the effect that this has on health outcomes is increasing demand and the pressure on health services.
Despite repeated claims from ministers over the last few years declaring parity of esteem between mental and physical health services, the reality is far from this. Mental health services have historically been viewed as the “Cinderella service”, notoriously underfunded. The services account for just 13% of the total NHS budget, but mental illness accounts for 23% of the total burden of disease.
Whilst budget cuts are reducing access to mental health services, other factors affected by austerity are increasing the demand for such services. A vicious cycle is created of increasing numbers of mentally unwell individuals, unable to receive the help and care they need therefore experiencing a worsening of their conditions.
Benefit sanctions, the bedroom tax and food poverty are leading features of the last decade of austerity. All of which have been are cited by individuals on crisis phone lines, or by those considering suicide.
Pressures within the NHS workforce
The workforce crisis in the NHS is well documented. What is less common knowledge is the impact of the workforce crisis on the frontline staff, who are working hard to cushion service users from the worst effects of cuts.
The number of mental health nurses has continually decreased over the last decade at an unprecedented rate. This is despite several Government pledges to increase numbers.
More and more NHS workers are reporting feeling unwell due to work-related stress and considering leaving their jobs because of the pressure they are under. Devastatingly, the Office for National Statistics data has revealed that more than 300 NHS nurses have died by suicide between 2011 and 2017. Poor working conditions, increased pressure and changes to student bursaries – all of which are features of austerity Britain, have been listed as factors.
Austerity has created a workforce crisis in the NHS, worsening mental health outcomes for the very people whose profession is to support those with mental ill-health. More demand for mental health services is created, whilst a decreasing workforce reduces the access to services.
Access to services
In addition to the workforce crisis, the number of available mental health beds has also continually decreased since 2010 in the face of increasing demand for services. The number of beds occupied has also consistently exceeded the 85% target occupancy rate.
Fewer beds and staff combined with higher demands consequently leads to longer waiting times. Vulnerable individuals’ can experience a worsening in their conditions that make them more complex to treat as a result of this increased wait.
What does the future hold?
Dr Puras, the UN special rapporteur, addressed the over emphasis on trying to “cure” mental illness the same as physical. The number of people prescribed anti-depressants across the developed world has soared in the last twenty years.
Without properly addressing the social factors that can cause or contribute to mental ill-health, prescription of antidepressants is simply a sticking plaster solution.
To begin to improve mental health globally, inequalities must be tackled along with social exclusion. Until austerity measures are finally reversed, the full impact on mental health cannot be seen in its entirety.
We must challenge the notion that poor mental health is caused by and cured by individuals, and instead demand the social change necessary to improve mental health factors both globally and within the UK.