Poverty and mental health practice - Making connections

Work by the Kings Fund has highlighted that Mental Health Act 1983 detention rates are nearly four times higher in deprived areas than more affluent parts of the country.

Perhaps unsurprisingly, this is also the case with depression where rates are two times higher in poorer parts of the nation. However, despite this stark data, a striking feature of social care practice with people with mental health difficulties is the extent to which poverty is usually relegated to the background.

We want to raise awareness and make connections between social inequalities and mental health.

The hugely influential The Spirit Level by Richard Wilkinson and Kate Pickett used the prevalence of mental health as one measure of the impact of inequality.

In this approach, rates of mental illness are seen as indicators of the broader nature of society. The links between socio-economic factors and mental health are intertwined but also play out in complex ways. 

For example, Wilkinson and Pickett argued that equality generates wider social cohesion, lower crime rates and higher rates of trust amongst citizens. These and other factors impact on the quality of life in communities and thus potentially on the mental health of individual citizens. People from marginalised groups, for example asylum seekers and refugees or those who have experienced other forms of trauma, are more vulnerable to the development of mental health difficulties.

The stresses of daily experiences and pressures of living in poverty such as debt, worry about being able to cope with emergencies and precarious accommodation can all contribute to poor mental health.

Health inequality approaches argue that the roots of many of the issues that we now classify as mental illness fundamentally have their roots in poverty, social inequality and injustice. The impact of austerity has been to deepen these inequalities. The 2019 UN Special Rapporteur on Poverty by Professor Philip Alston was damning of this impact.

The report highlighted the poor provision of mental health care, alongside related issues such as the increased use of food banks and the rise in homelessness.

It concluded that:

In the summer of 2023, a Joseph Rowntree Foundation study reported that nine in ten people on universal credit were regularly going without essentials.

In a recent interview, Sir Michael Marmot laid out a clear plan for tackling UK health inequalities:

The positive impact that such measures would have on the mental health of the nation would be staggering.

So, if the links between poverty and mental health are established, practitioners need to broaden their understanding of ‘risk’ to include how inequalities can lead to psychiatric distress. We also need to pay more attention to supporting people out of poverty as part of their route to sustainable recovery.

This will include income maximisation such as ensuring that people claim all their welfare benefits and importantly, assisting people to return to paid employment, as this will have a secondary positive impact on their recovery.

If we consider this to be a journey to anti-poverty mental health practice, then the first step must be a recognition of how social inequalities are implicated in mental health.

We will need to work against the current that nudges us to focus on a narrow view of risk – as harm to self and others – and always remember that social inequalities, especially deprivation, constitute a risk to people's mental health.