There are fears of a mental health crisis in the UK. A lot of discussion understandably focuses on the availability of services to treat mental health problems. But there’s a much broader, public health context which is increasingly difficult to ignore.
In 2020, the Mental Health Foundation told the Fifth Senedd’s Health Committee that while we absolutely do need better mental health services, this won’t be enough on its own.
We already had big demand for mental health services - and need - before the pandemic, so we do need to understand public mental health and the position of prevention and interventions in the community.
The pandemic situation may be improving, but its long term impact on mental health and, crucially, the factors that contribute to this, remains to be seen.
The determinants of mental health and wellbeing are largely about the society we live in, rather than medical
Mental health is, to a great extent, shaped by the social, economic, and physical environments in which people live. Inequalities in society are associated with a significant increased risk of mental ill health. Poverty is a key player.
People in poverty can face constant, high levels of stress, for example due to struggling to make ends meet, overcrowded or unsafe housing, fear of crime, and comparatively poor physical health. Poverty is clearly linked with a number of mental health problems, including schizophrenia, depression and anxiety, and substance misuse.
It's a two-way street. Poverty can be both a cause and a consequence of mental ill health, e.g. where debilitating symptoms and stigma around mental illness have an impact on a person’s income and ability to work.
This disadvantage starts before birth and accumulates throughout life.
What does data tell us about poverty and mental health?
- In Wales, 20% of adults in the most deprived areas report being treated for a mental health condition, compared to 8% in the least deprived.
- Children from the poorest 20% of households are four times as likely to have serious mental health difficulties by the age of 11 as those from the wealthiest 20%.
- Suicide rates are two to three times higher in the most deprived neighbourhoods compared to the most affluent.
- The more debt people have, the more likely they are to have a mental health problem. One in four people experiencing a mental health problem is in problem debt. People with mental health problems are three times more likely to be in financial difficulty.
- Good quality employment is one of the most strongly-evidenced determinants of mental health. In January 2021, 43% of unemployed people reported poor mental health (compared to 27% of people in employment).
The pandemic and beyond
Before COVID-19, almost a quarter of people in Wales lived in poverty. Children are more likely than other age groups to be in poverty, with 31% living in poverty. Future statistics will tell us more about the pandemic’s long term impact on poverty, but we do know that during the last two years, the least well off in our communities have been hit the hardest.
Low paid workers have been the most likely to be furloughed or to lose their job. Groups who were already more likely to be in problem debt before the pandemic are now at even greater risk. There’s widespread concern about a deepening cost of living crisis.
The link between poverty and mental health is unequivocal, and addressing financial inequalities and the socio-economic impact of COVID-19 is likely to be high on the political agenda as we move out of the pandemic.
The Health Foundation calls for greater protections for low paid workers, as well as targeted support for people whose mental health has deteriorated to get back into work. More fundamentally, it says, mental health needs to be taken much more seriously by governments.
In October 2020, the previous Welsh Government updated its mental health delivery plan to take account of the wider impacts of the pandemic. The budget proposals for 2022-23 include increased funding for mental health services, and recognition that improving public mental health requires a whole-government approach.
As a society, we cannot improve mental health or tackle the scourge of mental health inequality without tackling poverty and addressing income and wealth inequality. So these must be at the heart of a national effort to boost mental health equality.
Senedd Committees focus on inequalities
The Health and Social Care Committee launched an inquiry on mental health inequalities in January this year. It will be hoping to influence the Welsh Government’s successor mental health plan (the current delivery plan ends in 2022). The Committee’s consultation and engagement work to date highlights a range of different groups of people disproportionately affected by mental ill health. Unsurprisingly, poverty and financial uncertainty are among the contributing factors causing significant concern.
The Committee will also be linking with the Equality and Social Justice Committee, and Children, Young People and Education Committee, given the wide-ranging issues involved. The Committee’s first formal oral evidence session will be held on 24 March 2022, with mental health organisations and the Commissioners for Children and for Older People. This will help set the scene for further evidence gathering in the summer term. You can keep up to date with progress on the inquiry web page.
- Senedd Research, A perfect storm? Debt and the pandemic (2022)
- Senedd Research, Poverty and supporting low-income households (2021)
- Health Foundation, Unequal pandemic, fairer recovery - The COVID-19 impact inquiry report (2021)
- Senedd Research, A mentally well Wales (2021)
- Samaritans, Dying from inequality (2017)
- Mental Health Foundation, Poverty and mental health - A review to inform the Joseph Rowntree Foundation’s Anti-Poverty Strategy (2016)
Article by Philippa Watkins, Senedd Research, Welsh Parliament