Sunday, May 20, 2018

Mental well-being is a political question

 It is inconvenient to hear but psychological distress is political. Studies have shown an association between the implementation of austerity policies and increasing mental health needs. Austerity after the recent recession hit the poorest hardest. Families with the lowest incomes got poorer and deprived areas saw the greatest funding cuts at the level of local government. Resources used to support community living and social support for isolated groups, such as the Sure Start centres for young families, were cut. Benefits reform has led to increased mistrust and shame that has contributed to split and beleaguered communities.  

 Psychological distress (often categorised as “mental disorders” and other terms we, as psychologists, are not always comfortable with) is not distributed equally across society. People lower down the socio-economic ladder suffer more mental distress than those higher up, with the gradient particularly pronounced for women. Inequality is also associated with poorer wellbeing for those at the sharp end. Debt and having a poor-quality job – such as those with zero-hour contracts or where there is little control or reward to be had – are risk factors for experiencing mental illness. 

Multiple studies have shown a link between low socio-economic position and increased rates of depression and anxietyUnemployment is associated with a higher risk of suicide. Similarly, poor quality or overcrowded housing is linked to poorer mental health in adults and is worse for children’s educational and health outcomes. Living in a neighbourhood blighted by violence or with a high crime rate is associated with trauma. Those experiencing oppression through living in communities in which there are high levels of racial inequality and discrimination are more likely to feel distressed.

Take the current housing crisis. Young people are spending more on rent with less hope than ever of meeting society’s expectations of home ownership. People may feel insecure, less in control of their lives or even unsafe in their current accommodation. If someone feeling like this went to their GP or to a mental health service, their response to these life experiences may be interpreted as “symptoms” of a mental health problem. Struggling to sleep and ruminating on thoughts of failure are commonly associated with depression. Antidepressants or CBT to cope with anxiety may or may not be offered and may or may not temporarily help the individual. But it is not going to change their situation or prevent others from ending up in the same place.

 If we don’t examine the wider context of why and how someone develops their distress, the problem can end up being situated inside the person. It is a person’s brain that is the problem and not these wider factors. This individualisation of psychological distress not only puts the onus for recovery squarely on the individual’s shoulders, but it shifts the focus away from the societal, cultural and political factors which contribute to people being in these positions in the first place. Tackling poverty, inequality, poor housing and deprivation is much harder than treating an individual’s depression or designing policies to increase access to mental health services. To do anything differently suddenly makes “mental health” deeply political and that is what many would like to avoid. But to quote the World Health Organisation: “Why treat people only to send them back to the conditions that made them sick in the first place?”

Thinking about mental health as something that starts and stops with the individual is never going to lead to a healthier and more connected society. We need to see the bigger picture, to consider how things like social disadvantage and inequality tug at the very fabric of what makes society functional. 

The government’s recent proposals for child and adolescent mental healthith its narrow focus on the role that schools and colleges can play, the government’s proposal is actually a huge diversion away from the real issues, which we would argue is rising poverty and poor educational policies. And we are not the only ones to think so – last week a joint report from the Education and Health and Social Care Select Committees found that “it lacks any ambition and fails to consider how to prevent child and adolescent mental ill health in the first place”heir report also revealed that the connection between social disadvantage and youth mental health was not part of the brief that the researchers, providing the evidence to underpin the proposals, were given.

From here

1 comment:

Tim Hart said...

This reminded me of a book review that a friend of mine sent me recently where the ‘revelation’ of the book was that depression is not always an individual illness, but can be caused by social circumstances. This piece is similarly ‘revelatory,’ boldly proclaiming that in relation to mental health: "We need to see the bigger picture, to consider how things like social disadvantage and inequality tug at the very fabric of what makes society functional." I wonder whether I could invite the writer to take another step back and see an even bigger picture; that is the way social relations are currently determined under capitalism. Perhaps it is capitalism that is the main cause of mental ill-health and its abolition could be the main cure.