Poverty and mental health

Health professionals often work with the individual, treating mental health challenges such as depression as a ‘brain illness’ which has emerged as a result of disturbed chemistry within the body. As therapists and counsellors we often work with depression as a ‘mind illness’; working with the individual’s thoughts and stories about their situation and themselves, as well as providing space to access and process their emotions.

But is this the whole story?

Does poverty contribute to mental ill-health by causing the erosion of resources that help people stay well?

This research, shared on the National Elf Service website ( a place for discussions about health research) supports that idea. The following excerpts are from the article written here by Andy Bell, Deputy Chief Executive at the UK based Centre for Mental Health about the research: the design of the research, the findings and the implications for practice.

How might low income and income inequality contribute to depression? 

“At the national level, the authors cite policies which limit access to health care, education and public transport alongside pollution and a lack of healthy food as causes of poorer physical health, which in turn increases the risk of depression.

At the local level they explore two concepts. The first is ‘social comparison’, by which people with fewer resources feel ‘social defeat or status anxiety’ as a result. The second sees inequality as eroding ‘social capital’: by reducing social interaction, trust and cooperation, “promoting social isolation, alienation and loneliness” and undermining ‘perceptions of fairness’. These factors may be especially pronounced in adolescence and be exacerbated by “other group identities, for example ethnicity or gender”.

For an individual, the authors cite the ‘psychological stress’ stemming from the other two levels as the ‘final mechanism’ by which inequality increases a person’s risk of depression.” – Andy Bell

The study apparently warns that, as income inequality widens worldwide, so “we should expect worse mental health globally in the years ahead” and that the burden will likely fall hardest on those who “already bear a disproportionate burden of mental health problems”.

So what does that mean for us working in the health and allied health fields for mental health?

My thoughts are that politics and policies matter to our work – beyond just issues of funding for mental health services and similar issues. If we wish to reduce and prevent mental illness it is important that we engage not just in the detail of working with individual clients, but also engage in the broader research and discussion about social determinants of health and mental health stressors at the population level.

It also reminds me that when we design programs for people struggling with mental health we need to be very mindful of the issues of access that poverty can bring to make sure we are not inadvertently excluding those who might most need the services.

What do you think? How does this change how you think about mental health (if at all)?

If this interests you and you’d like to read more please do check out the summary and discussion article by Andy Bell here or the original research paper itself:
Patel V, Burns JK, Dhingra M, Tarver L, Kohrt BA, Lund C. (2018) Income inequality and depression: a systematic review and meta-analysis of the association and a scoping review of mechanisms. World Psychiatry. 2018 Feb;17(1):76-89. doi: 10.1002/wps.20492.

Photo by Sharon McCutcheon on Unsplash

If this article raises strong feelings of distress for you personally and you are based in Australia don’t forget that there are many great help lines available. Thousands of people access these daily and there is absolutely no shame in doing so if you need to talk with someone.

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