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.

Child abuse and neglect in Australia 

Recent research conducted by the University of South Australia’s Centre for Child Protection shows the staggeringly high number of children being reported to child protection authorities in Australia, and of those being reported 90 per cent have multiple reports being made about “incredibly concerning” abuse and neglect.

Professor Arney said authorities needed to respond to the child protection epidemic as a health crisis.

“That includes working out how we can reallocate resources to meet the extent of the need and how we can identify the earliest opportunities for intervening in family life,” she said.

“At the moment we are waiting until the problem gets so bad that the only recourse we have is the statutory child protection system.”

Read this article by ABC News for more details of the findings.


So why do I mention this?

This is of course incredibly relevant to therapy, insomuch as preventing child abuse and neglect can help to prevent a lot of potential future distress that people might need to treat with therapy. While it can be unpopular to make comment on policy and politics when we work in the helping professions, there is also the view that the structures of society itself do contribute greatly to the wellbeing of individuals, and as such are highly relevant to the work of therapist and other support and health workers.


 

I personally wonder whether the incredibly low Newstart Allowance in Australia (social security payment for those out of work) is contributing to unnecessary household hardship and stress, and contributing to entrenched disadvantage. See here for some discussion about Newstart.

Research in the UK has revealed that here is a strong association between family poverty and a child’s chance of suffering child abuse or neglect. Adverse events in childhood, including abuse and neglect, are associated with a negative effect on adult economic circumstances. See here for this research into the link between poverty and child abuse.

What do you think? What things do you think might help reduce the rate of abuse and neglect for children in this country?

If this article raises strong feelings of distress for you personally and you are based in Australia don’t forget that there are many 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. Ini addition, the Blue Knot Foundation has a Helpline 1300 657 380 as well as online resources and workshops specifically for adult survivors of child abuse and neglect.

 

Why I love working in community mental health

I’ve been musing lately on my experiences in running art therapy programs for community mental health providers.

Why creating welcoming spaces for people in crisis or experiencing extreme states matters:

Mental health sufferers face both stigma and other challenges to joining in mainstream activities. Low energy, low mood, feeling anxious, fidgety, being prone to angry outbursts, finding speaking up or staying quiet hard, having loud internal negative self talk, hearing voices  – any or all of these can make showing up hard and make finding a safe and welcoming space harder still.

Many people who come to community mental health programs often have a range of social, economic, health and trauma experiences that they are dealing with that are linked to or compound the experience of a mental illness / mental distress / mental health challenges:

  • Poverty can make it harder to afford medication or therapy
  • Trauma experiences can make it hard to relax or trust others, or to open up
  • Concentration and energy levels can make it hard to hold down work (or study), which in turn can increase social isolation, economic distress
  • People can juggle their own mental health issues while also caring for family members with mental health issues
  • Alcohol and other drugs can be used to help mask the pain but at the same time contribute to financial, social and other health challenges.

Here’s what I know even more deeply than I did before from this work:

People are complex whole beings. They are a life story, they are friends and parents and neighbours. They are dreamers and fighters and nurturers. They are carers and volunteers and advocates. They are artists and storytellers. Having a mental illness diagnosis doesn’t define a person or tell you anything of the entirety of who they are.

People have moods that come and go, we are all variable hormonal, social, responsive beings who have capacity for change, above and beyond our symptoms.

People with mental health challenges may find it hard to find or access the very resources that might help them most. Brain fog, anxious feelings, low energy and other challenging felt experiences can make remembering, researching or processing information difficult.

People are more alike than different. Our dreams and fears are remarkably similar no matter what our age, income, past experiences or current challenges. We all want human connection with people we like and trust, to feel closeness and to be respected and understood, and sometimes to be cared for and nurtured. We want some kind of physical and material stability, to attend to the basic needs of our life without all consuming stress about money, debt or housing. We want to make a contribution to the people and world around us, and we want to express ourselves in the world. We want to feel well in ourselves, healthy, and to access some kind of help, medical or otherwise, for physical/ emotional struggles we might face.

It takes guts to get help. It takes immense courage and determination to commit to doing the things we know are good for us, especially when getting there and being there can sometimes feel extremely hard.

We often think we are unique with our fears and doubts and ‘weaknesses’, and this causes shame. When we speak about our experience to supportive others it lightens our load. It also inspires others to feel better about their experience. We feel less alone when we can reveal more of who we really are and what is really going on for us.

Compassion and acceptance of ALL of us can happen gradually and in baby steps. It is an ongoing practice to show ourselves compassion, towards our limitations, towards the parts of us that are fearful, angry, hurt, hurtful. It is an ongoing practice to develop an encouraging voice that allows us to try new things and show ourselves, even when we are not ‘perfect’.

Getting help through medication, being in support groups, accessing social workers or being in one on one therapy is a really important step towards recovery.

——–

 

 

 

Is art therapy really therapy?

For sure! You can take mental health issues to an art therapist like you could to any mental health professional. This is one of the biggest differences between seeing an art therapist and having a relaxing session with an art teacher.
With an art therapist you can experience the joy and pleasure of art making PLUS you get a sound psychotherapeutic approach that is designed to foster self acceptance, self expression and healing, in a space that is confidential, and held by a trained professional. The art therapist holds space, models a good working relationship with creativity, and is sensitive to many different dynamics in the room.

To the casual observer an art therapy group session might look like a ‘craft session’ but to the trained eye there is so much more taking place: the subtleties of working with people’s stories, interpersonal dynamics and relationship building are happening quietly in the background. Training in psychotherapy and art, and practice are the ‘X factor’ that helps an art therapist hold the space and create an opportunity for a reflective and transformational moment that is far more than the materials used or the ‘activity’ undertaken.

How does art therapy work? American art therapist Julie Houck reflects on her work:
“I have learned that Art Therapy not only helps to make sense of one’s experiences, but offers catharsis by bringing long held unconscious material to the conscious level…I have been very fortunate that others have entrusted me not only with their stories, but also with their personal journey towards healing. I understand the fear and courage it takes to trust in the process, and the overwhelming feelings that follow by bringing vulnerability to surface.”

Art therapist Alyssa Rose Crenshaw works at Oregon’s largest mental and behavioral health provider for children and families and says: “I take pride in offering a variety of art based approaches to meet clients where they are at and allow them to guide the direction of treatment. Sewing and fabric based arts have a particularly healing quality and offer clients the opportunity to feel a sense of control and mastery which they may have rarely experienced before,”.

 

 

It doesn’t have to be perfect but you do need to start

I started my business with a small amount of savings that had to be my actual pay (think coffee money) and cover all business costs until the business started providing for itself. My partner took on the heavy lifting of household finances and I was free to work on my business. That first year I needed every cent to pay for room hire, art materials, insurance, coaching and all the other bare basic start up costs for an art therapist.

At the start it felt like EVERYTHING cost money, money I didn’t have.

I wanted to start getting clients, but I didn’t have business cards or brochures, and I didn’t have fancy professional photos, or a logo or designer so how would I get started?

Bottom line – I just did.

A few hours with a graphics software and some photos I’d taken myself, a small black and white print I’d made a few months earlier and I had a logo and brochure designed. Less than $200 with a cheap online printer and a week later I had my first actual ‘collateral’* for my business.

(It wasn’t easy. Well tbh making it once I started was actually easy but GETTING STARTED was excruciating. I procrastinated like anything for months before I finally jumped right in.)

So then the brochures arrived.

I wish I could tell you I was highly systematic and confident in handing those bad boys out. But I wasn’t. I gave some to friends and asked if they could put them in their favourite cafes (because I was too shy). Within a few weeks had my first paying client (that was like magic – I couldn’t believe it actually worked! I almost fell off my chair when she called asking about an appointment).

“Winners take Imperfect Action while others are perfecting their plans.” – Kevin Nations

The moral of the story is that even if you are a cheapass, oh I mean frugal, oh I mean skint, first business owner or stepping out into a brand new creative project you need to START. NOW. With what you have. Without putting yourself into financial ruin.

You can work on the packaging as you go, you can rebrand later when you are making a profit. Sure your materials might not win any awards for prettiest graphics, but here is what I know for sure**: if you don’t put yourself out there and tell the world you are open for business you will not have a business.

  • Having 100 business cards out in the world, even if you think the graphics are less than superb, will build your business faster than a very good intention to one day have the perfect business card designed and made.
  • A business Facebook page that you use once a week and are still figuring out how to use has more chance of helping clients find you than the strongly held wish that someone else would come and save you from all things social media.
  • Five posters up in cafes will get more attention for your workshop than 100 in your bottom desk draw.
  • A simple web page even if it’s just ONE page with your name, one paragraph about what you do, photo and contact details is better than no online presence at all while you secretly hope you will one day wake up as a confident web designer and all your problems will be solved.

Now I’m not talking about skimping on the core stuff, the things that create your service and provide a reliable experience for customers. Your training. Your insurance. Your legals and professional memberships. Your supervision. Anything where there is a set quality expected by your customers or law. But there are certainly other areas of your business where ‘some’ is better than ‘none’. In my experience these include marketing, an online presence, getting the equipment you need to do your job, providing yourself with mentoring or coaching support, putting time aside for self care.

In these areas I encourage you to embrace the idea that it absolutely doesn’t have to be perfect, but you do need to get started. 

 

*Fancy marketing terms for branded things you use with clients like business cards, brochures, posters, ebooks, stuff like that

** Don’t you love this phrase?! My friend Karen Gunton uses this all the time. When you’re stuck or confused she suggests you ask “What do I know for sure?” and list those things.


Does this resonate? Have you started something with imperfect perfect action? What is one thing you might get started on NOW even if it’s not perfect?

 

 

 

 

Who wants to play?

Who needs an an infusion of deep, soulful, playful creativity at their next face to face event!?? I’m open to fresh collaborations in Australia in 2018 (or Europe May/June 2018). I would love for the right fresh fun collaboration plans to wing my way.
Imagine….
🌟A visioning session before your content master class, to connect people deeply with their what, why, how and who
🌟A break out group at your conference with gentle art therapy based processes unleashing new ways of seeing old problems
🌟 A creative morning session each day of your wellness retreat

I am flexible, practical and creative when it comes to planning events and collaborating.

I create a safe, sacred, well bounded group experience.

I am a qualified transpersonal art therapist and coach and experienced group facilitator.

Who wants to play!?

Drop me a line via my contacts page to start a conversation.

Does your inner child need some play time?

What do you do that is playful, open ended and full of joy?

In my experience, connecting with the inner child needs a few foundation- conditions to be in place…. For me these are:

  • Feeling safe – no one is criticising or judging me, I can’t ‘fail’, I’m not scared of making a mess or getting something wrong
  • It’s ok to be me – there is room for diverse outcomes, I know my unique expression is welcome, I’m not having to work to a detailed map, I’m not forcing my outputs to match someone else’s
  • Other people are playing too – it’s not a competitive environment, people are relaxed and seeing what emerges, I can concentrate on me because everyone is engrossed and taking care of themselves
  • There is a sense of wonder and awe – maybe the space feels like a place out of time, or the materials are delighting me, or the depth of connection with others is making me feel like anything is possible.
  • My senses and imagination is engaged – I feel lit up and enthusiasm is driving what I do

Connecting with that inner sense of joyful exploration might feel different for each of us.

No matter how we do it, it is wonderful to put down the weighty responsibilities of adulthood and deep dive into playfulness from time to time. Let’s schedule it in!

If you are in Sydney and would like some time to play, perhaps with a young person in your life, check out my ‘yarn dolls’ workshop. This Saturday Mixed Media Mini Masterclass is in Glebe on Saturday September the 23rd at 1-4pm. Places are strictly limited so please reserve your spot while there are still some available. Book now.

An afternoon of play – no homework, no prep, nothing you need to bring. Just come along and enjoy.

 

‘But I’m not creative’

That’s what I hear sometimes when people hear about my art therapy groups.

Really? You don’t think you’re creative? Even better reason to come along and see that you are!

You don’t have to be an ‘artist’ or have ‘talent’ to work with an art therapist. Art therapy is a form of expression, a way to get the inside out, and a way to connect with the power of creativity, the deep life-force in us all.

The art therapist guides you, creates a safe space, provides an opportunity.

You step out, feel your way, see what emerges.

The art isn’t there to earn a gold star or a grade. You can’t fail.

It’s not being made to sell or impress.

It’s being made to express, to speak for you and to you.

Honestly. With rawness, and strangeness and mystery. With bluntness and humour and whimsy.

What you make might surprise you in how easily it speaks on your behalf.

Your creativity may have a different opinion on this whole situation you see. It might come out to play no matter what you say on its behalf.

Try it and see.

 

Structure and flexibility

In art therapy we need to provide structure: a bounded time, clarity of roles, guidelines for safety and confidentiality.

But we also need to provide flexibility, the ability for participants to go as deep as feels comfortable, some choice in materials, choice in expression.

If we have few boundaries and little structure in our groups then partipcants have the benefit of making choices and exerting control, but not the benefit of embodying flexibility. The lack of structure can trigger those who do not feel safe without structure. they may feel like they are in freefall or chaos or lost in too much space.

If we have firm boundaries and a lot of structure participants have the benefit of embodying flexibility (responding to what is) but less opportunities to make choices or exert control. The lack of flexibility can trigger those who do not feel safe within with intrusion or demands or not enough space.

A dance with our edges. A dance with our preferences.

Image: mixed media art I made a few years back as part of a series