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.

100 tiny winter sadnesses

This week as the weather turns cold here in the Southern Hemisphere I was thinking about those feelings of melancholy that can arise as the days shorten and the wind is icy, or maybe just when we are tired and weary. These observations for me are often not deep grief but small sadnesses that are often tinged with sweetness about the fragility and beauty of life.

Here are some that I thought of:

Walking home in shoes that pinch

Watching grey lipped people caught in t-shirts by the first winds of Autumn

Saying goodbye to a small child whose face can’t believe you would go right now in the middle of fun

Someone coming a long way and preparing for the journey only to not get what they came for

Wishing someone would do something different and knowing they won’t

The smell of a dinner coming from another house when you have nothing planned

Going to take the last sip of your coffee only to realise you already have

Trying to save a spider only to realise you’ve already wet them with soapy water beyond repair

Noticing your teeth have gone yellow

One lone white eyebrow hair sitting amongst the many

The faded poster for a lost cat

A chain store moving into your row of village shops

The basket of odd socks that you can’t quite bear to tackle

A lost button

Messages stuck on a phone with no password to listen to them

 

No, I couldn’t think of 100. I only got to 15. Are there any tiny sadnesses you would add?

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Today I honour fleeting sadness and melancholy as a part of life – feelings that are with us sometimes, and that we hopefully move through easily and gently if we do not fear them, and notice when they arise. Observing our feelings and thoughts, exploring them, expressing them in therapy or through art is a helpful way to make sense of our world.

Poignant observations about the changing seasons have been part of storytelling and poetry for a long long time. You may be in a different season today – but what do you notice that speaks to you of that season, and evokes some emotion? Try a list of your own… 100 tiny summer joys? 100 churning Autumn changes? 100 hopeful emergences in Spring?

If things feel sad, hopeless or flat most days and have felt that way for two weeks or more, you may be suffering from depression. Here is more information From Black Dog Institute on when to seek help and also where to seek help.

What I wish I could say to every person in therapy

What I want to say to clients who have experienced trauma and are coming to me for art therapy:

You are wounded, not damaged – there is a difference. Wounds are something that have happened to you, not who you are. Wounds can heal.

Just because you feel worthless, doesn’t mean you are worthless, and these feelings can change.

These feelings are real and overwhelming but this is not how you will always feel.

You are not ‘crazy’ for feeling grief and loss and self doubt and pain.

You’re not a failure because these feelings are still here.

You are strong – you have survived and you are still here. You are in counselling – you are taking steps to make things better.

You can feel better, things can get better – there is hope.

You are not selfish for being here, talking about yourself – this is hard work, it hurts, avoiding it is easier, you’re here because you care about having good relationships, doing well in the world, feeling ok in the world. There’s nothing selfish about wanting that.

You are trying to shift your patterns of thinking and your own belief structures and sometimes your view of and relationship with your family. This is huge work that no-one around you may even recognise or be familiar with.

I recognise how much work this is, how undone you can feel in the midst of it as old pains are remembered and old feelings felt. As best you can, be kind to yourself and give yourself credit for this work that you are doing. As best you can, trust in the process.

You are unique – I don’t know how it feels to be you, but I can listen and try to understand. Together we might help you see yourself more clearly or with fresh eyes too.

I am here with you, we will go on this journey side by side and I will do my best to accept you exactly as you are, with kindness, and no expectation that you should be anything other than you are.

We may work together briefly or for a longer time, and I trust that whatever you choose will be right for you. A lifetime has many steps in it, and even a short journey taken with another can leave lasting ripples, or so it has been for me in my life.

I believe that you are on a path of healing, that something inside you is unfolding, and that you are oriented towards growth. I also believe you have the wisdom of the universe packed deep inside you, and that through facilitating art, meditation and empathetic interpersonal exchange I can help you access this wisdom. I don’t ask or require that you believe this, but I hold this belief deeply inside myself and it anchors me in our work together.

Even if you can’t see it right now, I see the beauty and wisdom and good in you.


Work with me? Contact me to discuss whether we are a good fit for one on one sessions, or whether group work might suit you better.

Just what the doctor ordered

Many people recognise that art making has therapeutic benefit, emotionally, socially and even physically.

So, imagine you are in the office of your GP, and rather than prescribing medication you are prescribed 8 weeks of art lessons. Sound like a wonderful but way-out idea from some utopian future we might all dream of? Not so! Seniors in some suburbs of NSW can now access this right now via their local doctor or allied health professional. I interviewed Michelle Heldon, Acting Manager of the NSW ‘Arts on Prescription’ Program to find out more about the goals of the program and where the idea came from.

Hi Michelle, could you tell us a bit about how this program cam into being? What was the idea behind setting it up? 

The program is called  ‘Arts on Prescription’. It links participatory art activities run by professional artists to the traditional medical model of health services. Its aim is to help people to improve their health and wellbeing in multiple ways through creative expression. Basically what happens is that a Doctor or health professional can prescribe someone participation in this arts program, similar to how they would prescribe medication.

Participants will be involved in a range of arts experiences including painting, textiles, sculpture, music and movement. A similar program exists in the UK, which inspired this project, but because HammondCare who initiated it here is focused on positive ageing and aged care, this project focuses specifically on engaging older people rather than the general community.

No Arts on Prescription program has been done yet in Australia, in fact nothing like this has been done anywhere in the sense of this being designed specifically for people over the age of 65.

And who would be referred to this program?

People who have unmet health needs, an overall sense of decline in wellbeing, maybe they are socially isolated, experience depression or have decreased mobility. The referrer thinks that this person’s quality of life would benefit from participating in some art-form or another. For example say they have low self esteem but they light up when they talk about photography, this is potentially something this person could pursue to find that lost side of themselves. A person can also refer themselves if they feel they could benefit and approach the Arts on Prescription team who will link them with a referrer.

It has been promoted through aged care networks as well as through councils. Our primary focus is on people who are still living out in the community rather than in nursing homes, but it is open to people in residential care too if they are still relatively independent.

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Image: HammondCare. The workshops span different materials including painting, movement and clay

How does this differ from the various existing community activities, including arts, that might already be offered by say, a local council or community centre? 

The thing that makes this program unique and appropriate for older people is that people have to be referred. In that way it’s validating that art can help on a medical level not just as a hobby. To have someone trusted like a GP or health professional let them know that ‘this is probably something you have never thought of before but if you go and do some painting it might help ease feelings of depression or anxiety’.

The form is just like a referral form to go see a specialist, but in this case it’s for going to see an artist. Instead of filling out a form for anti-depressants, they are filling out a form that is for 8 weeks of dancing or 8 weeks of painting.

Its encouraging people to ‘give it a go’. They program is fully funded so they don’t have to pay anything. This is about reaching new people and showing that there are all sorts of ways to improve our health where we personally play a part in our own healing.

Who else is involved in delivering the program?

The project will be undertaken in two locations: HammondCare’s Hammondville and North Turramurra sites. HammondCare hosts the program but it is also being run in partnership with the University of New South Wales (the School of Public Health and Community Medicine, and UNSW Art+Design) Also the project has the support of the South Western Sydney Medicare Local.

The artists are key to the program. All the artists have experience working with groups and working with people with specific needs. Some of them are also trained in therapy but we employed them as artists based on their own art practice – how they experience art for themselves and how they would like to share that. We also chose people who were interested in working with an older population.

For me having worked in Hammond Care for a number of years, I’m really aware that you have to have a strong commitment to empowering the people in your groups. We did a lot of training for the participating artists on how to involve someone, how to allow people to participate, to create space for them to engage and feel comfortable to express themselves.

We also have care workers from the health industry who can assist the artist in each session – they provide help for the participants for personal care or with mobility etc.

We only take 6 people in each group, its quite intimate but still creates a feeling of social interaction and connection. It’s a great way to bring people together and create a new network in people’s lives.

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Image: HammonCare. Participants connect with their creative selves as they learn new skills and build confidence.

And what do you think the benefits might be?

I spoke with someone last week who was in his 80’s and he talked about his love of ceramics. In his 20’s he was taken to a gallery and because he knew the man organising the exhibition, he was able to touch some of the pieces. He told me about running his hands along the inside of a 200 year old Chinese pot, and explained emotionally that ‘that’s one of my happiest memories in my life’.

Wow, I got goosebumps as you told me that…

Exactly, and to have a way to reconnect with these memories through participating in art in your 80’s is such a wonderful thing! Activity that can enhance overall wellness in number of different ways. So that story gave us insight into the kind of program that he could get involved with, and he can reconnect with something that he really loves, but might never have had the opportunity to try as a younger person. This gentleman has recently started a Clay work program with Artist My Le Thi and is creating beautiful artworks and sharing stories with his group.

I’ve worked with older people for over 10 years and one thing I’ve noticed, is that this generation is difference in terms of accessing healthcare or asking for help. A lot of older people have the mentality of ‘you put your head down and keep on going’, a lot of them think ‘you don’t make a fuss’. So they are not always as willing to ask around for health information, or look into other types of therapies, and the GP themselves becomes a core source of guidance. As well, a lot of them have not been initiated into their new phase of life, they may have some unfulfilled hopes and dreams, particularly people who might be experiencing anxiety, depression and a loss of sense of self.

Research from the UK suggests that it reduces visits to the doctors when people go and do participatory art. Its not just a mental health aspect that these types of programs address but also the physical side – regaining mobility and flexibility is really key. We also plan to do physical research measures e.g. activity level monitoring, grip strength as well as wellness interview about mood, self esteem etc. We hope that the evaluation will show some solid results and programs like this can receive ongoing funding and the potential to roll it out in a range of organisations. As it’s so new we are learning and discovering along the way. We will get as much feedback as possible from the participants and artists to continually be improving and creating the program.

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Image: HammondCare. Participants express themselves through colour and form.

 To sum up, what drew you to work on this program, why do you think it’s special?

Something like this provides insight for medical professionals to look at things in a different way – this project is a way to help validate all services that have a creative element in them. It’s bigger than this project for me, it’s about a wider shift in thinking, to see health differently, empowering people to take a part in their own healing. There is still a general idea that you go to the doctor and that they are going to fix you, instead of you going to the doctor expecting the doctor to support you to make changes. A project like this really illustrates this different shift in approach.

There are a lot of things out there that are happening and that are great but they are not always being evaluated and so can get swept under the rug or not validated.

It’s a way of sharing with the wider world ways of thinking about art and ways of thinking about health. Art as therapy still often gets put in another realm beyond standard medicine – this is a way to bring the realms to together and to identify that connection.

What is personally exciting for you about being involved in this program?

I feel like I kind of fell into this – everything in my life led me up to working on something like this. I feel like things have merged together. I’ve always loved art since I was a little girl, I studied art, my grandma had dementia that led me into aged care, my grandfather is a wonderful poet and I work at the Museum of Contemporary Art. I started doing aged care when I was in art school not knowing back that that I would link the two. I went on to study art therapy, which was so important for me but being involved in something like this is a merging of all these different things in my life.

I guess my reflection is that there are many many different paths and they don’t all look the same. I am grateful to HammondCare and the many people that have touched me with their stories. Getting involved in this work has really affirmed for me that I didn’t have to be defined by one particular aspect, me being an Artist, an Art Therapist, an educator, a carer. I could just be myself and authentically share with the people around me.

Sometimes I feel controlled by the labels, but I believe that there are always opportunities for new things, for expanding quality of life and to not be limited into being one particular way. And that’s what I think this program is all about and what I hope the people being referred and getting involved have the opportunity to experience as well.

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About the Program

To get more information about the Arts on Prescription program or to download a referral form go to: http://www.hammond.com.au/services/positive-ageing or call the Centre for Positive Ageing + Care Ph: 02 8788 3900.Michelle can be contacted at: mheldon@hammond.com.au

To see some current programs in action check out the Arts in Ageing Facebook page: https://www.facebook.com/artsinageing/?ref=aymt_homepage_panel

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About the interviewee

Michelle Heldon is a visual artist based in Sydney who has been working in aged care for over 10 years. She has a Bachelor of Fine Art with Honours from the National Art School and has exhibited overseas and in Australia. Michelle currently works as an Artist Educator in the National Centre for Creative Learning and is the Coordinator of the new Artful: Art & Dementia program at the Museum of Contemporary Art, Sydney. Michelle has also studied Transpersonal Art Therapy and co-ordinated and curated the HammondCare SES Living Memories Art Exhibition in 2014 and recently began the role of Project Manager and Artist for the Arts on Prescription program.

About the interviewer

JadephotoJade Herriman (Dip TAT, BSc and MSocSci) is a transpersonal art therapist and coach. She draws on over 15 years experience working in government and higher education as a sustainability professional, researcher and facilitator. Jade integrates the principles of client centered counseling and group facilitation with art therapy processes and her own experience of creative practice. Jade holds a variety of events within organisations or for the general public and offers one on one art therapy or coaching, either face to face or remotely. Read more here.