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.

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Taking social isolation seriously

Recent research supports the idea that feeling socially isolated can impact on our physical as well as mental health (1).

One of the reasons I love running groups is that a facilitated space can help people connect with others quite deeply in a way that feels safe.

Quite simply, connecting with others feels good and is good for our health, but can become hard when we are nervous, shy, or don’t trust others because we have been subjected to violence or abuse. Sometimes poverty, transport issues or physical isolation can make it hard to see and spend time with people. Similarly mental health challenges can contribute to social isolation, because our behaviours can be seen as ‘hard to deal with’ or even just ‘unfun’, leading to social connections falling away over time, which can further add to the distress a person in crisis is experiencing.

Social connection has many benefits; a sense of mutual support, feeling less alone in times of crisis, practical support such as help with problem solving or with physical tasks, an opportunity for fun and laughter, hearing stories of other people’s inner worlds that show us we are not alone in our feelings, and more.

Some statistics out of the United Kingdom (2) show that social isolation and loneliness in older adults is widespread:

  • 17% of older people are in contact with family, friends and neighbours less than once a week and 11% are in contact less than once a month (Victor et al, 2003)
  • Over half (51%) of all people aged 75 and over live alone (ONS, 2010)
  • Two fifths all older people (about 3.9 million) say the television is their main company (Age UK, 2014)
  • 59% of adults aged over 52 who report poor health say they feel lonely some of the time or often, compared to 21% who say they are in excellent health (Beaumont, 2013)

The relationship between isolation and loneliness is a complex one, involving social contact, health (physical and psychological) and mood. (3)

Now we are beginning to see that poor social skills, social isolation and loneliness may also be associated with poor physical health, and pose a risk to future health in the same way that other lifestyle factors like smoking do.

“We’ve known for a long time that social skills are associated with mental health problems like depression and anxiety… But we’ve not known definitively that social skills were also predictive of poorer physical health. Two variables — loneliness and stress — appear to be the glue that bind poor social skills to health. People with poor social skills have high levels of stress and loneliness in their lives.” says Chris Segrin, head of the UA Department of Communication (4).

The good news is that social skills can be learnt, and new patterns of relationship can be developed.

So what do we do about this?

Lifeline suggests the following actions if you are feeling lonely:

  • Connect or reconnect with friends and family – staying in contact with loved ones can prevent loneliness and isolation. If your family don’t live nearby, technology can help you stay in touch
  • Get out and about – regular outings for social functions, exercise, visiting friends, doing shopping, or simply going to public places can help
  • Get involved in your community – Try a new (or old) hobby, join a club, enrol in study, or learn a new skill. Try looking online, at your local TAFE/Community College, library or community centre for things in your area that might be interesting to you
  • Volunteer – helping others is a great way to help yourself feel more connected
  • Consider getting a pet –pets are wonderful companions and can provide comfort and support during times of stress, ill-health or isolation
  • Get support – If loneliness and social isolation are causing you distress, you should discuss your concerns with a GP, counsellor or a trusted person

In my personal life I am going to try to be more regularly in touch with people who may be socially isolated, and in my work life I’m going to try to learn more about social isolation and how formal programs and interventions can help reduce the stress of loneliness.

How about you?

Final thoughts…

If loneliness is an issue causing you distress please take it seriously and consider taking some steps to reduce it. Here are some links to services if you’d like to talk to someone to help you come up with a plan.

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(1) See more at https://www.sciencedaily.com/releases/2017/11/171106090116.htm

(2) Campaign to End Loneliness www.campaigntoendloneliness.org/loneliness-research/

(3) GOprogramme,Findings17 (available at: www.growingolder.group.shef.ac.uk/ChristinaVic_F17.pdf)

(4) See more at https://www.sciencedaily.com/releases/2017/11/171106090116.htm