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.

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.


(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