Steven Walker says action is needed to avert crisis amongst the poor and young
One of the consequences of the pandemic and the Tory government’s shambolic response will be a predicted huge increase in unemployment and cutbacks in the welfare state to pay for their incompetence. Poverty will also increase from the already shocking total of four million households living in relative poverty at the end of 2020. The link between poverty and mental ill-health has been recognised for many years and is well evidenced. In general, people living in financial hardship are at increased risk of mental health problems and lower mental wellbeing. People in the lowest socioeconomic groups have worse mental health than those in the middle groups, who in turn have worse mental health than those in the highest. This ‘social gradient’ means that mental health problems are more common further down the social ladder.
The evidence of this social gradient in the UK is clear. For example, the Health Survey for England has consistently found that people in the lowest socioeconomic class have the highest risk of having a mental health problem. As another example, a 2017 survey commissioned by the Mental Health Foundation, with participants from across the UK, found that 73% of people living in the lowest household income bracket (less than £1,200 per month) reported having experienced a mental health problem during their lifetime, compared to 59% in the highest household income bracket (more than £3,701 per month).
The mental health risk of economic hardship starts early in life. Socioeconomically disadvantaged children and adolescents are two to three times more likely to develop mental health problems. People in debt are more likely to have a common mental health problem, and the more debt people have, the greater is the likelihood of this. One in four people experiencing a mental health problem is in problem debt, and people with mental health problems are three times more likely to be in financial difficulty. Employment is one of the most strongly evidenced determinants of mental health. Lack of access to either employment or good quality employment can decrease quality of life, social status, self-esteem and achievement of life goals. In the Mental Health Foundation’s survey across the UK in 2017, 28% of people who identified as unemployed reported current experience of negative mental health, compared to 13% of people in paid employment, 20% of people in full-time education and only 9% of people who had retired.
Studies have found that unemployment has a range of negative effects, including relative poverty or a drop in standards of living for those who lose a job, stresses associated with financial insecurity, the shame of being unemployed and in receipt of social welfare, and loss of vital social networks. The Organisation for Economic Co-operation and Development (OECD) has described how job loss has a traumatic and immediate negative impact on mental health, and noted that there is further damage where unemployment continues into the long term.
A study published by the Centre for Mental Health last year found that children from the poorest 20 per cent of households are four times as likely to have serious mental health difficulties by the age of 11 as those from the wealthiest 20 per cent. Children and young people with a learning disability, who are statistically more likely to be in poorer families, are three times more likely than average to have a mental health problem. And children from African-Caribbean communities in the UK have parents with higher rates of post-traumatic stress disorder and suicide risk and are more likely than average to be diagnosed with schizophrenia.
This increases the likelihood that children in these communities will be over-represented in the numbers diagnosed with a mental health problem. The charity Young Minds recently published research that revealed 83% of respondents under 18 said the pandemic had worsened their mental health. Self harm among young children and teenagers is increasing, along with depression, anxiety and suicidal ideation. Child and Adolescent Mental Health Services (CAMHS) have been depleted of resources for a decade during austerity, leaving staff overwhelmed and long waiting lists for help and support. Things were very bad before coronavirus, but as with the NHS, CAMHS have been left totally unprepared to face the consequences of a pandemic.
Every government over the past 25 years has promised to either reduce or eradicate child poverty. They have all failed. Unless the root causes of children’s increasing mental health problems are addressed, the current system is failing another generation of some of the most vulnerable children in Britain. They will become the adults of the future with mental health problems, at risk of potentially ending up in the prison system, homeless, with relationship breakdowns, addicted to drugs and alcohol and ending their own lives. It does not have to be this way.