Poverty, mental health and an unkind welfare state

27 May 2021 Nick Garbutt    Last updated: 27 May 2021

Pic: Unsplash

A proper debate about the links between mental ill health and poverty and what needs to be done about it is overdue.

It is long established that poverty increases the risk of mental health problems. It can be both a causal factor and a consequence of mental ill health.

In Northern Ireland the latest (pre-pandemic) figures show around 350,000 (19%) people in relative income poverty including approximately 107,000 (24%) children. And according to Housing Executive figures around 22% of the population live in fuel poverty. The economic impacts of the pandemic are likely to increase these numbers.

The experience of pandemic has served to heighten awareness and should be a catalyst for change. We are currently experiencing a worsening of our collective mental health. According to the latest ONS statistics 21% of UK adults experienced some form of depression in early 2021 – more than double the figure from before the pandemic.

Those most affected by this rise are people in lower income groups. There is mounting evidence that they have suffered disproportionately in multiple ways.  

Health authorities are well aware of this and in Northern Ireland a new Mental Health strategy has been out for consultation and we can expect it to be implemented before too long.

It is a strong document which recognises both the poverty linkage and the necessity of taking an all of government approach to mental health.

It states: “Prevention of mental health problems and early intervention when they occur is both possible and cost-effective. People’s mental health is shaped by a number of social, economic, cultural and environmental factors, which can make people more or less likely to develop a mental health problem. Evidence shows that poverty and mental ill-health are closely associated, and disadvantage can have long-term consequences.”

Yet troubling questions remain. Principal amongst them is the extent to which some parts of government are not just not helping but actually undermining this laudable aspiration.

People in relative poverty have already paid a heavy price during the pandemic. They are more at risk of being infected because they tend to be on jobs which cannot be done remotely - many in social care, for example are low paid. They are less likely to have gardens, space or spare rooms for home schooling, are more likely not to own a laptop. Once all the emergency measures currently in place disappear there are many who fear for the future of their work, how they will pay rent, and what will happen to them if they have fallen behind in payments. Scope previously analysed some of these factors here.

As we anticipate rising levels of mental health problems post pandemic it is abundantly clear that we should be prioritising people in poverty.

The Department for Health understands this, so too the Department for Communities whose Minister Deidre Hargey recently wrote a piece  Scope denouncing the scourge of poverty and announcing a long-term Anti-Poverty strategy. This follows a series of measures that her department has taken to support vulnerable people and groups during the pandemic.

Whilst all of this is welcome it will not be sufficient until we have a Welfare System worthy of the title. It is not just a question of the inadequacy of payments but an apparent inability to recognise that many claimants are under considerable psychological distress.

Surely a decent social security system should recognise that it is supposed to be a service designed to support people in need.

Throughout the pandemic the Covid Realities project has been taking evidence from people impacted by the way the system works.

Here’s just one testimony it collected from Northern Ireland. This from a single mother of two children called Andrea: “I was shocked to receive a phone call from Medical Assessors from Universal Credit on Friday. The man who called me was very curt and very aggressive in his demeanour. He basically threatened that my money was going to be stopped if I didn’t show signs of getting a job. I asked him quite nicely about what the government was implementing to help single parents to homeschool but also look for jobs and child care. He basically told me he was the messenger and that another call would come next week and then they would make decisions about my Universal Credit. I’m terrified.”

Given that the whole purpose of welfare is to provide a protective role to citizens in need it is hard to comprehend why agents of the state are permitted to act and to speak in a way that increases stress to vulnerable people. They should be ameliorating, not exacerbating stress.

Whilst we must beware of medicalising economic and financial problems, we should also remember the damage that mental health problems wreak on society. For example the costs of mental health problems to UK workplaces are estimated to be £26 billion across the economy, or £1,000 per employee per year.

Then there’s the adequacy of benefit payments. Before Covid-19 it was  established that  payments were not adequate for covering basic living costs and there were particular issues around the five week wait for a first payment that either leaves claimants in debt or without support.

This five week delay inevitably causes worry and distress at a time of vulnerability – and it is hard to see how this is consistent with government attempts to improve wellbeing given the evidence that demonstrates the link between poverty and mental ill health.

It is also part of the reason why the Trussell Trust reports that a large proportion of people using food banks during the pandemic owed money to the government.

When pandemic struck costs increased for many claimants because they were at home more of the time, facing higher heating, food and schooling expenses.

Whilst welcome, for many families the £20 per week uplift in payments was inadequate. And now all claimants face the uncertainty of not knowing whether the uplift will be removed in September, as threatened or not. This is a continuing source of stress.

So when we come to discuss mental health and poverty we are being disingenuous if we fail to examine the impact that the very system put in place to alleviate distress has on those who rely on it. This applies just as much to the way it is operated as to the levels of financial support it provides.

Either we are serious about tackling mental health or we are not. If we are we have to prioritise those most vulnerable – people living in poverty. And that involves a radical re-examination of how we stigmatise, dehumanise and mistreat those unfortunate enough to need our support.

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