Counting the cost
Openmind 152, July/ August 2008
Hardly a day goes by without news of the increasing financial pressures that individuals are facing across the UK because of the ever-rising cost of essentials such as food, transport, fuel, water and housing. These signs of our national economic troubles include an increasing amount of average household debt, currently estimated to be £9,216 per household (excluding mortgages).
There are plenty of 'facts and figures' in this news coverage, but they pay little attention to the costs to mental health and wellbeing that financial difficulties generate. People's mental health suffers when they are struggling to make ends meet, worrying about debt and racked with insecurity about whether they will be able to keep a roof over their head, their electricity connected and their children fed.
Research shows that disadvantaged communities in the UK have much higher rates of mental distress and suicide than less economically and socially disadvantaged communities. People living on incomes below the average wage are twice as likely to develop mental ill health as people on average and higher incomes. Many people in debt receive treatment from their GPs for stress, anxiety or depression. Depression, anxiety and suicidal thoughts are part of the territory of debt and poverty, and the costs that are generated as a result fall on individuals, families, services and society.
The evidence also suggests that poverty and debt not only contribute to mental ill health, they are also a consequence of it. When people using mental health services are asked about the major issues that concern them in their daily lives, personal finances are consistently identified as a major source of difficulty and distress.
People who have mental health problems have significantly higher rates of unemployment than both the general population and other groups of disabled people. Welfare benefits therefore are the major source of financial support for over 75 per cent of the adults of working age who find themselves with mental health problems for short, long or recurring periods of their lives. It is far from easy for people trying to manage their lives with mental health problems to obtain the full benefits they are entitled to. But even if they do, the weekly income they provide is inadequate to meet basic needs. Choices have to be made between buying food and paying bills. Replacing outworn clothes, shoes and furniture generates major crises. Haircuts, travel and going to social events become luxuries.
Making ends meet on a low income when prices are rising pushes people into debt. The debts of people with mental health problems are the result of their difficulties in managing on low incomes, as well as coping with mental health crises and life changes. Surveys of the circumstances of mental health service users have shown that debt is a common and growing experience. The most common type of debt among mental health service users are rent arrears, utility debts, catalogues, loans and credit cards. But as agencies such as the Citizens Advice Bureaux report, the costs of debt repayment for many individuals with mental health problems far exceed the rates quoted by commercial credit companies. When you have a diagnosed mental health problem and a low income you find it difficult to be accepted for mainstream credit. The costs of using alternatives are high. Having a diagnosis of mental ill health and being unemployed means that you are at an increased risk of finding yourself paying rates of interests between 20-400 per cent to commercial companies as well as loan sharks. It is a heavy cost by any calculation and one that reflects the stigma and discrimination that people on low incomes with a mental health diagnosis face in relation to accessing financial services.
Addressing the costs of poverty and debt calls for a change of direction in mental health services. The issues raised need to be located in a society where debt - usually called credit - is promoted as a way of obtaining the 'good things in life' and where the income differences between the very rich and poor are steadily widening. These trends have a negative impact on mental health and wellbeing across society. Those suffering the most are faced with more than a lack of income in their daily lives. Their rights and relationships are affected by what they have to live on. Poor people are routinely made to feel less than full citizens in their contacts with others, and these experiences impact negatively on their self-worth.
Community-based responses to this situation through the establishment of credit unions and food co-ops, alongside advice services for those facing financial and housing difficulties, have all been shown to make a positive contribution to the lives of people living in poverty, and it is important to ensure that investment in such developments is encouraged and recognised.
Alongside this, it is important that mental health services recognise that people with significant mental health problems are more likely than most to find themselves excluded by poverty from participation in social activities that are taken by granted than others. This cannot be viewed simply as a consequence or 'symptom' of their mental distress. It needs to be located in the ways in which poverty engenders feelings of powerlessness and insecurity, and compounds the discrimination and stigma that individuals with mental health problems encounter in their daily lives. Mental health workers need to develop poverty awareness in the way they assess and work with service users, as well as the ways they develop service responses to situations in which poverty and debt play a major part. Such awareness begins by listening and learning from those service users who are struggling to live life to the full because they lack the financial resources to meet their basic needs.
My thanks to the Suresearch members who contributed to this article by sharing their experiences.
1. Social Exclusion Unit (2004), Mental Health and Social Exclusion, SEU.
2. Morgan, E. et al (2001), An Uphill Struggle. A Survey of People Who Use Mental Health Services and are on Low Income, London: Mental Health Foundation.