Read on Twitter
Lets talk about poverty and mental health/ a thread /x
So we know that mental illness rates are on the rise, whether this is because they are actually increasing or because we are better at diagnosing remains to be fully seen, but I would hazard a guess its both.
So we know that mental illness rates are on the rise, whether this is because they are actually increasing or because we are better at diagnosing remains to be fully seen, but I would hazard a guess its both.
When we look at the cause of illness, some is genetic and biological, but from my perspective and this seems to be backed up by the evidence, a large amount (and if not most for many specific diagnoses) are related to a person's experience of the world.
Put rather simply, those at higher risk of developing an illness because of their biology will more likely develop it if exposed to an environment that is 'pathogenic', i.e one that is either likely to cause, or catalyse, disease processes.
We have known for a long time that mental illness rates show a skewed distribution to those who are poorer, and those who immigrate. The explanations around the latter are myriad, but overlap with the former. Simply put, many who are unwell live in or near poverty.
For longer term patients, often this financial decline is secondary to the their illness (which it doesn't need to be,) but the systems are not always there to help them rebuild their lives. For newer patients, there always seems to be a large factor of financial or social strife
We talk about the influence of drugs, which increase illness rates, as if they care purely causative. But we ignore the social factors that enable and make drug use a pleasant idea, which is principally avoiding pain. This is a uniting factor across many who I see.
When we consider human life and experience, we all agree on what we consider basic needs. These include food, shelter, love, warmth, etc. The underlying link between all of this is security, and security gives us the room to grow toward our aspirations,
For those locked in poverty there is a double hit, a lack of security and a lack of hope. To simply endure a life of living meal to meal with bills stacking up in a breaking home is not one that lends to happiness (in general, not discounting other things.)
Where I see this the worst is in my patients with chronic illnesses that rely on state benefits to survive, and although we are blessed to have any, the gradual erosion of this and tougher guidelines means that many are actually coming into hospital for this reason.
Whether it be because they are being traumatised by constant worry and vigilance over finance, or political strife, or simply because the systems are so broken they cannot get their medication, these are all factors that perpetuate suffering. We do not do enough.
I have seen many patients make incredible recoveries from severe illness, only to be sent to a hovel in a backstreet and left to wallow. We do our best to help, but if the systems are not there to help them then they can relapse. Society in general embraces those who are ill..
but the systems around them are far from adequate. Let us consider psychological services, perhaps the most important in mental health. Great staff, great service, but simply not big enough. Large waiting lists, and those who are 'unwell' but not 'too unwell' are delayed in help.
Eventually this leads to crisis. And the cost of private therapy can simply outprice health for them. This is an area where the NHS borders on the US system, not through design, but through reality. If people were more financially supported, they could access other services.
These services dont need to be official NHS, but can be something as simple as group activities, vocational training, support groups etc. Many are free. But if you are living pay cheque to pay cheque, these are often inaccessible. Who has time to be happy when bills are due?
As a trainee psychiatrist, I have noticed this startling pattern in those who relapse, in those who present for the first time, and it is often as a consequence of social inequality and chronic trauma of this that brings on illness, regardless of specific personal vulnerability
And we know that escaping poverty is really quite difficult. Societal structures are held in place because they work for the rich, so holding a few thousand families in poverty means little for them. But for those people, who I treat daily, it means the world.
If we could help those in poverty escape from it, it opens up their opportunities to escape some trauma, to access services earlier, to build a life with greater security and more akin to what they deserve.
So how do we fix this? Not easily. But it becomes a societal responsibility led and practiced by the individual. I can think of a few ways
1) Legalise drugs but open safe use centers, this reduces the risk of dangerous use, improves access to rehab and kills dangerous trade
1) Legalise drugs but open safe use centers, this reduces the risk of dangerous use, improves access to rehab and kills dangerous trade
2) Bring in universal basic income and greater financial support for those in poverty. Place funds into support programmes, including social and spiritual. Open up the door to a quality of life that we can all say is not just equal, but aspirational.
3) Push money into primary and secondary prevention programmes, i.e national changes that reduce the risk of illness. For example greater access to therapy and recruitment/training of psychologists and social workers.
4) Identify and utilise vocational rehabilitation earlier in treatment, work with companies to incentivise the employment of those who have been unwell. Its not enough to not discriminate, we must assist where we can,
5) Realise and improve upon the effect of political and economic changes that penalise the poor and reward the rich. Put simply, tax more those who benefit from keeping people in poverty and give that money to those who need it most.
6) Take a personal responsibility for enacting this change without waiting for approval. It takes little to donate a few pound, or a tin of beans, or volunteer at a shelter once a month.
7) Vote with your conscience, and think what would you need if you were suffering. Many of us vote based on fear of losing out, but not in the hope of giving to those who have already lost. Vote as if your nearest and dearest were suffering.
8) Read and understand more about the effects of poverty on peoples happiness, take responsibility for making changes in your life that will benefit not just you, but others too.
9) Educate those who disagree, but realise that, in the end, change comes from emotional entanglement. Not everyone can be reached, but we only need enough of us to make a difference. Don't waste your energy fighting battles for the sake of it.
10) Be happy to reach out for help if you need it, a kinder country is one where we all feel safe to ask.
As always, i would love your ideas.
*note, around drug legalisation/decriminalisation, this is complex issue beyond a single point in a thread, so here is a link on a more in-depth view https://www.nytimes.com/2020/10/05/upshot/portugal-drug-legalization-treatment.html
And as kind Twitter user said to be recently
'love always wins.'
'love always wins.'
in b4 - this is communism. Nah, it isn't. It's socialism, but even then, it's making the best of a hybrid system of socialism in a predominantly capitalist system which I fear will always remain. Don't make the perfect the enemy of the good.
And, as always, please #retweet and tag in those who you think could raise awareness xx
And I am aware in tackling such a topic I may have made some generalisations which people do not like, so please feel free to educate me xx
