Recently, I was talking about how I believed being poor impacts your experience of the most fundamental things – education, housing, life expectancy and mental health – and someone countered that, in fact, mental illness doesn’t discriminate, that it can happen to anyone. This might be true, but we are manifestations of the society we live within and our society absolutely does discriminate.
Like many of you reading this, I belong to the approximately one in four people in the UK who have experienced mental illness. Some of that was genetically inherited and the rest was readily supplied by a poor, unstable childhood.
I am incredibly lucky in many respects. My anxiety is relatively mild, I’m able to intervene early and can afford to take measures if I feel myself sliding into depression. Writers aren’t well off but, when needed, I can find the spare money for therapy and, as a freelancer, I can take a few days off if I really need them, knowing the rent will be paid and my world won’t fall apart.
Mine would be a very different story if I was still on benefits or working at my old job at a call centre. If my only resource was a constantly stretched NHS service, where, once I’d dredged up the energy and courage to seek help, I’d likely wait weeks for an appointment, then months, or even a year, for treatment to begin. Maybe I would search the internet for help but the suggestions of mindfulness and yoga, massage, online counselling, apps and self-help books would feel impossibly hard to reach while struggling day to day to pay for rent, bills and food; all while feeling that any opportunities were for other people, and working a job where my perceived value was the same as my contracted hours: zero.
In my experience, poverty and mental illness can be intrinsically, undeniably connected and NHS data shows that twice as many people in disadvantaged areas got a referral for mental-health treatment in 2016.
I wonder how often 'feeling a bit low' has become something much more destructive and life-limiting, only because the help didn’t come soon enough – or at all?
It’s not hard to understand why. Of course, living with the uncertainty and grind of poverty causes its own mental strains. Daily worries about keeping a roof over your head, debt, how you’ll feed your kids, crappy housing or feeling hopeless about prospects would take its toll on anyone’s mental health.
But mental illness can also erode what little security there is from within. Untreated, it can lead to lost jobs, relationship breakdowns, substance dependence or abuse, more debt and further bad decisions. These are things that slowly push a person, perhaps barely clinging on, or even those trying to raise themselves up, right off the edge into the abyss.
There are ways this self-fulfilling cycle could be stopped: shorter waiting times for diagnosis and treatment, early intervention, greater guidance and support to find local organisations like Mind, but, it seems, we’re a long way from that. British Medical Association research found some 3,700 NHS patients waited more than six months for talking therapies in 2017 and 1,500 for longer than a year. And these stats, grim as they are, probably vastly underestimate the full scale of the problem, since nine in 10 clinical commissioning groups, which fund these therapies, kept no records of waiting times at all for four of the most common kinds of therapy.
I wonder how often “feeling a bit low” has become something much more destructive and life-limiting, only because the help didn’t come soon enough – or at all? How frequently has that delay in treatment caused havoc in the life of someone who had no other options and who didn’t know where else to turn? How often have future generations suffered dysfunction, passed down from living in homes where mental illness was their strongest memory of childhood?
Recent psychological research commissioned by the Joseph Rowntree Foundation on how poverty affects people’s choices found those living in poverty had a “here and now” decision-making response, rather than thinking about the long term. It seems to me that policy makers are just as culpable of “here and now” thinking, and it is society that will be paying the debt for many generations to come.
Increasing access to mental-health care for those whose lives depend on these services, and understanding the true cost of failure to do so, could change not just individuals' lives but whole communities. Not only for the “here and now”, but for the mental health of future generations, too. That process starts with acknowledging the brutal truth that, yes, mental illness can affect anyone, but not everyone is given the same chance to fight it.