Discursive of Tunbridge WellsPodcast – Does Poverty harm your mental health?
The audio for this podcast can be found here.
Hello and welcome to discussions in Tunbridge wells, the podcast produced by the Salomons Centre for Applied Psychology in Kent. My name is John McGowan and I’m joined by our regular panel of Anne Cooke, Angela Gilchrist and Rachel Terry.
First of all Anne, where are we recording from today?
Anne Cooke
Well we’re sitting in our rather nice offices in a lovely manor house outside Tunbridge Wells in the countryside; looking out the window I can see a blackbird and some rabbits. We’re not going to be here very long because we’re very excited to be moving into the centre of Tunbridge wells, so we’ll be hitting the town in our lunch breaks.
John McGowan
Yes. We’ll spend our entire time going out for coffee and lunch, is it palatial? I don’t know, we seem to have reached the less palatial end of the building.
Ok, today’s episode is titled ‘Does Poverty harm your mental health?’
Now the effects of poverty, austerity, and inequality have been discussed quite a bit over the past few years in all sorts of ways. We’ve been in a climate of austerity and public sector savings on the back of a recession. The discussion today is prompted by two things though. First there’s some recent coverage of a forthcoming book from the London school of economics group involving Lord Layard and titled ‘The origins of Happiness’. It is quite a long term research agenda for Lord Layard who’s’ been involved with many such initiatives. This book (of which we’ve seen an early advance copy), offers analysis as to the reasons some people are happier than others. One of the ways it’s made an impression in our corner of the firmament (which is specifically around mental health), is suggesting that poverty, while it plays a role in happiness, is perhaps much less important than many people think. This has raised a few eye brows, including a letter in yesterday’s Guardian. A letter in the Independent as well suggests that mental health problems are a very significant reason for unhappiness by themselves so you may be unhappy because you are mentally unwell or have a mental health problem.
Now this stands in contrast to a number of other views and in particular another fairly recent report that we have wanted to discuss for some time from the Joseph Roundtree foundation. This one is authored by Iris Elliot, and offers what maybe a less surprising conclusion that poverty and inequality are very significant in the development of mental health problems.
So we are going to try and tease apart some of the claims and some of the measures and some of the implications of some of these different reports. Over to the panel now; Angela, could you give us a little bit of background of what is going on with these contrary claims, but could you initially just orientate us to this report from the LSE group?
Angela Gilchrist
Yes I will try. What I’d first like to say about the LSE report is that it’s looking at wellbeing as a whole. I wouldn’t want to convey that it’s an unsophisticated report, because I don’t think that is true, but it is worrying from the point of view of mental health but we’ll get into that as we discuss. It takes the concept of happiness in a single measure of life satisfaction for adults and emotional wellbeing for children. That is a very interesting way of looking at things and this report does give us lots of interesting information about the things that impinge on our wellbeing. Its big problem though is that it separates out the factors that may well impinge on our mental health. But it does suggest that mental health is the biggest single predictor of happiness.
Rachel Terry
I think we need to be a bit careful using this term ‘happiness’ because it’s life satisfaction that the authors were looking at, not happiness, as this is very individual and hard to define.
Angela Gilchrist
Yes I think happiness itself is a very subjective kind of measure isn’t it? What constitutes happiness is going to be very different for different individuals. I do think this report teases out some of the things that tend to make people happy overall, so that’s useful.
Anne Cooke
Yes, I think it’s useful from a number of points of view, I think it’s really helpful to focus the attention of politicians because this is going to be politically important report to focus politicians’ attention on wellbeing and not just economic growth, which is what people traditionally talk about so this really welcome. The focus on mental health is welcome as this is traditionally thought of as a Cinderella topic. Politicians don’t think about it nearly enough, mental health services only have about 5% of the NHS spend on them.
Rachel Terry
This report is really clear on emphasising that isn’t it? There should be much more money spent on mental health services.
Anne Cooke
Yes absolutely, that is really welcome, as is the public health angle they take, thinking about prevention, thinking about getting into schools and childhood wellbeing, taking away the soul focus on results. As the mother of two children it is a really welcome development. But there are some problems with it; I think you indicated some of those. One of them is things are a bit different if you’re poor. They talk about the fact that overall income is not correlated with happiness or their measure of satisfaction, as you say, but I think that’s very different if you’re very poor and it did seem that they hadn’t really looked at the implications for the very poorest people in society. There’s a danger of writing those people off in some sense, almost like animals sacrificing the vulnerable individuals for the good of the heard, I think there are big ethical issues about that.
John McGowan
Hmm, does money not make you happier though? They seem to claim it doesn’t. I’ve been living in hope that if I had a bit more money and a new Maserati approaching my 50th Birthday I’d be a significantly happier individual, slightly crushing to be told no.
Rachel Terry
I think that the way this report has been written up has done it a disservice. Reading it myself, going back to the original report, I didn’t take the message that poverty doesn’t impact on life satisfaction or happiness. In fact there were quite a few direct quotes that I’ve taken from the report which go against that so for example, things like; “an ethos of mutual care is crucial for a happy society and such an ethos would be highly collated with greater equality of income, people are not happy when there is distressed social dislocation, oppression, inequality.” So for me there were things within the report which did highlight the problems with poverty and inequality it’s just that it wasn’t given a main emphasis. I mean I think it goes without saying that poverty and distress are connected. The report also did say that one of the down sides is that the data that they’ve got is very individual focussed and the way that they have been able to analyse the data is very much looking at factors in isolation, rather than being able to look at the interrelationships between the factors. So, they do acknowledge that to some extent. Unfortunately that means the message about the relationship between poverty and mental health gets lost a little bit.
Angela Gilchrist
I think that is a significant flaw of this report, that the interrelationships between factors are not studied. So I think the limitations of the research methods on the findings need to be made clear to the public. I would worry about this being an influential document as far as mental health is concerned. Some of our listeners may know that Lord Layard’s recommendations lay behind the formation of the IAPT programme (Improving access to psychological therapy) which of course has been a wonderful thing in many respects. But they’ve also been highly criticised for their emphasis on trying to get people back to work rather than looking at mental wellbeing as an aim in itself.
Rachel Terry
I think there are areas to critique this report like you say, but there are also massively positive messages, like what Anne was saying at the beginning. I think that if we are discrediting this whole report that would be a real shame because overall it does a lot for arguing for much more consideration of wellbeing, that we should be enhancing life satisfaction and putting more money into mental health services. So I think if we’re just giving a negative message about the report that is a massive shame when it could be used for our benefit.
Angela Gilchrist
I would agree, as I said at the beginning I think there is a great deal in this report that’s of value, but we need to be careful how the information in it is used and reported.
Rachel Terry
Definitely.
Anne Cooke
I agree and I started by saying what I really like about it, but to me it has one fatal flaw, it did seem there was bit of a misunderstanding of the nature of mental illness, in the sense that there are statements like, ‘The biggest cause of misery is mental illness’. Well mental illness doesn’t arise in a vacuum and also mental illness, is a name for a particular human emotion and it’s not something special that only experts can diagnose and you have to have a technical treatment for. Mental illness is a name that we use to talk about when our emotions get so strong that they threaten to become overwhelming. It’s not a different thing. So in a way that could be seen as quite illogical, we’re saying that severe misery causes severe misery, and I think there’s a real danger there. That misapprehension is actually shared by a lot of people in society; as psychologists it does make us very uncomfortable to think that a rather simplistic assumption might be driving a whole policy. And of course that could be a very welcome message for this idea that mental illness is something going wrong in people’s brains that needs a technical fix. That could be a quite welcome message for our current government, because if it’s nothing to do with the events and circumstances of people’s lives but just to do with their brains, then it gets them off the hook, both in terms of what might have led to that misery and depression or anxiety and also in terms of changing society such that things improve, because it’s all down to individual therapy.
John McGowan
Just to pick up a couple of practical things before just diving into that Anne, to say that going back to what you said Rachel there was some coverage that may have pushed the message that poverty doesn’t matter, you know a little bit or suggesting that the LSE group is claiming that poverty doesn’t matter. We’ll link to a piece in the Guardian on our blog site. The report itself in the form of a book isn’t out yet, but we are very grateful to the LSE for sending us an advanced PDF copy to discuss. We only got that yesterday so we’ve all had the chance to at least look at it. We will also provide a link on the blog site to somewhere where you can ask for a copy of it because they do seem to be making some PDF copies available. There is a webpage for some talks they were giving about it; the main contributors were giving a talk about it the other day. Within the initial coverage most of the reaction has been based on this initial coverage and we’ve read a letter to the papers, a group that we have some connection with Psychologists against Austerity, they’ve already written something that’s been a bit critical about it. I think what they are picking up on Anne is what you’re saying about this notion of mental illness or mental ill-health can lead to unhappiness. The actual detail about how mental ill health arrives itself. There is come coverage but it’s quite, seems on me anyway on a first read quite small. Feels like it just kind of exists there in some way.
Angela Gilchrist
It exists apart from life circumstances which I think is the fatal flaw.
Anne Cooke
Yes because mental health problems arrive in the context of the events and circumstances of our lives, and I haven’t seen that so far in what I’ve read, and I think that’s a very central thing.
John McGowan
In some ways this is, in terms of Lord Layard’s own pretty extensive contribution to public policy, I think this is probably reflective of a stance that has lasted a number of years really, clearly decades actually, in the sense there are unaddressed mental health problems in society and that there are means and methods which we underinvest in but which can make a difference to those, so we have the improving access to psychological therapies initiative. Again that caught some criticism too, because it was seen as being in some quarters as, I have to say I was not uncritical of it myself at points. You are treating the mental health problem rather than what might underline rates of mental health problems, you’re looking at the individual rather than others factors. So what’s the evidence to the contrary because the other report that we have in front of us, the Joseph Roundtree Foundation report, it starts off absolutely clear, poverty increases the risk of mental health problems. That’s the first line.
Anne Cooke
Yes, I think there’s good evidence of that, there’s also good evidence that if you look more openly inequality is really important not necessarily only absolute poverty, but the rates of inequality in a society pretty much tracks the rates, or the other way round the rates of mental health problems pretty much track the levels of inequality, so I think that’s quite clear. My other worry about putting all our eggs in the basket of individual therapy, it’s just the scale of stuff that would be needed and there’s never ever going to be enough therapists to go around to meet the need. It’s a bit like trying to mop the floor while leaving the tap running, there’s just not going to be enough, not to say that we shouldn’t try it, I mean we’re all therapists, we are all wanting to help people provide therapy, but I do worry about this idea that that’s the answer to the problem of mental health.
Rachel Terry
I didn’t get that take home message when I read the LSE report, I had the take home message that actually what we need to do is change our policy making decisions away from money and austerity and instead focus on increasing people’s life satisfaction so we should be focusing on making people have more fulfilling positive lives in general, broadly we should be taking a health promotion perspective in all our policy making decisions, rather than putting everything into therapy or whatever. So I personally thought the take home message from the LSE report was very different from perhaps how the others in this group have taken it.
Angela Gilchrist
No Rachel I agree with you, and I do think that on the whole that it sends out a very good and positive message and I think its laudable as well that’s position is to take it out of the arena of just looking at GDP and looking more broadly at the factors that impinge on life satisfaction. But as I say I do think its treatment of the mental health situation is worrying. That I suspect is because there aren’t any psychologists involved in this project.
Anne Cooke
Yes, I wasn’t going to say that!! Hahahaha
John McGowan
OOOOOOOhhhhh
Angela Gilchrist
Well, I’m sorry, nobody has thought about the psychology of this, it’s about the economics or sort of broader, like you know, its mentioning work and all of the things, and relationships and all the things that impinge on our happiness but the problem as we’ve already stated is that mental health problems are seen as something that exists separately from our circumstances so they are just diseases that can be targeted through therapy and we needn’t worry about changing the bigger matrix that it gives rise to.
John McGowan
I wonder if one of the issues is in terms of an outcome measure, I’m not 100% sure of what to make of the life satisfaction outcome measure, in some ways there’s an appealing simplicity to it.
Anne Cooke
Do you want to say what it is?
John McGowan
Ummm, what’s the phrase exactly? It’s asking people about the degree they are satisfied with their lives, and in some ways there’s an appealing simplicity to that. Part of me thinks ‘God it’s got to be more complicated than that hasn’t it?’ But also it’s something separate from mental health outcomes. It isn’t the same thing so they can say, empirical work, they do talk about, is it Wilkinson and Picket the spirit level? They do talk a little bit about that, they looked at it very briefly in the context of inequality specifically; they do say. But empirical work on the effects of inequality on life satisfaction has yielded very mixed results; many studies have failed to find any effect so they clearly are dubious about the effects of inequality on life satisfaction. I’m guessing other people might meet that evidence base, even in terms of life satisfaction somewhat differently. We are also talking about something else, we’re also talking about psychiatric morbidity rates of mental health problems, which I think we’re suggesting. And this other report from the Joseph Roundtree Foundation actually gives a very thorough analysis of the ways in which poverty and inequality are quite profoundly related to mental health outcomes.
Anne Cooke
That’s the empirical angle that Angela was alluding to. The psychological theoretical angle as well because psychology has a lot to say about the possible mechanisms by which the very very poor in society could lead to both a lack of wellbeing and also mental health problems. I would argue that those two are two sides of the same coin, the report seemed to be seeing them as different and one of the things I’d possibly challenge. But anyway in terms of psychological methods there’s lots of things like what we know about scarcity, when something is in very scarce supply that’s what preoccupies us, when we haven’t got enough to eat we think about food all the time, those kind of things. There’s stuff about agency and how we’re not able to affect our surroundings that has a very detrimental effect. So there’s a whole load of psychological theories as well I think, that we have to look at, not just empirical data.
John McGowan
I’m just trying to think how the issues of poverty kind of shake out in terms of people’s understanding of mental health issues, because at the moment, we have discussed this many times, and written about it many times as well. We’re currently being, I think, in several quarters being given some quite strong messages about mental health and about mental health as something that can happen to anybody. It can absolutely happen to anybody. And in some ways I can see the rationale of that, you know, having a mental health problem you don’t have to fit a stereotype, or stereotype of somebody perhaps you know, not able to deal with the stresses of real life, so it can happen to anyone. In some ways that’s a laudable message but it also seems to risk being in ways a distorting message, perhaps, because these things may be more likely to happen to you if you’re poor. Along with many other health issues.
Angela Gilchrist
That is true, it’s undoubtedly true, but we can’t minimise the suffering of people who’ve got enough economically, but they are still overcome with depression or anxiety or can’t function well in the world. I’ve had the privilege of working with some of the richest people in the world and some of the poorest. I’ve worked in private hospitals in very wealthy areas and I’ve worked with people in squatter camps in Africa. So I’ve really seen both ends the spectrum.
John McGowan
We do have something of a mixed message here and it’s hard not to look inside people’s heads. For example I was giving a talk at the LSE before the election in 2015 and we were talking about metal health problems. Paul Farmer was there from MIND and was I think partly taking this line about trying to de stigmatise things in the sense that they can happen to anybody. I was trying to make some points about poverty and inequality and after that I remember hearing in the news coverage coming up to the election. I was driving home one night and there was a story about increased suicide rates, especially amongst middle aged men, and there was a story about underinvestment in mental health. By the next night those stories were together and in some sense suicide was something that happened to individuals who felt suicidal and the answer was more mental health services. I suppose that’s what gets me into implications. You know, what are the implications of this because on one hand we’ve got (and we’ll link to this on our site) pretty thorough growing analysis of the role of poverty and inequality in mental health problems and on the other hand we have an interesting report but one that seems to place mental health problems in a slightly more separate place with services as the answer. So what are the implications of this?
Rachel Terry
For me the implications are that it needs to be a multi-pronged approach. So there needs to be massively increased spending on mental health services, there needs to be a shift away in policy thinking from financial considerations solely onto consideration of health promotion broadly, mental health promotion and people’s wellbeing and happiness and there needs to be a massive tackling of inequality within society and poverty. So I think it needs to be multi factored and it’s not simple.
Angela Gilchrist
It’s not at all no. I’d agree with Rachel, it needs a multi-pronged approach and we need to get away from the idea that therapy can solve everything. It’s certainly a very very useful tool, of course it is, but it can’t solve the bigger problems that have given rise to these inequalities that have in turn impacted on people’s mental health. We need to be thinking more broadly in terms of public health approaches. In terms of community approaches, in terms of prevention in schools, and you know, we need to hopefully get to the point where we’re all thinking about mental health as something that each one of us has to maintain in the same way as we have to maintain our physical health. It’s almost as if mental health only gets thought about when it’s really gone wrong. We don’t’ encourage people to think about how to maintain it in the same ways as we help people to maintain their physical health through diet and exercise and all the other things. We just simply label and stigmatise those unfortunate enough to have mental health problems. Put it out there as something that can’t possibly affect us, or so most people seem to think. There are shades of that in this report; I’m not saying anybody deliberately intended to be discriminatory but the idea that mental health is just out there. Anxiety and depression are just things that occur to people, and people who are very different from the ‘norm’ as it were. They need treating, everybody else is alright.
Anne Cooke
Yes, that’s what I was going to say. Possibly not a huge amount is going to change as long as we have this idea of mental illnesses as thing that just strike people out of the blue. And your emphasis on mental health and degrees of mental health or lack of it, which actually maps quite well onto the concept of wellbeing here. But the report sees them as different; they’re saying the lack of wellbeing is caused by mental illness, where as I would see it much more as, we need to think in terms of mental health as something akin to wellbeing that we have shades of, like you were saying. As long as we think of mental illness as this kind of random scary thing that inflicts certain people, not the rest of us, then we won’t talk about it in schools, for example. I did some research with a trainee a couple of years ago, interviewing teachers about how they talked about mental health in the classroom, and we found that they didn’t. They completely avoided the subject because they were scared of it. They didn’t think they had enough expertise. They were worried that the parents would criticise them for talking to the children about these weirdos. It’s very very sad, and I know I would say this as it’s a thing I go on about, but as long as we have this idea of mental illness as separate from the normal run of human experience, we will think of it as something that is only addressable by technical treatment and not by changing the events and circumstances of people’s lives that give rise to lack of mental health.
John McGowan
Two points occur to me just in what you’re saying. One is just to go back to my example of suicide rates, and I do think that’s potentially quite an instructive one. There are a lot of different ways of seeing suicide rates, not just that the under investment in mental health services is the cause and greater investment is the solution. It’s not like mental health services necessarily do such a bang up job with suicidal feelings anyway, particularly there’s lots of reasons why they may not and taking away people’s responsibility for themselves isn’t always the most helpful thing. But there’s a lot of different ways of seeing that. You can see it as part of a recession; you can see it as being about unemployment, skill shortages, a changing role of men, social epidemics that occur in ways that in which we are still catching up with via the internet, transfer of social and cultural information via that. There’s a lot of different ways of seeing it.
I suppose the other thing that was part of what you were saying Rachel about not seeing it in terms of economics. There’s a quote from somebody that I never met, I heard them say it, I never saw who they were but I stayed with me for the last 10 years. One of my colleagues at work was showing somebody round the previous building that we were in down the drive and I remember this person saying to Fergal, he said ‘I prefer investments to cuts’, I thought don’t we all, hahahaha. It’s so easy to say and in one way to do think that this LSE group are trying to meet that head on, one way, they are actually trying. There is a case we are looking at, they’re trying to look at what might save money, be cheaper, you know, actually use what is a finite pool of resources. I do think we deserve some credit for that. I do question a little bit in terms of mental health where they end up, and I also hope that the Joseph Roundtree foundation report, which we haven’t talked about so much possibly because it’s not so controversial or something. I do hope that people will take a chance to have look at that because it does offer some really interesting and thorough breakdown of the elements as to how the notion of inequality and poverty might really flow into mental health problems. It really brought that alive for me.
Angela Gilchrist
I think the most important point in the Joseph Roundtree report for me was that poverty could be both a cause and a consequence of mental ill health. It is looking at what comes from where. We’re not really seeing that in the LSE report, although I’d say again there’s lots in the LSE report that is really laudable and I hope that people act upon. The idea for example that we as individuals, tend to be most unhappy when we are at work but actually happier than if we don’t have work. And it says in the report that there are some implications there for modern management. Why are we unhappy at work? Although we’re happier than we would be if we were unemployed obviously, but most of us spend a 3rd of our lives at work and those are hours that most of us seem to regret spending if we’re to believe this report.
John McGowan
It also beats the drum for working mothers of which we have two at this, I mean the phrase working mother seems like something out of my childhood in the 70’s when that was disapproved of.
Anne Cooke
We have a working father as well!
John McGowan
Well yes, you know nobody has ever accused me of damaging my children’s mental health, it says something positive about that and there’s lots of positives to take.
Angela Gilchrist
I think 60% of mothers now return to work in the first year of the child’s life, I mean that’s astonishing really, compared to how it used to be. This also is showing that mother’s mental health has a profound effect on the emotional wellbeing of children. (Emotional wellbeing being the measure that the LSE report has used in children’s wellbeing).
John McGowan
It’s shocking when you think how utterly overwhelming your first child can be, what a mess we might make of that. But anyway, I think we’ll have to wind it up there. We’ve left links to various things that we’ve talked about on our website; we’re currently recording this on Friday, hoping to have the podcast up by Sunday.
Just a few final things to say, which is that the best way to follow the podcast is to subscribe, you can do that on iTunes, our iTunes listing, it will be nice to have a few more there, you can actually write a review on iTunes as well. Although perhaps only if you have something nice to say! Also you can find articles touching on a number of these issues on our blog ‘Discursive of Tunbridge Wells’ and we will leave a link to that in the show notes. You can follow us on Twitter at CCCUappsy and on Facebook if you look for Canterbury Christ Church University Applied Psychology. We’ll be back soon and thanks for listening.