by Cathy Campbell, Ellen Duff and Sally Zlotowitz
“The pandemic is a portal. We can walk through it with our dead ideas. Or we can walk lightly, ready to imagine another world.”
Psychologists for Social Change aim to develop new ways of being, seeing and doing in the field of ‘mental health’* and well-being. This includes moving beyond models that focus solely on the individual. We are committed to promoting understandings of psychological health and care for others in distress as a political act - one which involves not only psychological therapies, but also efforts to promote social conditions that enable and support the possibility of well-being for all through tackling the social inequalities that drive ill-health in many local, national and global contexts.
PSC have described the mechanisms through which social and economic policy can damage the population’s psychological health, notably the impact of austerity. We also describe how it is possible to do the opposite by generating more trust, connection, security, meaning and participation through social and economy policies. It is in this spirit of hope and solidarity that PSC added our name to the campaign calling for us to #BuildBackBetter from COVID-19. The five principles in the letter map out social conditions which would significantly increase opportunities for psychological health, not only in relation to COVID, but also in relation to future health threats, including those created by climate change - particularly amongst the socially disadvantaged who tend to suffer the poorest health and the least protection from adversity.
by Karim Mitha
A decade ago, Professor Sir Michael Marmot published his landmark review highlighting the stark inequalities in our society. Along with Wilkinson and Pickett’s “The Spirit Level”, the report helped to outline the impact inequalities and other socio-economic factors have on population health, known as the “social determinants of health”. Despite the number of recommendations made, particularly in relation to good and fair employment, healthy places, and improving standard of living, the subsequent decade of austerity did little to make any improvements in tackling these issues. In many cases there has instead been a regression, particularly in relation to housing and employment. The current COVID-19 pandemic has made existing social inequalities in our society achingly visible, and seems likely to compound these divisions further. We already know that certain groups are disproportionately affected by the virus, with BME communities experiencing particular structural and health inequalities including barriers to self-isolation, and the spike in domestic violence in lockdown. As we try to weather this crisis, it seems particularly timely to reflect on the findings of the “The Marmot Review – 10 years on” recently published by the Institute for Health Equity.
“England is faltering”
The report is stark. It portrays a bleak picture of the impact of sustained cuts to social services and how this has exacerbated existing inequalities. The very first words of the report, “England is faltering”, are a call to action – asking how is it that in a high-income country social policies have been implemented to further disadvantage the working class, vulnerable, and marginalised, who experience greater years of life living with disability than those in less deprived backgrounds.
The report acknowledges the debate in the age of austerity regarding prioritising social or economic progress. The Coalition government, from 2010 onwards, used rhetoric of national identity and social solidarity, invoking a nostalgic idea hearkening back to the Second World War of “we are all in this together”, to push through reforms and cuts. This was done under the premise that Britons would band together and accept cuts which were portrayed as necessary to get the economy back on track. Marmot is careful to note it is difficult to establish a direct causal link between these austerity policies and the increase in inequalities over the same period. He does, however, suggest that sustained cuts in health and social care have combined with wider socio-economic factors to jointly reduce individual stability and security, which are important for psychosocial wellbeing. Marmot particularly highlights changes in the employment and housing sectors.
The myth of “we’re all in this together”
Marmot outlines how multiple political and economic factors have combined to contribute to areas, particularly in the North of England, feeling “left-behind” and has helped to compound the experiences within “ignored communities”, where there is little hope for alleviation of poverty or social mobility. The housing crisis, cuts to child and youth centres, and continued disinvestment in particular geographic areas have all played off each other in a negative spiral of disadvantage, further exacerbating and entrenching existing inequalities. The health impacts are severe. Life expectancy overall has stalled and has actually fallen amongst the most deprived. The social gradient of health – where those at the top have the least need – has also worsened. Men living in the 10% most deprived areas will spend 30% of their lives in ill health compared to 15% amongst men living in the 10% least deprived areas. Amongst women, those living in the 10% most deprived areas will spend 34% of their lives in ill health compared to 18% for women living in the 10% least deprived area.
Similar inequalities exist in mental health need. Vulnerable and disadvantaged groups, often concentrated in more deprived areas , tend to be disproportionately represented in mental health service use. The report notes the worrying trend of increased mortality rates amongst middle aged-adults due to “deaths of despair”, deaths due to suicide, alcohol, and/or substance misuse. These can be understood as coping behaviours in response to socio-environmental strain and pressures. Marmot explores ‘avoidable mortality’, defined as deaths which could have been avoided through timely and effective health interventions. Amongst the poorest 10% of English people, deaths of despair are three times higher than amongst those in the richest 10%. This is where examining the influence of wider factors is important as it is often those experiencing the most socio-economic disadvantaged who are particularly susceptible to job insecurity, unemployment, debt, and lack of social support, which are linked with increased suicides.
Overall, the report portrays a bleak picture. Marmot notes that those living in more disadvantaged circumstances have been besieged with substantial changes in many social determinants of health. When people experiencing the greatest socio-economic adversity are socially “written off” and lose a sense of attachment and trust to their local areas , the boundaries of social cohesion are frayed. It is difficult to believe messaging such as “we’re all in this together” when social mobility is increasingly unlikely and already disadvantaged communities feel increasingly marginalised, vulnerable, and forgotten. Given this, it is difficult to not see how these factors have, along with cuts to community and social services, have contributed to higher levels of suffering and despair we can see manifesting as a 'mental health crisis'. It is quite concerning when we see the blanket of the social welfare state fraying – with successive governments failing to understand the long-term and societal implications of policies under austerity.
The politics of poverty and wellbeing
The report critiques the “individualist” agenda - that people’s poor health is a consequence of the choices they make. Marmot notes that being in poverty limits the available choices people can make and thus poor health actually reflects the limited range of choice available, along with the psychological strain and pressures that disadvantage brings (ie: poor quality housing, debt and financial strain, etc). Marmot also notes the impact of cuts to social care and the concomitant increase in youth violence and child and adolescent mental health disorders. Given these factors, it is unsurprising that his recommendations centre on improving children and young people’s environmental living conditions, fairer employment for all, increasing living standards, and creating healthy and sustainable communities.
Marmot also argues that in an era of localisation, it is important for local authorities to embed a social determinants of health perspective into their health and wellbeing strategies, as tackling deprivation can improve health and wellbeing outcomes for all residents. Marmot highlights the “Wellbeing budget and strategy” in New Zealand which looks at wellbeing as an investment for a happier, healthier population.
Marmot views the various social prescribing programmes in England as beneficial. He notes that this approach may help to build those connections and networks, as well as help people to gain confidence and a sense of agency, through being able to be seen as an active citizen. However, he also notes that this may not be able to address some of the underlying and challenging experiences and threats to mental health that those who are the most disadvantaged may be experiencing, and thus social prescribing efforts must be made in conjunction with movement on wider determinants.
Faced with the evidence of what the past decade has dealt onto the most marginalised in society - having the social welfare system and the promise of social mobility pulled away, feeling "left behind", stigmatised, and blamed - it is easy to see the futility of trying to address psychological concerns divorced from socioeconomic context.. Understanding a “whole-systems” approach is essential in being able to address the impacts of heightened neoliberalism and increased inequalities on mental health and wellbeing, particularly for those experiencing multiple forms of disadvantage.
Ultimately, it is clear that a decade under austerity has been detrimental with those most at risk and most vulnerable most affected. If we were to take the approach of countries like New Zealand, and embed wellness into our planning, strategy, and it being an overall aspiring target to achieve, we might be able to overcome these structural factors and facilitate improved physical and mental health and wellbeing of our fellow citizens.
The BMJ has astutely noted that the experience of the COVID-19 pandemic demonstrates the imperative of tackling inequalities and how systemic factors such as structural racism and class inequalities can facilitate susceptibility to disease, which can have global consequences. The pandemic climate has shown us how uniting to tackle inequalities and helping our most vulnerable will actually help improve health outcomes for all. The Marmot review has shown the consequences of failing to do so. In order to address the health of the whole population, it is important to pay particular attention to the most vulnerable and address inequalities. After all, as the proverb goes, “a chain is only as strong as its weakest link”.
Author note: Karim Mitha is a public health professional and a member of PSC. He is completing his part-time PhD in the sociology of mental health at the University of Glasgow.
People across the world are facing unprecedented times. The novel coronavirus Covid-19 has been designated as a pandemic by the World Health Organisation. We all are affected, whether directly by the illness (ourselves or someone we know), or by policies and guidance being enacted by the government; or very possibly both.
Psychologists for Social Change’s previous briefing paper on austerity notes five key ways that mental health can be impacted by public policy. We believe these also come into play at times of huge social uncertainty such as during the current pandemic:
1. Being trapped and powerless
It is no understatement to say that the uncertainty around what will happen feels overwhelming at times. High levels of uncertainty can lead to more physiological stress than a known negative outcome. So the sense of powerlessness that many people are feeling in the face of the virus has led to increased levels of anxiety and distress. Some people who have been most detrimentally affected by austerity and cuts will struggle even more.
2. Fear and distrust
It is understandable that there is a very high level of fear for those of us with health conditions or loved ones who are more vulnerable. The UK government has warned that we should expect loved ones tol die, and death rates are mounting around the world each day. There is also heightened fear around how the NHS and other services will cope. This has been exacerbated by many years of cuts to health services, and a social care system which remains woefully underfunded even without the context of the current Covid-19 crisis. With beds requisitioned from the private sector, there are still question marks over who will profit from the current crisis. At times like these, distrust of those in power is likely to mount, especially for people who already feel let down by the government. There needs to be scrutiny around the new coronavirus bill to ensure that it does not undermine human rights.
3. Humiliation and shame
As humans we are naturally concerned about our status relative to others. The growing inequality gap across the UK is thought to have increased our risk to ‘social anxiety’ as a nation. This is said to be partly responsible for the breakdown in cohesion across communities and society. As the rich get richer the spread of wealth becomes polarised. This causes greater distancing between groups and a breakdown in ‘bridging relationships’ which support people to access resources beyond their immediate social position.
When under threat like this, our defenses come up, cohesion breaks down and it is easy to blame or stigmatise others. Rising inequality over at least the last decade has eroded our social ties causing division which has contributed to a rise in populist nationalism. Against this backdrop we have already seen a rise in racially aggravated incidents as people come to terms with the virus. The out-of-our-control nature of the unfolding situation can fly in the face of some of our deeply-held values as people who want to help or support others. Sitting with these values whilst feeling powerless may make us feel torn about what to do. We could feel shameful because the right answer isn’t going to always be clear.
The election result could be changed by people shifting their opinions on specific issues, which is why it is worth engaging others on issues you care about. But what if you’re starting from very different positions?
Sinead Peacock-Brennan and Laura McGrath
It feels like this election is taking place in polarised - and impenetrable - bubbles. The Brexit referendum has reorganised British politics, not least through providing powerful new social identity categories of ‘Remainer’ and ‘Leaver’, then forcing people to both pick and defend a side. Despite the EU being conspicuously absent from public priorities in 2015, one fallout from the Brexit vote has been a fracturing of existing political tribes. Speculation abounds over how ‘Labour Leavers’ and ‘Tory Remainers’ could upturn long held safe seats and reshape our political landscape.
Rather than fluidity in politics opening new spaces for dialogue and understanding, our changing political times have instead entrenched division. Moral and emotive language, of treachery and surrender, in a social media landscape, which reinforces our existing views rather than challenging them, has only acted to heighten hostility. Throw into this mix the impact of a decade of funding cuts, the climate emergency, floods, accusations of racism in both Corbyn's Labour and Johnson's Conservatives, and no wonder it can seem harder than ever to listen to, never mind understand, people with different views.
At Psychologists for Social Change, we use psychological research to inform political debate, policy and social action. We have highlighted the damaging impact of austerity on mental health and examined alternatives such as universal basic income or services. We have also critically analysed the ‘happiness’ or ‘wellbeing’ agenda in British politics, as well as considered what better education and children’s mental health services might look like.
These briefing papers and commentary might inform your conversations with friends, family and colleagues in the run up to the election. In these divided times, however, we realise it is not enough to work out what the issues are and where you stand. What happens if you realise mid conversation that you are in a different bubble to the person you are talking to? You might shut down and decide that it is a lost cause, or engage in a heated discussion which leaves you both irate and frustrated, holding even more firmly onto your existing beliefs. Or is there another approach? One that encourages discussion, and could possibly build consensus for political change? Here are some ideas.
South Wales PSC are on the case to make sure the Welsh government’s approach to mental health is focused on creating mentally healthy communities so that everyone can thrive
Photo by David Chubb on Unsplash
My name is Lyndsey and I was born in 1988 to a Welsh mother and father. My father left when I was two and my mum raised me and my two older brothers alone. Mum worked really long hours to provide for us the best she could, but with three children and a house to run, she struggled. Both financially and mentally.I was brought up on a well-known housing estate in south Wales. As a young child, it was a scary place to be. Emergency services were always around because of burnt-out cars, always gang trouble and issues with drugs. As I got older, I became oblivious to the trouble and found the community spirit amazing. Everyone would help each other out with anything needed.
I enjoyed primary school for a time but I experienced personal trauma and school then became a struggle for me. I never felt like I belonged there, like I was different. I used to “act out” because I never had the confidence to speak out. Going to secondary school, I no longer had the escape I needed. I struggled with my anger and felt I had nobody to turn to. I channelled my frustrations in the wrong way, which resulted in me being excluded from school with no qualifications at 15. I struggled for the next few years.
I started full time work at 19. It was there I met my now husband. Things happened quickly and I fell pregnant. Once the baby arrived, I moved areas to be a family. I moved to Abertillery and struggled with the different way of life. I also had postnatal depression and had no knowledge of any support networks that could help. Being so far from my family’s help, I felt isolated and couldn’t see a way out.
My mental health took a beating and I struggled to be a parent. I’ve continued to struggle, but it took my son being born in 2017 to finally get help. After battling postnatal again, my health visitor put us in touch with Families First. The help and support we’ve received from them has been phenomenal. Without the support of everyone involved at Families First, I genuinely fear my children wouldn’t have had a mother. Having them on hand has been a brilliant opportunity for me. I’ve done Circle of Security with them and that has given me the tools I need to be a better parent. They also got me onto a childcare course to give me a chance to better myself. It’s something I always wanted to do but never had the financial means.
Due to my husband starting his own business, we are not entitled to any benefits. We only receive child tax credits, which means that once the bills are paid there’s barely enough money left to feed the children. We get by on £100 a week. That’s £100 to pay the mortgage, utility bills, feed and clothe our children.
Your clearest explanation of the New Economy yet - plus how it connects to wellbeing and Extinction Rebellion
Confused about what exactly Community Wealth Building is? Like the sound of the latest Green New Deal but unsure what it means? Let Miles Thompson be your guide as he reflects on a rousing first Stir to Action festival
In July, I rather surprised my tent which had only just been taken down from Glastonbury, by putting it up again just outside of Frome. The occasion was the inaugural Stir to Action festival. Its title: “Playground for the New Economy”.
Stir to Action, founded by Jonny Gordon-Farleigh, produces both STIR, a quarterly magazine, and a nationwide series of workshops informing the public about aspects of the “New Economy”. But what is the New Economy? Hopefully this blog, summarising some of the content presented at the festival, will give you an overview if the term is new to you. It is also hoped the blog will map out a terrain where we can build more links between those interested in New Economies and those interested in Psychologists for Social Change (PSC). Both seem passionate about reforming the structures that create and maintain inequality, advancing alternatives to austerity and tackling the social determinants of distress.
Obese and high-weight individuals are stigmatised and blamed for their poor health. This bullying approach is further harming these individuals and is not the solution to this complex health challenge
Last month in the US WW (formally Weight Watchers), launched Kurbo, a nutrition and weight loss app aimed at children aged 8 to 17. The app uses a traffic light system, nudging children towards consuming ‘green light foods’ (fruits and vegetables), limiting ‘amber light foods’ (protein and dairy) and avoiding ‘red light foods’ (sweets, chocolate etc).
Gary Foster, chief scientific officer at WW told the Huffington Post “This isn’t a weight loss app. This is an app that teaches in a game-ified, fun, engaging way what are the basics of a healthy eating pattern.” The app has received widespread backlash in the media, with parents across the UK arguing that the focus on weight loss puts children at risk of eating disorders and life-long body dissatisfaction. As a psychologist working in a bariatric servicer, I would argue that this risk doesn’t end when the child grows into an adult. That weight-based stigma has negative mental health impacts and that the responsibility and blame placed on the individual for their poor health is both harmful and over simplified.
Around a third of children in the UK aged 2 to 15 are already labeled as overweight or obese. Children are becoming obese at an earlier age, and staying obese for longer. Regardless of how we might feel about an 8-year-old logging their fish fingers into an app, weight based stigma which emphasises individual responsibility for weight is still a widely accepted basis for discrimination and humiliation, It is an approach to viewing weight that children are socialised to think is normal through culture, entertainment, advertising, health policy, as well as mainstream and social media.
Violent youth crime won’t change until we start speaking about it differently. We need to recognise the psychosocial factors that contribute towards violence and the ineffectiveness of our current response towards crime
In the past 18 months, the UK has seen a spike in violent crime. Recent figures released by the Home Office suggest that offences involving knives have increased by two thirds since 2014. The use of these weapons by young people against other young people, in particular, is rising. Although the issue has been addressed by the media and politicians, discussions have focused on criticising police cuts and promoting tougher sentences for individuals caught carrying offensive weapons. This public narrative doesn’t include consideration of how wider social and psychological factors impact the act of committing a crime.
When knife crime is reported to the public, the emphasis is almost solely on the incident itself. Media outlets spare no detail recounting the events and condemning the perpetrators for what is seen as a senseless act of violence. In political debates, these incidents of violence have been used to highlight the impact of austerity, including police having reduced capacity to deter and respond to these events. While some journalists have highlighted the closure of youth clubs as a relevant precursor to the upsurge in crime, this consideration of broader context tends to be the exception rather than the norm. For the most part, the media decontextualizes acts of violence from the wider influences on behaviour - the conversations only begin in the moment a crime is committed. The myriad other influencing factors remain in the margins.
Yet, there is a large body of evidence to suggest that offending behaviour can have its roots long before the act occurs. Young people who are exposed to Adverse Childhood Experiences (ACEs), such as physical, verbal or sexual abuse, or whose parents are in prison or going through divorce are more likely to become involved in crime. And, though we are all susceptible to experiencing ACEs, poverty acts as a risk factor - people living in the most deprived areas report the highest levels of ACEs. The more ACEs a young person has, the more likely they will be criminally involved by the time they reach their teenage years. This evidence shouts loudly that youth violence is influenced by factors that emerge or are present long before the act of crime itself. It is clear that current narratives focusing only on the act of violence itself are ignoring a range of social and psychological factors that are also a part of each young person’s story.
Where do we focus our efforts is often a question that new PSC groups ask. In this series of blogs, we attempt to provide some answers. Here PSC Oxford explain their thinking
Photo by Nick Fewings on Unsplash
Psychologists for Social Change in Oxford started a little under a year ago. Much of its infancy was spent trying to find its identity, which was shaped by the shared values of branch attendees. With Oxford being in the midst of a homelessness crisis, we naturally wanted to start here as our initial focus. Our journey began by reaching out to local homeless shelters to offer support where we could. Some of our members have been attending events to link in with ongoing projects, such as the development of a women’s homelessness shelter in Oxford.
We decided also to focus on change through dissemination, publishing an article in The Oxford Mail. Our article emphasised the urgency of bolder and braver approaches to homelessness in Oxford, and the benefits of psychologically informed perspectives on the issue. More recently, we reached out to an innovative local charity ‘Greater Change’, which you can learn about here. With Greater Change, we brainstormed potential collaborations, such as investigating the factors which contribute to the stigmatisation of people who are homeless.
How do we move beyond platitudes and empty words in our response as a society to the systematic and widespread abuse of people with learning difficulties?
The BBC Panorama programme ‘Undercover Hospital Abuse Scandal’ shown on 22.05.19 shows devastating treatment of people with learning difficulties and a lack of respect for their human rights. The Position Statement below is PSC's response.
The issues documented in the programme in long-stay hospitals are recurring and therefore cannot only be attributed to an individual failure of care by a specific group of staff in a particular institution. They must be seen as reflecting a range of failures of health, education and social services throughout the lifespan of the person who needs support. Of course, those involved need to be held accountable for the horrific nature of their actions in accordance with the law. However, there is a pattern to the continued abuse of people with learning difficulties (*please scroll down for a discussion on language) that silences, marginalises and excludes them from vast sections of society and makes abuse more likely.
More children are being admitted to long-stay hospitals. This increase coincides with the government’s austerity agenda, where there has been a reduction of funding in real terms for social care and education. This equates to cuts in services, with families being unable to access respite support such as short breaks or community activities which meet the needs of children and young people with learning difficulties or autism. In the education system, the focus on a narrow range of academic educational outcomes, alongside less money, has led to a curriculum environment that cannot tolerate diversity in children’s approaches to learning, and staff who do not have the training and support to make sense of the behaviour of children whose needs may be harder to understand. Children with learning difficulties are being off-rolled or excluded if they cannot meet the behavioural expectations of the classroom. Such actions do not always lead to the child being able to access a more suitable placement.
PSC is a network of people interested in applying psychology to generate social and political action. You don't have to be a member of PSC to contribute to the blog