An important letter and accompanying report was published in the national press this week abhorring the effects of austerity and neoliberal politics on mental health services and on mental health generally . This is timely, not just because of the election, but because of the spiraling risks for now and for the future. Anyone working in services knows how they are being severely cut, making it harder and harder to access the kind of help that is needed. Only short-term ‘revolving door’ services are available to people in very serious need. Children’s mental health services are the most poorly funded, much less than adult mental health services which in turn have a fraction of health budgets. As an investigation by the charity Young Minds recently showed, children’s mental health services are in crisis.
Yet this is just at a time when services have never been more needed, and the effects of the recession and of austerity are really biting. For example, in Britain male suicides have soared in the last decade, according to the ONS, while one huge study of over 63 countries has found a clear link between unemployment and a rise in suicides. A recent lancet article chronicled a huge rise in suicides in the US linked firmly to unemployment. In Greece there have, not surprisingly been increased suicides as well as other worrying signs such as more children being abandoned. Rising inequalities in Spain have also been clearly linked to worsening mental health problems in Spanish men. This is a picture that is being replicated in many research studies, particularly in terms of the link with depression.
Even if we take the yard-stick governments use, then if austerity is linked to mental health problems this is tremendously short-sighted. If a child has emotional problems their future job prospects are worsened by about 50% according to studies. We also know that, for example, child abuse and neglect rise hugely when income inequality increases, which in turn dramatically affects mental health.
In fact of course it is not just mental health but also physical health that is profoundly affected by bad economic times. An American study showed that being unemployed, even for a short period of time, increases the risk of heart attacks, and that having multiple job losses massively ups that risk. This was a big study, of over 13,000 Americans between 50 and 70 over nearly a decade. The risk of acute myocardial infarction after job losses were very high, as great as seen in smoking, high blood pressure and type 2 diabetes. Other studies suggest that child poverty as well as stress as an adult, and living in poor neighbourhoods, can all have an effect on one’s gene expression, particularly in relation future immune responses. Here people who experienced childhood poverty had different gene methylation from those who hadn't, despite the fact everyone in the cohort had achieved the same socioeconomic status later in life. Early poverty left a detectable and lasting molecular mark on an individual's DNA.
Barely a day goes by without a study showing the impact of poverty and economic stress on psychological health. One important study showed that children born onto worse economic circumstances are likely to have a different psychological makeup through their lifespans.. Those born in poorer circumstances, they found, took more risks and were more impulsive when faced with choices, for example gambling more. They also had far more signs of stress as measured by various biomarkers that predict effects like cellular damage. In evolutionary terms it seemingly is sensible to develop more impulsive, risk taking strategies if life is expected to be dangerous or short. This is not the strategy of those born into more affluent circumstances who are able to defer gratification, and generally achieve more stable relationships, better jobs and better health, for example.
Many studies are showing similar results. For example one study showed that food insecurity hugely increased the likelihood of every kind of mental health disorder in adolescence, that a one standard deviation increase in food insecurity was associated with a 14% increased odds of past-year mental disorder among adolescents. The ways in which these processes become enacted throughout the lifespan are complex and subtle. Another study showed that children from lower socio-economic circumstances are less able to screen out stimuli than those from better economic circumstances. Their very brain waves are different, for examples poorer children having higher theta waves. They also had higher cortisol levels, maybe less surprisingly. It is likely that living in poorer environments leads one to be more vigilant, relying more on basic survival mechanisms. and so be less able to relax and concentrate than more privileged children. This in turn as we know will have an effect on immune functioning. Indeed rather shockingly we have found out that by only about 6 months we have learnt that infants from lower socio-economic circumstances are less able to concentrate and are more stressed, on average, both in free play and in attentional tasks. The effects of poverty and deprivation start very young and can last a lifetime. Indeed they even affect how long a lifetime is.
This is a time when we need to be fighting for our services, as the letter by over 400 psychotherapists attests. Yet we also know that morale is lower in public services, commitment is being tested hugely by increased pressure, top-down management, financial squeezes and what can feel like contract breeches which research shows lowers commitment in such services. We are facing a crisis now, but maybe the bigger one is yet to come and is incubating now, so that NOW is the time to fight for our services and for future mental health.