- Sarah Browne
We are living through the worst recession since the Second World War. With high unemployment, static incomes, cuts to benefits and public services and spiralling living costs, increasing numbers of people in Britain are struggling financially to survive.
The Trussell Trust runs a network of 270 foodbanks across the UK. Last month it reported that it is launching two new banks every week and expects to feed 200,000 people this year, over 100 per cent more than in 2011. ‘Foodbanks are seeing people from all walks of life turning to us for help,’ said Executive Chairman Chris Mould. ‘Every day we meet parents who are skipping meals to feed their children or even considering stealing to stop their children going to bed hungry. It is shocking that there is such a great need for foodbanks in 21st century Britain but the need is growing.’
Save the Children, the charity best known for helping children in poverty in developing countries, has launched its first ever appeal to raise money to support children in the UK. In its new report, Child Poverty 2012: it shouldn’t happen here, over half the 1,500 children surveyed said that their parents were unhappy or stressed because of lack of money and four out of five of the 5,000 parents questioned said they had to borrow money to pay for essentials like food and clothes. Childline’s recently published 25th annual report shows that economic pressures are having an increasingly powerful effect on young people’s mental health. Thirteen per cent of calls to Childline last year came from children who were worried about family relationships, with many reporting that money worries were causing their parents to row.
A number of mental health helplines are reporting huge increases in calls from people with financial worries and job insecurity. Mind has seen a surge in calls to its helplines since the start of the recession and says that calls about personal finance and employment issues have doubled since 2008. Sane has reported a disturbing increase in the number of people calling their support line with depression and anxiety due to financial uncertainty. Sane’s Chief Executive Marjorie Wallace said recently: ‘They report that their fears about losing their jobs and being unable to find work are making them ill. A vicious circle is being created with cuts to mental health services coinciding with increased demand, especially for psychological counselling, leaving people with nowhere to turn at times of crisis.’
Samaritans’ helplines reported last December that calls about financial stress have doubled in the last three years. Now one in five calls made to Samaritans is about job concerns, housing problems, debt and other financial worries. A spokesperson for Samaritans says there is considerable research evidence to show that economic recession is linked to higher suicide rates; in 2008 there was a sharp rise in suicide that bucked the overall downward trend. ‘Unemployment, job fears and financial worries lead to anxiety, depression, low self-esteem and feelings of hopelessness, which in turn increase the likelihood that someone will think that their life isn’t worth living.’
Earlier this month the Guardian Higher Education Network reported a dramatic increase in the number of students who have taken their own lives in England and Wales since the start of the recession. Suicides by male students in full-time higher education grew by 36 per cent between 2007 and 2011 but the number of female students suicides almost doubled, according to new figures from the Office for National Statistics. Hannah Paterson of the NUS says that a combination of rising financial and academic pressures, coupled with recent cutbacks to university support services, could be partly to blame. ‘Over the past five years there has been a huge increase in the amount of stress students are feeling. Being a student is a stressful time. Now finance and debt problems are adding increasing pressures. When you’re paying that much for your education, coming out with a good mark matters even more.’
Michael Lilley is Chief Executive of My Time, a social enterprise based in Birmingham that provides holistic and intercultural psychological services. The service’s CORE statistics show a clear correlation between increased anxiety and depression and suicide ideation and financial hardship caused by the recession. ‘We have seen a rise in suicide attempts and self-harm, especially among men. Other key issues for our service users are benefit issues, increased domestic violence and higher numbers of children in child protection due to neglect, including not being fed or clothed to acceptable levels,’ he says.
Recession and mental health
A wide range of studies testify to the damaging impact of recession on mental health. In 2011 the World Health Organisation published a report, Impact of economic crisis on mental health, that sets out the strong link between people’s mental health and socioeconomic conditions. Unsurprisingly, the report shows that people who experience unemployment, impoverishment and family disruptions are at significantly greater risk of suicide or developing depression and alcohol disorders than those who are unaffected. A one per cent increase in unemployment is associated with a 0.79 per cent rise in suicide and an increase in deaths from alcohol abuse. During times of economic adversity, men especially are at increased risk of mental health problems.
The report also stresses that social welfare and other policy measures can offset the worst mental health effects of an economic crisis. The report recommends family support programmes, higher alcohol prices and restrictions on its availability, debt relief programmes and accessible and responsive primary care services.
The WHO report compares suicide rates in Sweden and Spain from 1980 to 2005. Sweden went through a severe banking crisis in the early 1990s but its suicide rates were unaffected. By contrast, during Spain’s banking crises in the 1970s and 1980s suicide rates increased as unemployment rates rose. The WHO report suggests that one of the main differences between the two countries is that Sweden made financial provision for social safety nets, such as family support, unemployment benefits and health care services; Spain did not.
Downturn in the UK
How is the UK doing in terms of social support for those who are struggling with unemployment and financial worries? At the recent sixth Psychological Therapies in the NHS conference, we were reminded of the pledges at past conferences from ministers talking about the importance of investing in psychological therapy for the unemployed. In 2008 Alan Johnson, then Secretary of State for Health, said that unemployment should carry its own health warning and he wasn’t going to watch history repeating itself and let another generation of people sink into depression. The same year we heard Greg Beales, Special Advisor to Prime Minister Gordon Brown, say that ‘because of the economic downturn, getting these services up and running and responding quickly to patients’ was even more important. In the 80s and 90s he said, ‘we left a whole swathe of people to drift out of the workplace, some of them never to return’.
This year we heard Care Services Minister Norman Lamb sounding equally sincere about the importance of psychological care in the NHS, and in particular in helping people with mental health problems return to the workplace. He made no special mention of the recession or the unemployed.
It is clear from talking to counsellors on the ground that the benefits shake-up couldn’t have come at a worse time. A professional lead for counselling in an IAPT service said: ‘People who have had their benefits stopped end up in our service. Half the time what is needed is social support – help with housing and help getting their benefits – not psychological therapy. You’ll get clients asking counsellors and mental health practitioners to just write a letter to support them in maintaining their benefits, saying that in our opinion there is no way they are fit to go back to work. We’ll do that by all means. It’s something we never did in the past so we’re changing the boundaries a bit.’
The Austerity Report 2012 asked 300 GPs how they felt the recession was affecting their patients’ health. They were asked only to consider those instances where patients specifically linked their behaviours or conditions with financial hardship or concerns about job security during their appointment. GPs felt that worries over financial security, coupled with people working longer hours, have raised people’s stress levels. Seventy six per cent of GPs believed that the economic downturn has had a negative impact on their patients’ health in the last four years. Seventy seven per cent of GPs felt there has been an increase in new cases of mental health conditions in the last four years linked to the economic climate; 54 per cent said that the greatest increase was in anxiety, and 46 per cent said the greatest increase was in depression. Sixty two per cent of GPs said they have seen an increase in contacts from patients who appear to be more in financial distress than in need of help for a health condition.
One GP from Cumbria quoted in the report said: ‘We really have nothing to offer people who are depressed/anxious regarding work/money. What they need is decent jobs. Pills and an eight-month wait for very poor quality counselling is not going to make any difference.’ Another GP from the north west said: ‘I think just letting the patient talk and if they understand that you are sympathetic to their plight they feel better. I guess we are prescribing more antidepressants; I reluctantly refer patients for counselling because the waiting times are ridiculously long now.’
The squeezed middle
As we know, work is good for mental health but that doesn’t mean that people who have been lucky enough to hang onto their jobs are immune to the effects of the recession. Employee Assistance Providers (EAPs) are working with employees who statistically have better mental health than unemployed people. But, says Andrew Kinder, Chief Psychologist of Atos Healthcare and also Deputy Chair of the Employee Assistance Professionals Association: ‘The employee who calls us is not necessarily stressed about losing his/her own job. It may be their friend or their partner who is losing their job. Or it may be their children who have graduated but can’t get a job and have come back to live at home because they are lumbered with debt. Rents are extremely high at the moment so they have no hope of moving on until they find work.’ People are worried about what the future holds, he says. ‘They may have children at university or elderly relatives in expensive care homes; they may be about to lose their child benefit…’ Every month things are getting a bit tighter. So often, he says, it isn’t just about how the sums add up at the end of the month; it’s the psychological pressure. They talk about everything closing in on them.
Concern about debt comes up a lot in EAP work, Kinder says, and it’s something his organisation has to address in the companies they work for. ‘It’s hard to do debt management courses in the workplace because no one wants to admit that they’re in debt – if you can’t handle your own finances, then how are you going to handle those of your employer?’ So, he says, they run financial awareness courses instead.
‘When you’re holding all this together in your mind, it can feel like a monster,’ says Kinder. ‘When you go to an EAP counsellor, you start laying it on the table and looking at it together, seeing what is in your control, what you can change and what you can’t. Sometimes a client has debts but tells you they haven’t actually been opening their letters. Then they’ll come back and tell you there’s this other debt they’ve been hiding and the reason for the debt is a relationship problem… It’s like peeling off the layers of an onion. Then you get to the inner layers. You can see that they’ve been holding onto so much on their own that it’s a relief to tell someone and start doing something about it.’
Kinder’s experience echoes the reports of increased suicide, particularly among men. ‘I’ve seen organisations where there’s been one suicide, closely followed in the next couple of days by another and then by a third. All men in their mid-50s. All with concerns about money and relationships.’ He says there are far more suicide attempts than people actually realise because they don’t get reported. ‘Unemployment creates more suicidal depression but suicide is also linked to job insecurity and relationship strain, and that doesn’t get talked about nearly enough,’ he believes.
Couples and families
A recent Relate survey, conducted with the Guardian as part of its Breadline Britain series, reveals how couple and family relationships are being affected by austerity. Seventy one per cent of Relate’s 2,000 counsellors said that money is becoming a more severe problem for their clients. Forty per cent of counsellors said that, compared with two years ago, they are seeing more couples splitting up where money worries are a major contributing factor. The majority of the counsellors (90 per cent) said that money worries made their clients depressed, with 80 per cent saying couples are arguing more as a result and 65 per cent saying it affected their clients’ physical health.
Another issue emerging from the research was that many clients are unable to finish their counselling sessions because of money problems, despite being offered intensive courses of four to six sessions charged on a sliding scale from £6 to £45 per hour. Ruth Sutherland, Chief Executive of Relate, says the survey highlights that relationships in the UK are under increasing pressure, in part hastened by the economic climate. ‘It is distressing to hear that so many people who want access to support to improve their relationships are unable to have this because of financial concerns. We know that relationships play a vital role in supporting people through periods of stress, such as losing their job, but this can also place significant pressure on the relationship. For most people, their relationship is the most important thing in their lives. Relate know that help and support can be vital to making relationships work and we are keen that people can access this when they need it.’
Another key finding of this survey was that a growing number of the 150,000 clients Relate sees each year are being forced to stay together, despite having decided to split up, because they can’t afford the cost of setting up two homes. Couples with children are more likely to find themselves stuck in this position but it applies increasingly to childless couples and those higher up the income scale. ‘Let’s all be clear about the real cost of austerity,’ says Ruth Sutherland. ‘The impact of being in a relationship that isn’t working is toxic. It is harmful to your children and it permeates every other aspect of your life. If the Government wanted to protect the mental health of the country, both now and in the future, they would target these cuts differently.’
Counselling and poverty
What help can counsellors offer clients with serious financial worries? What can a counsellor do to help someone trapped in poverty to change their situation? BACP member Mora Maclean was a debt counsellor working with clients from a very deprived community before she trained as a person-centred therapist. ‘Many counsellors bear witness to poverty and inequality and their impact on the individual and could perhaps help outside the counselling room by speaking out about such things,’ she says.
She thinks that the most important thing is that the counsellor is aware of, works on and monitors their own attitudes, prejudices, fears and beliefs around debt, welfare benefits and people living in poverty. They need also to be mindful of inequality and the particular harm that relative poverty can do – where people are excluded from and unable to participate in society and their community. ‘I believe this kind of personal development work around these issues is crucial if a counsellor is going to be able to offer a genuinely empathic and prizing relationship of any depth to clients. I also feel that the importance of this can’t be overstated in the context of the increasing demonisation and stigmatisation of people in receipt of benefits.’