Sun, Mar 15, 2009 page9

• Social inequality heightens mental health problems

  A new WHO report reveals that mental health problems are far worse in ‘rich’ nations that are socially unequal — and that individual treatment is not the solution

  • By Mary O’Hara / THE GUARDIAN,
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  Ithas been acknowledged for some time that poverty can be a trigger for poor mental health, but a study published on Wednesday by the WHO argues that it is inequality that has the most profound and far-reaching consequences for individuals and wider society.

  The study, which draws on research from throughout Europe, concludes that mental health difficulties are most pronounced in countries such as Britain, which, although rich, have high levels of income and social inequality.

  The report’s author, Lynne Friedli, warned that governments need to sit up and take notice and that policymakers need to “face up to the fact” that marked improvements in mental health and well-being will depend on first tackling the gap between rich and poor.

  

  The report, carried out by the WHO for the Mental Health Foundation, looked at recent research across a range of disciplines. It argues that only radical and broad policy changes will counter directly the trend of growing inequality. It goes so far as to say that the social and economic prosperity of Europe will depend on improving mental health and well-being.

  “There is overwhelming evidence that inequality is a key cause of stress and also exacerbates the stress of coping with material deprivation,” the report says. “The adverse impact of stress is greater in societies where greater inequality exists and where some people feel worse off than others. We will have to face up to the fact that individual and collective mental health and well-being will depend on reducing the gap between rich and poor.”

  So-called happiness league tables frequently show that people who live in countries without gaping income inequalities between rich and poor — Sweden tends to be at the top of such surveys, with the UK hovering toward the bottom — are generally more content, but Friedli was keen to point out that the WHO research goes “much deeper” than many of the surveys that make the news.

  Commissioned to look at how mental health affects a range of health, social and economic outcomes, the study concludes that international research shows “beyond doubt” that mental health needs to be taken as seriously as physical health. Looking at the trends on physical health outcomes when a country becomes richer — which point to a positive impact on factors such as mortality rates — it found the opposite to be true of mental health.

  “As countries get richer, rates of mental illness increase,” the report says.

  It argues that the level of mental distress among communities “needs to be understood less in terms of individual pathology and more as a response to inequalities involving relative deprivation across society.”

  The report concludes that high levels of inequality when it comes to “social status” can have a serious impact on how individuals within a society see themselves, and how this manifests itself in their overall mental health.

  Echoing some of the conclusions reached by the academic Richard Wilkinson in his latest book on inequality, The Spirit Level, the report also concludes that “greater inequality heightens status competition and status insecurity across all income groups and among both adults and children.”

  Bearing in mind the report’s conclusions — and the fact that Britain’s stark income inequalities are dominating news coverage of the recession — there is every chance the policymakers will be forced to take note. The WHO study is part of a growing lexicon of work examining the relationship between health, economics and well-being which, in addition to Wilkinson’s latest book, includes Lord Richard Layard’s book Happiness.

  Layard examined the costs to the economy of a failure to foster better mental health and his analysis has directly influenced policy in the UK — most notably in the recruitment of thousands of extra therapists to make “talking therapies” readily available on the tax funded National Health Service.

  But while Layard’s work placed mental health squarely in an economic context, Friedli, who wrote the report on behalf of the WHO’s regional office for Europe, said this latest analysis sheds light on why mental health is “absolutely fundamental” to how whole societies function.

  Friedli said the WHO looked at international studies on “mental health, inequality and resilience,” and the conclusion to be drawn is that “injustice and inequality are deeply toxic to us.”

  She contended that, to date, there has been an “undue focus on individual solutions” to mental health difficulties such as depression, when what is called for is a “social solution.” While cognitive behavioral therapy (CBT) — the therapy recommended by Layard and others — works “for many individuals,” she said, the urgent need is to address the fact that “our mental health is incredibly sensitive to inequalities.”

  What is needed, Friedli said, is “a radical rethink” of the kind of society we want to live in.

  “For all kinds of complex reasons, we cannot adapt to inequality. [Research shows] that our response to injustice is written on our bodies. Those countries in Europe that have huge inequalities have to deal with this at a society-wide level. I’m an advocate of CBT, but no amount of CBT will address this. If we look at the population as a whole, mental health reflects the kind of society we live in,” she said.

  In a salvo aimed directly at government, Friedli said the cost of “going for economic growth” has been “social recession.”

  Andrew McCullough, chief executive of the Mental Health Foundation, a leading British charity, said the research adds to a wider discussion about the relationship between physical and mental health, and that a “tipping point” may be being reached on how much of a priority mental health gets in government. In terms of what the research suggests about inequality and mental health, McCullough said it is likely to feed in to the policies of all the major British political parties.

  “It’s not just [the governing] Labour [party] talking about this,” he said. “Inequality is something the [opposition] Tories [Conservatives] appear to be interested in too.”

  McCullough said there is a danger that, in a recession, political attention would be focused elsewhere, but he hoped the WHO research would lead to “serious reflection” on the impact of inequality on mental health.

  “This is a complex issue,” he said. “It’s not about simple cause and effect. We hope the report will help explain why inequalities result in the outcomes they do.”

  The report highlights a number of areas where policy could be altered to address inequalities and therefore mental health. It recommends that “social, cultural and economic conditions that support family life” are followed through, such as “systematically” targeting child poverty and encouraging family-friendly working. An emphasis in the workplace on improving opportunities and conditions, in particular for people with diagnosed conditions, would also help, it says. Broad policy responses that challenge the stigmatization of people living in poverty are also necessary.

  The current economic climate and the public questioning of the huge financial rewards that have gone to the very rich could be the beginning of a national discussion around the impact of inequality on mental health, Friedli said.

  “What is happening could be the start of a national debate about the damage such glaring inequalities does — and it can’t come too soon,” she said.
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