Introduction
We are releasing a set of three briefings focussing on precarity, access, and mental health. They are the result of a two year process of consultation with grassroots and user-led groups in London, discussing the barriers faced by those who live with mental-ill health, distress, or trauma. Collectively, the briefings highlight the need to consider mental healthcare far beyond medical interventions, and instead call us to reimagine the material — including the systems and structures that create and exacerbate distress in the first place.
Read together, we show how the marginalisation of the so-called mentally ill extends beyond stigma or an inability to “talk”. Instead, it is woven into the structures of our society. Taking a wider view of mental health sometimes involves flashy new interventions; and others, the solution is very simple, boring, even. Here we highlight the need for better funding for grassroots groups in the context of the cost of living crisis, accessible and affordable transport, and more transparent systems for managing welfare claims. They may not seem exciting, but each are valid and necessary forms of mental health care, which would improve the lives of so many.
Background
When we talk about mental health, often the conversation is so broad that we lose specificity and talk about mental health as a universal experience touching all of us. At NSUN, we know that the impact of mental ill-health and distress is unequal, and that many who experience the sharper end of mental ill-health and distress are invisibilised, pathologised, and excluded from mainstream conversations. Focus on prevention excludes those of us who live with long term mental ill-health where ‘recovery’ can feel like a distant concept.
Over the past two years, we have been talking to grassroots groups and individuals who live with long term distress about their experiences at the intersection of mental ill-health and experiences of precarity and access. We have been looking into issues like social security, transport and accessibility, and grassroots responses to the rise in the cost of living. We have been asking: what are people living with mental ill-health experiencing, and what needs to change?
When looking at social determinants, there can be an undercurrent of understanding the causes to focus efforts and resources on prevention. Whilst prevention is important, conversations about prevention often exclude those who live with long term mental ill-health, which can be lifelong and whose wellbeing and conditions remain critically important.
People who live with long term mental ill-health may live up to 20 years less than those who don’t have this experience. Government data from 2018-2020 shows that adults described as having so-called serious mental illness (SMI) were from 2.5 to 7.2 times more likely to die before the age of 75 than adults without. Factors that are at play here include being more likely to be worse off (described by the Money and Mental Health Policy Institute as the ‘mental health income gap’) and to have experiences of multiple different forms of ill-health that are less likely to be appropriately treated or taken seriously.
In these briefings, we are looking at the experiences of Londoners experiencing multiple forms of marginalisation. We cover issues including the cost of living crisis, accessibility and transport, and the social security system. This is not an exhaustive list of issues, but we hope it is a contribution to the current conversation with an explicit emphasis on lived realities and often marginalised voices.
One thing is clear to us: we need to understand what is going on in order to remake the systems that have so much impact on the lives of people experiencing multiple forms of marginalisation.
Read the briefings and their recommendations
1: Funding grassroots groups is mental health care
2: Welfare support is mental health care
3: Accessible transport systems are mental health care
Alternatively, you can download a plaintext version of the three briefings as one word document by clicking here.
Conclusion
Good quality, meaningful policy recommendations are abundant, but this doesn’t always mean they lead to change or are taken on by those who develop and action policy change. Acknowledging this inertia, and the ongoing cycle of recommendations and little change for the better feels like an important feature of our current times.
Some of the recommendations from the briefings are grand, such as reforming the welfare system or attending to the cost of living crisis. But others are simple; increasing signage on transport systems, a text update service for welfare claims, or changing funding agendas to allow grassroots groups to offer financial support. Of course, these do not go far enough, but they would make a start, and improve the lives of so many who experience mental ill-health, distress, or trauma.
Minimum income standards and guarantees often don’t go far enough to address inequity and marginalisation. There can be focus on behavioural change and an emphasis on ‘idealised’ behaviour, for example, excluding alcohol from budgets. Within these decisions are moral judgements about how people who experience poverty and deprivation should live their lives, and where the responsibility lies. Often, the conversation doesn’t move on from poverty being a consequence of individual decisions. This approach has caused significant harm to individuals living with mental distress and communities, and in reckoning with that, we need new responses to these social harms that have become entrenched.
Fundamentally, we want to see the policy conversation change: Let’s ask ‘what do people need to thrive?’ instead of ‘what’s the bare minimum?’. We must reject productivity-based arguments for better mental health support and better welfare systems. We must show value for the lives of people who experience multiple marginalisation, including those of us who live with long term mental ill-health, distress, or trauma.
Acknowledgments
Thank you to all who were involved in thinking alongside us about precarity and mental health, and for sharing their expertise. A particular thank you to Mary Sadid, who conducted this research and wrote the majority of these words. We are also grateful to Trust for London for funding this work.