We need to talk about wealth inequality and mental health

A joint post with Andy Bell, Chief Executive of the Centre for Mental Health

Wealth is something we’re programmed not to talk about. Yet in a society where the distribution of wealth is so uneven, and the impacts of that inequality on our mental health are so pernicious, it’s something we’ve got to face up to.

The impacts of financial inequality on population mental health are clear enough: the more unequal we are, the higher the rates of mental distress and mental illness. This is often measured in terms of income. But income alone doesn’t fully reflect either the extent or the toxicity of the health and wealth gap.

Wealth is about more than income. And inequalities in wealth tend to be even starker. The wealthiest in society have a vastly greater share of wealth than everyone else, and a large proportion of the population has very little at all. Wealth inequalities are also evident between genders (with men having a greater share) and they intersect with and exacerbate structural racism, among other dimensions of inequity and injustice.

The intersections between inequalities in wealth, mental health and power

Wealth inequalities tend to be reflected in mental health inequalities. The less wealth you have, the poorer your mental health is likely to be. The impacts of this inequality cross between generations, with children from the least wealthy households facing some of the biggest risks to their mental health that can last a lifetime.

Wealth inequalities reflect and reinforce power inequalities, which in turn harm mental health even further. Again, this operates at a high level, nationally and globally, where the concentration and accumulation of wealth among small numbers of people lead to similar accruals of power and influence. But it also manifests locally, in communities and within families, for example through male violence and oppression.

It is inevitable that wealth inequalities find their way into mental health services. People with the most severe or enduring mental health difficulties tend to be those with the least wealth. And those with the least resources have fewer ‘buffers’ against difficult times in their lives, which makes it harder to be ‘resilient’ if a sudden loss of income or relationship breakdown leaves them with little or nothing.

Tackling the mental health impacts of wealth inequality

Mental health services cannot by themselves redress wealth inequality. But they can mitigate its effects. Offering help and advice with money, housing, benefits and legal rights can help to mitigate financial inequalities while also dealing with the reasons people are struggling in the first place. They can ensure that effective mental health support is easily accessible to those with the least resources, including locating services close to where people are, in places they feel safe, and addressing digital exclusion when putting more services online.

The bigger picture remains crucial, however. More equal societies have lower levels of mental health difficulties. As Britain has become more unequal, rates of mental ill health have grown over the last two decades. While this is not the sole reason for the increase, it’s hard to ignore the evidence of a connection.

Rising inequality has been coupled with a long period of austerity in public spending that has stripped away social protections and mitigations for people’s mental health: from social security benefits to early years and youth services. Wealth inequality and austerity are deeply connected, with reduced social solidarity undermining political support for public services. And when wealth is more concentrated and thus stagnated, this further reduces tax receipts from economic activity, putting more pressure on public sector budgets.

Health and wealth are inextricably connected. Yet this is seldom acknowledged in either public discourses or public services. Instead, people are blamed for being unwell, or shamed for being ‘economically inactive’. The onus for addressing health and wealth inequalities is too often placed on those who are most disadvantaged by them.

Recognising inequalities in wealth and power is a good starting point for mental health services. Without that underpinning understanding, the reasons for so much mental distress are obscured, and the injustices that people with mental health difficulties face daily are ignored. By facing up to it, mental health services can support people in their daily struggles to survive. They can acknowledge what’s happened to people and seek to do the opposite. This is where a population health approach can really make a difference: not in berating people for their ‘lifestyles’ but in playing a reparative role in addressing social injustices.

This blog post is jointly written with Andy Bell, Chief Executive of the Centre for Mental Health, and is also published on their website.