Picture of feet taken from the floor perspective in a hospital waiting room istock liderina

Mental illness and barriers to access

This is the third in a series of blogs from Emma Marks, Senior Socio-Economic Duty Project Officer. 

Wilkinson and Pickett’s “The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyone’s Wellbeing” shows that as income inequality in a country increases, so does the need to justify and rationalise high levels of inequality. The conflict between believing that everyone has a right to equal access to resources and the reality that this access is flawed can create uncomfortable psychological discomfort: a cognitive dissonance for people. This “dissonance” can be reduced by creating tropes such as “the rich contribute something good even if they are selfish” or “the poor are kind to each other.”  As Wilkinson and Pickett state, “inequality changes the way people think about others”.

Over my 20 years working within mental health, I have witnessed how professionals discriminate against those at the sharp end of intersecting socio-economic inequalities. Whether that’s a psychiatrist over-medicating Black men or a psychiatric nurse on a crisis team telling someone who is relapsing because of problems with their benefits to “have a nice warm bath” or “go for a walk”. If people are already disadvantaged in our society e.g., because of their race or economic status, this creates an added barrier to accessing services and support. Putting yourself in a position where you could potentially be shamed by a mental health professional is a high-risk strategy. As Brene Brown states, “If we share our shame story with the wrong person, they can easily become one more piece of flying debris in an already dangerous storm”.

As someone who has had to “tell my story” to many a mental health professional when accessing mental health support, I know that it is very difficult to distinguish between the effects of the mental illness and the effects of the shame of mental illness itself. For example, being in the midst of mental illness can cruelly distort our sense of status and identity. Whenever I have been very mentally unwell my sense of identity is completely lost, and I feel that I have very limited rights to access opportunities and experiences that I would normally take for granted when I am well. So, whilst my mental illness is one factor for me in reducing typical “wellbeing type activities” such as going out for a meal with friends, walking, singing, reading or watching TV, it is the shame and the stigma of not feeling “good enough” that exacerbates lack of access to these too. 

So, when assessing how people from the sharp end of socio-economic inequality access mental health services it is disturbing to see that those who are at the sharp end of this inequality access services in a very different way to those who have more socio-economic privilege. For example, “people of African and Caribbean origin living in the UK have lower reported rates of common mental illness than other ethnic groups. However, they are more likely to be diagnosed with severe mental illness and are three to five times more likely than any other group to be diagnosed and admitted to hospital for schizophrenia.” (Catalyst for Change). Other research shows that Mental Health Act detention rates are three and a half times higher in the most deprived parts of England, alongside widening racial disparities. 

By looking at these statistics within a framework of socio-economic inequality we are able to gain a clearer picture of what is needed to support people to remove the barriers to access. We need to shift the narrative away from individual pathology to structural change – including a decent and accessible social security system, progressive taxation (including a wealth tax) and significant investment into housing, education and childcare – to really tackle the root causes of the growing mental health crisis in the UK. Until extreme inequality is tackled, within and between countries, we will not be able to “make mental health and wellbeing for all a global priority“.