The Coalition, austerity and mental health

Abstract

In the United Kingdom, the Coalition government’s recent commitment to improving mental health provision masks the extent that their policies of austerity have already brought harm to those same services. Government-driven policies have led to significantly reduced funding within mental health, increasing pressure on a system that was already chronically under-resourced. Further, people who are experiencing mental distress, and mental health service users, have been especially vulnerable to the harms of the current austerity programme, including being at the sharp end of the assault on public services and welfare spending. This piece discusses the impact of austerity, exploring the effects of government policies and with a critical perspective of the dominant discourses around mental health. It argues that by exacerbating social inequality, government policies are also directly leading to worsening mental health in the United Kingdom.

Keywords:

• austerity
• welfare reform
• mental health
• United Kingdom

In his speech to the UK Liberal Democrat annual conference this year, the Deputy Prime Minister, Nick Clegg, surprisingly focused on mental health. Clegg highlighted plans for how the government would in 2015 start putting treatment standards on a par with treatment for physical health. This is an attempt to fulfil the ‘parity of esteem’ commitment outlined in the government’s No Health without Mental Health strategy (HM Government 2011). This strategy aspires to give equal value to mental and physical health. New National Health Service waiting standards for mental health will be created for the first time, meaning that those who require ‘talking therapies’ will be seen within six weeks; whilst those labelled as experiencing a first episode of psychosis will be seen within two weeks. In addition to this, an extra £120 million of funding is to be allocated to mental health services over the next two years (Wintour 2014).

Additional funding for mental health services is of course welcome, as is an acknowledgement of the failure of the mental health system to deliver timely support to people who need it. However, this also completely ignores how, since the Coalition Government came into power in 2010, its policies of austerity have had a highly negative impact on mental health, mental health services and service users. Life under austerity is growing increasingly tough for the vast majority of people, and mental health is one of the casualties of this era. Greater numbers of people are being placed under increased financial strain and this is impacting on their mental health. Also increased pressures on services mean that the support available to people is reducing when demand is sharply increasing (O’Hara 2013).

Government-driven policies have led to the National Health Service making real-term reductions in investment in mental health services and have exacerbated the situation in a sector that was already subject to chronic underinvestment in services for both young and older people alike (Thornicroft and Docherty 2014). For instance, a report published in November 2014 by the House of Commons Health Committee demonstrated severe problems throughout the entire system of child and adolescent mental health services. Whilst demand has been rising, there have been widespread reductions in funding (House of Commons Health Committee 2014). Early intervention services are generally funded by local authorities; however, as a result of increasing financial pressures brought about by austerity measures, 60% of local authorities have either reduced or frozen their child and adolescent mental health services budgets since 2010–2011 (YoungMinds 2014).

Children and young people are experiencing large increases in waiting times for support and also increased referral thresholds, to the extent that some child and adolescent mental health services will only accept referrals when the young person has attempted to commit suicide at least once (House of Commons Health Committee 2014). It is fundamentally unacceptable that young people have to be at the point of killing themselves before they can actually access support. They are being failed by a system that is causing them increased harm by only responding to those who are in extreme distress. This also means that greater numbers of young people end up requiring in-patient treatment (with all of the associated damage that hospitalisation causes) when this could have been avoided if they were given support sooner. Ultimately there will be young people who take their own lives as a result.

Adult mental health services are similarly under increased strain. For instance, within acute settings the closure of more than 1700 hospital beds from 2011 to 2013 has led to warnings that the demand for crisis services is far outstripping supply (McNicoll 2013). Local authorities have seen widespread reductions in the number of adults receiving state-funded social care support, and mental health social care support has been particularly hard hit (Fernandez, Snell, and Wistow 2013). Although there has been significant historical underinvestment in mental health services (Bailey, Thorpe, and Smith 2013), the path of austerity that the United Kingdom has taken is exacerbating this situation.

The radical changes to the welfare system in the United Kingdom, central to the Coalition Government’s strategy, are having a damaging impact on people, increasing poverty and reducing the social safety nets that are in place. People experiencing mental distress, including mental health service users, are some of the key groups of people that have been hardest hit; for instance, in the targeting of disability and ill health-related benefits. Reforms have also included cuts in tax credits and child tax credits, and housing benefit reforms (including the bedroom tax). The introduction of a new and much harsher sanctioning regime in 2012 (where benefits are stopped for a set period for failure to comply with requirements of the jobseekers allowance) has had severe consequences. Sanctions, alongside benefit delays and financial difficulties related to the bedroom tax and abolition of council tax relief, are viewed as a key reason for why there has been an explosion in the use of food banks (O’Hara 2013).

Many individuals have been affected by multiple welfare reforms, and it is those on the lowest incomes who are most heavily affected. Around 21% of the population of the United Kingdom live below the government’s official poverty line, and virtually all of the welfare reforms are targeted at this group of people (Duffy 2013). The local authorities that have been hardest hit are also those in the most socially deprived areas, and so the reforms are serving to exacerbate pre-existing social and spatial inequalities (Beatty and Fothergill 2013; Whitehead 2014).

The current austerity programme is increasing levels of mental distress. There is a clear link between social deprivation and mental health, with poverty, income and debt all strongly associated with poor mental health (WHO and Calouste Gulbenkian Foundation 2014). There are well-established and known consequences to people’s mental health from living in poverty, unemployment and underemployment, and from living in areas with high levels of deprivation. By exacerbating social inequality, government policies are directly increasing inequalities in mental health.

Since 2010 there has been a 23% increase in prescriptions for anti-depressant medication in the United Kingdom (O’Hara 2013). This is indicative of a growing situation in which people increasingly feel unable to cope. It is also reflective of dominant discourses around mental health, in which the social and structural determinants are marginalised in favour of a focus on the individual (Morrow 2013). Instead of considering the impact of social deprivation on people’s mental health, and how reducing social deprivation might improve mental health and well-being, the path instead is to look to neurochemistry, focusing on what is wrong with the individual instead of what is wrong with society. Structural explanations are ignored in favour of an approach that tries to fit people’s experiences into a box that can be labelled in the same way as, say, diabetes or heart disease. This is a pathologising approach which suggests both that something is wrong with the person and that something is wrong with their experience, behaviour and perceptions (Beresford 2005).

It is also precisely because of this dominant medical approach that the government can espouse a commitment to ‘improving mental health’ without having due regard to the impact of the policies that they themselves have implemented. These policies are demonstrably worsening the lives of many, placing people under such financial and emotional strain that this is leading them into crisis. These dominant discourses also lack any incorporation of critical perspectives, including evidence from a vast literature of survivor accounts reflecting on how the current mental health system is oppressive, and coercive, and often does not provide the type of support that people want or find helpful (for example, Campbell 2002; Lee 2013). ‘Talking therapies’ may be of benefit to some but are not a one-size-fits-all approach; this cognitive behavioural focus again fits neatly into this medicalised approach, where the problem is firmly rooted within the individual. Although increasing funding for mental health services is a positive step, improving those services would require a move away from the dominant medical model that pervades mental health. A ‘more of the same’ approach is nowhere near enough to fix this problem.

Disclosure statement

No potential conflict of interest was reported by the author.