People get defensive when you talk about class or wealth and mental illness. I learned this earlier this week when I found myself embroiled in a Twitter debate over “the class issue.”
I did something unusual for me, and replied to a tweet stating that being middle class doesn’t lessen depression. I responded saying that I believe class is really critical to our dialogue about mental health: “Being middle class and having a safety net can give you a better chance at recovery… My safety net benefited me immensely. Financial help allowed me to get therapy. It meant when I couldn’t physically work that was ok.”
And then something interesting happened. I started receiving defensive replies. One person told me financial advantage is just “more noise”: it doesn’t change anything, they claimed. Someone else told me there’s no point talking about the “class issue” when someone’s on fire. But we do need to talk about the class issue – because it has a huge impact on how we make mental health recovery accessible to all.
Depression doesn’t stop being horrific because someone is middle class. I too understand that knee-jerk discomfort that a lot of people experience when we start to interrogate the intersections between class and mental illness. It makes a lot of sense. A lot of people with depression and seeming privilege are used to hearing the phrase “what have you got to be depressed about?” to dismiss their experience – a line of thought often bandied about by people with no understanding of depression as an illness. It’s not, as they would have you believe, a mindset or outlook that can be solved by a new lens or shifting perspective. And from that point of view, the fire analogy makes sense: telling someone they are middle class won’t put out the flames.
But that doesn’t mean we can, or should, ignore discussions of privilege when we talk about mental illness. Depression and anxiety can and do affect people from all walks of life – privilege and being middle class does not magic someone back to health. But there are important intersections between privilege and mental illness that we have to understand if we are to be more effective activists and allies, and help the poorest members of our society better access recovery.
1. Poverty and depression are interrelated
People living in poverty are more likely to suffer from depression, and the poorest fifth of the UK population are twice as likely to develop mental health problems than those on average incomes.
2. Poverty can result from mental ill-health
Unsurprisingly, poverty can come as a consequence of mental illness, with over 300,000 people a year put out of work due to mental ill-health. While many people can and do work with complex mental health conditions, mental illness can be debilitating and can leave some unable to work for substantial periods of time or at all in some cases. Where individuals do need to take time off, this can come with a significant financial penalty, with some employer sickness schemes operating on the basis of employer discretion, and (mandatory) statutory sick pay only paid at a rate of £92.05 per week for up to 28 weeks. That’s £159 less per week than an individual would take home if they were working full time on minimum wage.
A depressive episode is believed to last on average around 20 weeks, so you can quickly see how, under current legislation, mental illness could cause someone to fall into financial difficulty.
3. But poverty can also cause and exacerbate mental illness.
Both poverty and financial stress have been linked to worsening mental health, and higher prevalence of common mental health problems like depression and anxiety.
4. Our finances play a huge part in what recovery options are available and accessible to us
As the figures above illustrate, being able to take time off work to recover from mental illness is not an option afforded to everyone.
And while a range of mental health services are available through the NHS free of charge, for many these services are still far from reach. Many find themselves at the bottom of long waiting lists for therapeutic services with some patients waiting up to two years for treatment.
In addition to this, even when therapy is free it can come with a host of hidden costs. Last year, I came off the waiting list for specialist trauma therapy. When my name came up, nine months after referral, I was required to attend appointments a 40 minute journey (each way) from my workplace at the closest centre available. There were no appointments after office hours, or even at the very start or end of the working day to enable me to adjust my hours accordingly. That meant two hours 20 minutes of the work week lost for therapy each week. I was lucky. My boss was happy to agree to me flexing my hours to enable me to attend therapy every Wednesday afternoon for three months. But even so, on weeks where this wasn’t possible, I instead had to shell out for taxis (£10 each way) to get back to the office for meetings. How many people could afford that? How many bosses are that accommodating? How many people have flexible arrangements that would enable them to take an afternoon off every week? How many instead might have to reduce their hours or drop shifts? How many people would have to pay for additional childcare costs to attend treatment? How many would have to pay high transport costs to reach their care centre?
You see where I’m going here. Access to treatment is contingent on our financial security.
5. Our privilege can extend or reduce the fire
When someone is experiencing mental illness it is like they are on fire, and being middle class will not stop them from being on fire. But there is a difference we have to talk about.
Depression, like a fire, is damaging, terrible, all-encompassing and potentially debilitating to all that it licks with its flames, and it can affect both well-off and poorer folks alike.
The tools to recovery are like water, dripping down to extinguish the flames.
But poverty is a fuel.
And that should have an enormous impact on how we think about managing recovery. Because when someone is experiencing poverty, not only might there not be so much water available to draw down the flames, but, at the same time, someone is standing behind them slicking the flames with the gasoline of financial instability, job insecurity, poverty.
We need to talk about that because it means the hurdles in our recovery journeys are distinct, and it has important ramifications for how we think about mental health policy. It highlights how calls for mental health services need to be intersectional, but also how we need to go further than public health when we talk about treating mental illness, we also need to talk about economics, employment and welfare.
My recovery journey has been intertwined with socio-economic advantage. That didn’t make it easy, and nor did it guarantee recovery, because mental illness is more than environmental factors, it’s chemistry, it’s serotonin, it’s an illness. But my socio-economic privileges did help me out with a couple more watering cans to extinguish the flames.
Reminding myself of that makes me want to fight harder for the people who are at the same time being doused with gasoline.
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