How increased financial inequalities will require better support for those with mental health needs

The theme for this year’s Disability History Month, which runs from 18 November – 18 December, is hidden impairments. We often don’t think of mental illness as a disability, but for Kenny Johnston, founder and CEO of CLASP Charity, that recognition is key to ensuring people get the support they need.

Kenny’s comments were raised during a podcast recording arranged by Thrive LDN to look at how the increased financial inequalities created by the pandemic will require better support for those with mental health needs.

The panel brought together a wide range of professional expertise and lived experience, chaired by Dr Phil Moore, Mental Health Clinical Co-Director for NHS England (London), Chair of the Mental Health Commissioner Network for NHS Clinical Commissioners, and co-chair of Thrive LDN London Suicide Prevention Group. The panel included:

• Kenny Johnston, founder and CEO of CLASP Charity, which advises organisations on meeting their anticipatory duty for mental health disabilities
• Laura Blair, a peer researcher for Toynbee Hall’s recent Pandemic Stories, which looked at impact the pandemic is having on already-disadvantaged Londoners
• Anna Smiroglou, Equality and Inclusion Manager for West Midlands Combined Authority, who has worked with CLASP Charity on its guidance for organisations
• Andy Bell, from Centre for Mental Health, which aims to eradicate inequalities in mental health.

During the discussion, Kenny, who has experienced mental health discrimination first hand and has previously attempted suicide, points out that by law, if someone has a diagnosed mental health condition which is likely to affect them for longer than 12 months then it is a disability. “I don’t hear blind people being said to have ‘visual issues’,” he says. “We need to start with the terminology that mental health is a disability. If you recognise that, then more hands are there to help.”

The podcast discussion began with the acknowledgement that our mental health and wellbeing are inextricably tied to our income and employment. Across the UK, people in the poorest fifth of the population are twice as likely to suffer from mental health problems. It’s a two-way problem: if you have a mental health condition you are more likely to be poor. And if you are poor, you are more likely to suffer mental ill health.

This inequality has been highlighted and exacerbated by the pandemic. Fewer than one in ten adults (8%) without a pre-existing mental health problem have found themselves in debt, but this rises dramatically to one in four of those who do have mental ill health.

As Andy Bell pointed out: “Poverty puts you at vastly higher risk. A child under 11 in the poorest fifth of society is four times more likely than those from the wealthiest families to have mental health problems by the time they leave primary school.”

He said that intersectionalities – of gender, race, disability and, unfortunately, people’s experience of mental health support – will make the impact greater.

“This is not new to the pandemic,” he said. “But here is a chance to take them on.”

Laura Blair painted what she described as a ‘pretty dire picture’ of the circumstances of many Londoners. Some 43% of the Pandemic Stories interviewees lost income during the pandemic, ranging from £50-£2,500 per month, while their spending on essentials like food, electricity and the internet soared. Inevitably that led to an increase in debt. People had to either go without or use financially unsustainable ways of managing, such as using up any savings or credit cards, borrowing from friends or family if they could help, or resorting to payday loans.

“People who already had mental health problems saw it worsening, and a lack of support,” said Laura. “But also, the anxiety and stress that had been produced by the pandemic, particularly around finances was really contributing to worsening mental health, increased anxiety and stress.”

Anna Smiroglou believes there is a general lack of awareness of how to support people with hidden disabilities: “We need to embed wellbeing into all processes.”

West Midlands Combined Authority has carried out an in-depth equality impact assessment following the pandemic, to understand what they needed to do as an organisation across different areas of work. Its findings reflected the panel’s discussion. Anna said that employers need to have a better understanding of their role supporting people with mental health disabilities, but also “a good preventative approach to support people’s wellbeing at an early enough stage and to make sure that when possible ill mental health is prevented.”

CLASP Charity’s recent report We Can Do Better Together sets out guidance for organisations on their anticipatory duty regarding mental health: “Businesses need to remember when they are engaging with other businesses that they owe them reasonable adjustment – not just the public and service users, but people they engage with every day,” said Kenny.

Kenny added: “Having the right support mechanisms to enable people to get better within employment if a mental health issue arises. So not just primarily being reactive, but being proactive, trying to anticipate different needs and put different things in place.”

For Laura, there needs to be training for businesses at all levels, so that if somebody reaches out for help then everybody in an organisation understands how to respond. And, she says, there’s a responsibility of the employer to create an environment that doesn’t cause mental health problems.

“The one thing that’s really clear,” said Andy, “is that if you support people with practical basic needs, often that is what helps bring about improvements in mental health. Likewise, if you neglect basic needs, what you tend to find is that that’s a major cause of relapse.”

Challenged by Dr Phil Moore to come up with the three key things that needed to be done to address the inequalities that lead to mental health, Andy Bell suggested: reasonable adjustment at work, with employers being trauma aware; paying the living wage to keep people out of poverty; and making sure there was support for council tax, a debt you can go to prison for.

As Kenny importantly added, it is crucial to provide the means to assist people at the beginning, not when things reach a crisis. “It’s the law to put a fire extinguisher in every building – you don’t wait till a fire occurs in a building to actually then provide a fire extinguisher. Which is what we’re talking about when it comes to mental health. You provide the means in advance for people to reach out and get assistance.”