Londoners’ mental health and wellbeing: indicators of population mental health
The following intelligence outlines the evidence, research and insights captured across a range of areas through Thrive LDN’s research and community insights’ function.
The following intelligence outlines the evidence, research and insights captured across a range of areas through Thrive LDN’s research and community insights’ function.
Evidence briefings 
Wellbeing Introduction and context
It is important to acknowledge that before the pandemic, poor mental health was already a significant challenge for London, with the prevalence of poor mental health often disproportionately higher in communities facing other inequalities.[1] There is substantial evidence that the pandemic has simultaneously widened pre-existing inequalities whilst creating new ones.[2] As Londoners continue to be confronted with multiple interconnected and compounding crisis events, markers for population mental health provide an useful insight into how mental health outcomes are determined by a complex range of factors, with crisis events often acting as a catalyst for psychological distress and reduced wellbeing that, if left without appropriate support, can result in higher prevalence of mental health disorders and suicide.
This briefing examines trends and changes over time in Londoner’s resilience, feelings of loneliness and social isolation, anxiety and depression, and suicide as indicators to overall population mental health. Whilst we must focus on the prevention of poor mental health and ensuring that Londoners who need help and support receive it, we must be careful to use the information presented in this briefing appropriately and not to over-pathologise the natural process of how people adapt and cope with change and adversity. Medicalising normal and understandable responses to crisis events could perpetuate stigma around mental health. Furthermore, research indicates that populations do not typically engage with mental health narratives in the recovery phase of responses to major incidents.
[1] Office for National Statistics (2019) Personal well-being in the UK: April 2018 to March 2019: https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/bulletins/measuringnationalwellbeing/april2018 tomarch2019
[2] Public Health England (2020) Disparities in the risk and outcomes of COVID-19: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/908434/Disparities_in_the_risk_and_outcomes_of_COVID_August_2020_update.pdf
Resilience
Resilience and the concept of resilience has received much attention in the face of recent global crises which are interconnected and transcend nations, communities, and individuals. In light of the pandemic, economic and financial crisis, climate change, and unsettling global events such as wars and refugee crises that ensue, resilience has been viewed as one way of preparing individuals and populations to tackle the uncertainty that they are faced with.
Resilience, defined as ‘a positive, adaptive response in the face of adversity’[1], is widely regarded as an essential component of good mental health. It is the process by which individuals, communities, and systems adapt to challenges. It is critical to note that resilience does not just refer to building strengths and capabilities internally but involves having access to and receiving resources and support externally throughout life[2]. Resilience is modifiable and it is a constant process of negotiating challenging experiences to become manageable ones.
Throughout the pandemic, resilience was used as a way to measure how people were coping. Early findings demonstrated a clear relationship between resilience and coping with uncertainty, and the power of relationships, collectivising, and social networks. There is a clear need to examine these assets further and consider how they can be reinforced as a means of protecting Londoners’ mental health and building strength and resilience in the long-term[3].
Financial resilience
In the midst of the cost-of-living crisis, it is vital to acknowledge the impact this will have on Londoners’ resilience and overall wellbeing. Over one quarter (29%) of adults in the UK report that they could not afford to pay an unexpected expense of £850, with those on the lowest incomes and those who rent being the most likely affected[4]. Whilst data is limited on the direct mental health experiences of those currently worst impacted by rising living costs, it is clear it is a serious barrier and psychosocial stressor, which can wear down the emotional resilience of Londoners and therefore pose a significant risk to population mental health. Survey findings from the Royal College of Physicians[5] published in June 2022 found 55% of participants felt their health has been negatively affected by the rising cost of living. The perceived health and wellbeing of Londoners is already deteriorating.
It is clear that decrease in financial resilience will play a significant role in the reduction of population-wide emotional resilience, particularly amongst low-income, marginalised groups and communities that have faced a slower recovery from the coronavirus pandemic, further limiting their ability to ‘bounce back’ in the face of ongoing and future adversity.
Workforce resilience
Furthermore, the issue of worn-down resilience and burnout of health and social workers caring for those most vulnerable has been significantly exacerbated as a result of the pandemic, the financial crisis, and the pressures they have placed on both systems. After many months of operating in crisis mode with overwhelming demand and limited capacity, feelings of stress, guilt and psychological distress are having a tangible impact on the overall wellbeing of NHS staff; with 9 out of 10 NHS Trusts reporting worries about staff wellbeing at the beginning of the pandemic[6].
Research[7] published in May 2022 found that the health and social workforce are continuing to struggle with the changes implemented due to the COVID-19 pandemic. These changes have increased work demands resulting in increased staff burnout, stress while reducing staff morale and job satisfaction.
Now as the NHS prepares for the challenging autumn/winter period in the midst of a cost-of-living crisis characterised by increased fuel poverty, reliance on food banks and a record backlog in mental health referrals, resilience of the system and staff is essential. Anecdotal insights surfaced through Thrive LDN community engagement and networking activities continue to illustrate the devastating realities of living in poverty, which is now the norm for many Londoners.
[1] The National Scientific Council on the Developing Child (2015), Harvard.
[2] Masden 2001
[3] Thrive LDN (2020) Thrive Together: A summary of recent experiences and ideas to support the wellbeing and resilience of all Londoners: https://thriveldn.co.uk/wp-content/uploads/2020/11/Thrive-Together-report.pdf
[4] The rising cost of living and its impact on individuals in Great Britain – Office for National Statistics (ons.gov.uk)
[5] Royal College of Physicians (2022) Press release: https://www.rcplondon.ac.uk/news/press-release-over-half-brits-say-their-health-has-worsened-due-rising-cost-living
[6] House of Commons Health and Social Care Committee (2021) Workforce burnout and resilience in the NHS and social care: https://committees.parliament.uk/publications/6158/documents/68766/default/
[7] Gillen et al (2022) Health and social care workers’ workforce study: https://www.hscworkforcestudy.co.uk/
Self-reported anxiety and depression
The latest estimates from the Public Mental Health Dashboard[1] placed the estimated rate of common mental disorders, meaning anxiety or depression, at just below 20% of all Londoners. These estimates predate the unprecedented circumstances of the past few years, such as the COVID-19 pandemic and the historic peaks in inflation that U.K society has faced. Anxiety and depression, as the most common measures of psychological distress, have been observed to intensify greatly during periods of adversity, as was the case during periods of national lockdown and in previous economic recessions. Therefore it is important to monitor closely and acknowledge the extent to which the ongoing cost-of-living crisis has a negative impact on population mental health.
A recent survey has found that as of October 2022, 81% of people are worried about the rising cost of living, with two thirds of these (66%) stating that it was having a negative impact on their mental health and close to half (45%) stating that it was affecting their physical health[2]. Economic adversity in all forms is known to have a negative impact on mental health outcomes, with poverty, deprivation, debt, unemployment, food insecurity and falling behind on bills all acting as known risk factors in the development of depression and anxiety in addition to self-harm and suicide risk. Given that the latest ONS data has shown that the percentage of adults struggling to afford energy bills, rent or mortgage costs has risen throughout the year and in particular in the past few months to almost half of all adults (45%), the mental health ramifications of the UK’s ongoing cost-of-living crisis is not to be overlooked[3].
Depression and anxiety are consistently highest in those groups facing inequities; young adults, women, people with lower household incomes, people with a long-term physical health condition, people from ethnic minority backgrounds, and people living with children.
[1] OHID (2022) Public Mental Health Dashboard: Microsoft Power BI
[2] Savanta ComRes (2022) BBC cost-of-living survey – October 2022: BBC Cost of Living Survey – October 2022 « Savanta ComRes (comresglobal.com)
[3] Office for National Statistics (2022) Impact of increased cost of living on adults across Great Britain: June to September 2022: Impact of increased cost of living on adults across Great Britain – Office for National Statistics (ons.gov.uk)
Suicide
In London, more than 10 people take their own life each week.[1] Nationally, rates of suicide remain high, with 5,583 people in England and Wales taking their own lives in 2021 (the most recent available data), a number comparable to pre-pandemic rates. Approximately 75% of those who take their own lives are men, with the age-specific suicide rate for women being highest in those aged 45-49 years, and men aged 50-54 years.[2]
Although the official statistics on suicide rates in recent months have yet to be released, there is a recognition that due to the extreme challenges posed by the cost-of-living more Londoners will be considered vulnerable to suicide, leading to an increased risk of suicides across the city. Debt is amongst the strongest predictors of suicide.[3] Research from the Samaritans on the 2008/9 economic recession showed a 0.54% increase in suicides for every 1% increase in indebtedness across 20 EU countries, including the UK and Ireland.[4]
Intelligence collected through Thrive LDN’s Real-Time Surveillance System (RTSS) for suspected suicides have indicated some irregular and concerning patterns for suspected suicides since July 21-July 22 (data since August 2022 is currently being analysed). Over this period the proportion of cases citing financial difficulties as a contributory factor has increased, of which the relationship between age and gender a key concern. We already know that middle-aged men have the highest age-specific suicide rate in London. For more information on the RTSS please contact info@thriveldn.co.uk.
[1] Office for National Statistics (2022) Suicides in the UK: 2021 registrations: Suicides in England and Wales – Office for National Statistics (ons.gov.uk)
[2] Office for National Statistics (2022) Suicides in the UK: 2021 registrations: Suicides in England and Wales – Office for National Statistics (ons.gov.uk)
[3] Meltzer, H., Bebbington, P., Brugha, T., Jenkins, R., McManus, S., & Dennis, M. S. (2011). Personal debt and suicidal ideation. Psychological medicine, 41(4), 771-778
[4] Samaritans (2017) Dying from inequality: socioeconomic disadvantage and suicidal behaviour: Samaritans_Dying_from_inequality_report_-_summary.pdf
