Almost thirty years ago, in one of my earlier return visits to India, I was sitting chatting with my mother. Somehow the topic of poverty came up. She was really surprised that there were poor people in the UK. She wondered why that should be the case. I tried to explain the notion of relative poverty but obviously failed. The general assumption was that in rich countries everyone is rich. Trying to explain relative poverty itself takes some doing as people are often working long hours and struggling to feed their families and pay their bills.
Recent events such as climate emergencies seen in the UK and continental Europe, fires, an earthquake in Taiwan and the Russian invasion of Ukraine have brought home how interconnected we are and how interdependent we are even if we do not acknowledge it.
The euphemistically named cost-of-living crisis has been attributed to the UK’s dependence upon import of fuel and gas. Having had North Sea oil perhaps made the policymakers rather indolent to plan for the future. There is little doubt that very few politicians have a long-term vision, mostly their eyes are on the next election and an 18 month cycle is about the period they concentrate upon. A lack of planning by consecutive governments has been truly startling in this context. This lack of planning was clearly evident in the governmental and political response to the pandemic which may be subdued but is not over by any means. The shock of flu and Covid-19 infections in the winter will be accumulative and will undoubtedly hit those living in poverty and in overcrowded places.
Poverty levels are rising, with an increase in the number of food banks, lack of nutrition for children outside school terms and fuel poverty. The world’s sixth largest economy seems to be unable to look after its vulnerable citizens…when in many cases the vulnerability itself has been caused by the government’s policies and inactions. A mental health crisis tsunami is on its way not only due to the pandemic but fuel poverty and cost-of living crisis.
Particularly concerning is the impact of poverty per se and fuel, food and finance poverty on the on growth and development of brains of children and adolescents. The social and health impact on future generations where people are struggling to work in gig-economy and zero hour contracts must not be underestimated.
The headline in The Guardian of September 21 says:
Last week, the government has announced giving money to households to manage energy prices increases, with tax rebates for high earners and other measures which are likely to benefit high-income individuals more than low-income ones.
Reversal of National Insurance contributions will provide £7.66 p.a. to low income individuals but around £1800 to high income ones. Even the International Monetary Fund has stepped in:
IMF’s stinging rebuke is without a clear precedent.
Increasing Inequalities, threat of choosing between heat or eat, increasing mortgages and possibilities of losing homes are all real and likely in turn to contribute further to stress, distress and poor mental health — not only that of the current generation but future generations too.
So what are the potential solutions?
We need to think in a collective socio-centric manner. During the pandemic, street WhatsApp groups were established. This is one way of ensuring that those who are vulnerable can be protected and looked after by neighbours and friends. Food banks and energy banks may have a role to play and communities need to ensure that support is available according to need. The impact of Queen’s death brought people together and people queued for up to 24 hours to pay their respects. It reflected that people do come together in the times of crisis. Similarly, Covid-19 pandemic (irrespective of what our leaders did) brought people together with a definite sense of purpose.
When the then Prime Minister asked for 250,000 volunteers three times that number came forward.
So the community spirit and good will is there — we must channel this.
What is all this to do with psychiatry and psychiatrists? All psychiatry is social and we have a moral obligation to speak for our patients.
Through advocacy at local, regional and national levels, change can be made and sustained. The can-do spirit of the British nation has to be summoned again. This has to be seen in short, medium and long-term solutions. Working with policymakers, advocating and challenging when necessary, must happen.
Clinicians at all levels have a moral obligation to speak up for our patients and advocate for them. However, our training does not teach us to advocate which can be done on a professional basis through professional organisations and as clinicians as well as individual members of the society.
The time to come together is now so that at this time of social stress we can look after our patients better.