Mind the gap: the unequal impact of mental illness
Mental illness is a life-altering condition that has a huge impact on individuals, families, communities and even the economy. It is also incredibly common, with one in four individuals experiencing a mental health condition in the UK each year. Over the course of their lifetime, one in five people will feel suicidal and one in fifteen will attempt to take their life. This begs the question: why is something so damaging and pervasive receiving such little attention and budget in our public health agenda?
To start, let’s break down the impact of mental illness. On an economic level, mental illness constitutes the single largest health burden on the world economy, costing an estimated £1.6 trillion a year, surpassing the cost of physical diseases such as cancer or cardiovascular disease. In the UK, mental illness costs the NHS £70-£100 billion each year, equivalent to 4.5% of the nation’s GDP.
On an individual level, the effects of mental illness are devastating, with severe conditions causing a 10 to 25-year reduction in life expectancy. Yes, years.
How does that work? Over the course of their lives, 1 in 14 people will self-harm and 1 in 15 will attempt suicide. But that’s not the only way that mental illness kills. It is also associated with poorer physical health and increased health-risk behaviour. The King’s Fund has found high comorbidity between mental and physical health conditions, meaning that poor mental health and physical health often come hand in hand.
Additionally, mental illness makes individuals more vulnerable to violence. A 2013 UK survey found that people with mental illness were more likely to be victims of violence- with almost half of those surveyed being victims of violent crime in the previous year. This is especially worrying in the case of women, who are 10 times more likely to experience assault if they suffer from severe mental health problems.
In light of these devastating consequences, it is clear that mental illness is an urgent public health concern. And yet, the UK still widely ignores mental illness, with severe shortcomings in the provision of mental health support. Mental health research receives only 5.5% of the UK’s health research spending. In England, up to three-quarters of people with mental illness receive no support- referred to as the mental health treatment gap.
The lack of investment in such a pressing problem is perplexing, to say the least. Let’s take a closer look at who is suffering most from mental illness, which might give us some clues as to why public health systems have been so slow to respond to it.
The impact of mental illness is far from equal, with the greatest burden falling on already disadvantaged members of society.
Poor mental health and social disadvantage are strongly linked in a vicious cycle of increasing inequality. Early life circumstances including poverty, childhood adversity and violence are key risk factors that predict the onset and persistence of mental disorders. Mental disorders, in turn, are associated with lower income, reduced employment opportunities and productivity, as well as poor educational attainment. This creates a vicious cycle that puts individuals with mental illness in a disadvantaged position, which in itself causes poor mental health. This cycle plays a crucial role in the intergenerational transmission of poverty- inheriting the cost of mental illness from generation to generation.
For instance, a parent with mental illness will face reduced employment opportunities and a lower income. Their child will be raised in relative poverty, making them more susceptible to mental illness. They are then likely to reproduce the same pattern when they grow up.
In the UK, the unequal distribution of wealth amongst ethnic groups means that Black, Asian and minority ethnic groups have an increased likelihood of being disadvantaged in all aspects as compared to white British individuals. Statistically, these groups have reduced access to opportunities and a greater likelihood of lower educational outcomes, unemployment, and contact with the criminal justice system.
The Royal College of Psychiatrists has identified all of these factors as predictors of mental illness. Therefore, disadvantaged individuals, who are likely to belong to minority ethnic groups, are disproportionately affected by mental health problems and their consequences.
Even when socioeconomic status is controlled for, there are clear differences in mental health amongst ethnic groups. Black British adults, for example, face the most severe mental health symptoms on average. They are twice as likely to experience psychotic disorders than white British adults, even when comparing individuals from similar socioeconomic groups. Yet, Black British adults are the least likely to receive treatment.
It is widely acknowledged that individuals from minority groups that access care through the NHS experience racial discrimination. It has been shown that GPs are less likely to detect the mental health problems of individuals from an ethnic minority, and more likely to incorrectly describe other problems as related to mental health problems. The Royal College of Psychiatrists has observed substantial differences in crisis care, admissions, detentions, pathways into care, readmission and use of seclusion.
Who else suffers disproportionately?
Mental illness is especially pervasive and damaging among youth, representing the leading cause of disability in young people. Young women take the brunt of this: over a quarter of women between 16–24 years reported having a common health problem every week (as compared to 17% of adults).
Mental illness also disproportionately affects individuals that stray from the sexual norm, with a high prevalence amongst non-heterosexual individuals. English individuals who self describe as gay, lesbian or bisexual are two to three times more likely to have a psychological or emotional problem than heterosexual individuals. Young gay and bisexual men have been found to suffer high levels of suicidal ideation, with 10% of 16–19-year-olds attempting suicide each year. Yes, one in ten.
So what?
We must interrogate why mental illness, with such devastating consequences, has not yet earned a top spot in public health agendas. In the UK, only about 1 in 8 adults with a mental health issue are currently getting treatment of any kind. The failure of nations to provide mental health support is a human rights breach, compromising the right to care and dignity.
One can’t help but wonder if the issue has been so widely ignored because of who is most affected by it. Why have we been so quick to mobilise efforts around COVID-19, a new disease, while still ignoring mental illness? Perhaps if the burden of mental illness was carried by heterosexual, white men in positions of power, the response would be very different.
This text is adapted from my Master’s Dissertation, “What Social Innovation Can Do for Mental Health” (2020), written as part of the MDes Social Innovation programme at Ravensbourne University. Read the full work and consult references here.
