Walking together in the name of social justice

About our values

There is a momentum growing amongst psychologists who are pressing for social inequalities to be addressed. Here is a statement produced by clinical & health psychologists, calling on policy makers to address the impact social inequalities have on mental health

Position Statement on Social Inequality

Who are we?
As Clinical Psychologists and Clinical and Health Psychologists in training, our experiences and backgrounds are hugely varied. As a profession, our aim is to “reduce psychological distress and enhance and promote psychological well-being” (British Psychological Society, 2013). We work with people with a range of difficulties, across the lifespan, in inpatient, outpatient, physical health, secure and community settings, including voluntary and third sector organisations. Some of us also conduct research and work in academia. Many of us have held other careers prior to training as clinical psychologists. Through this broad range of personal and professional experiences, there are certain issues we are noticing which give us significant cause for concern. Collectively, we feel it necessary that we make these concerns known.

 
The purpose of this statement is not to speak on behalf of our service users, but to raise our own concerns based on both the distress we see in our professional settings, and on the evidence base of research and theories, which predict poorer outcomes for all people living in an unequal society.
 
What are we seeing?
Much media attention has been given in recent times to issues of social inequality, with the United Kingdom now the second most unequal country in the world (Inequality Briefing, 2014). Over a quarter of children, some 3.5 million, live in poverty and this figure is rising (Child Poverty Action Group, 2014). As a result, use of food banks in Britain has increased fivefold since 2010 (Oxfam Scotland, 2014). The “cost of living crisis” is real and many are living with its effects. We recognise that we, as a profession, are in a relatively privileged and powerful position, and that we may not experience first-hand some of the day-to-day experiences of rising social inequalities. Nevertheless, we do witness their impact on those affected by them in our working lives.
 
Social inequalities have been shown to have a detrimental impact on mental health and well-being, as well as physical health and academic achievement, across the lifespan. A significant body of research suggests unequal societies are more likely to experience a range of detrimental consequences, across the socio-economic spectrum (Wilkinson & Pickett, 2009; World Health Organization, 2008). People in disadvantaged circumstances who are dealing with emotional distress may, in times of economic hardship, find themselves to be further disadvantaged (Evans-Lacko, Knapp, McCrone, Thornicroft, & Mojtabai, 2013; Shah, Mullainathan, & Shafir, 2012). In 2012, the Chief Medical Officer reported that children from socially disadvantaged families were more likely to experience emotional distress and mental health difficulties (Department of Health, 2012). Without addressing these social disadvantages, it could be argued that any interventions with these families will have limited effectiveness.
 
Emotional well-being does not exist or develop in a bubble; it is affected by our social contexts. Some of these, such as ethnicity, gender, ability or socio-economic status, bring with them institutional marginalisation or discrimination, which increase experiences of inequality. Figures demonstrate individuals in more unequal societies have poorer overall mental health and emotional well-being (Wilkinson, 1996; World Health Organization, 1995).
 
As clinicians, we are witnessing parents having to decline psychological therapy for the children because they were unable to afford to travel to the mental health facility. Increasingly, some are having to miss therapy appointments as they fear they would be subject to benefits sanctions were they to fail to attend compulsory meetings at JobCentres. For some, multiple health problems prevent them from engaging with mental health services, with the result that they are considered ‘difficult to engage’ and discharged. As a result, their mental health is likely to deteriorate, thus perpetuating the problem. We have also witnessed individuals with significant intellectual and physical disabilities being told they are ‘fit for work’ and that their benefits will be capped, despite their substantial care needs preventing them from engaging in employment. It has also been brought to our attention that some people living with HIV have been unable to fight off opportunistic infections, even with the aid of HIV-specific medication, due to the constant stress of being homeless.
 
What this means for the people we work with and why this concerns us
The importance of social equality to people’s wellbeing and ability to thrive is often viewed through Maslow’s hierarchy of needs. When the more basic levels of this hierarchy (e.g., safe housing, sufficient food) are unfulfilled or under threat, children and adults may be much less able to “make use” of psychological therapy.  There are some great examples of successful therapeutic work with people living in very deprived circumstances, with homeless people, for example. However, we suggest that sometimes it is more appropriate for services to work together to prioritise a person’s basic needs, allowing for the development of a stable base on which to provide further therapeutic input. By recognising that distress and emotional wellbeing occurs in a social context, we can ensure that psychological therapy avoids conceptualising mental health problems as being solely within the individual. Indeed, psychological therapy can sometimes be unhelpful and ineffective until basic needs are met (Smail, 2005).   Furthermore, services under pressure are less able to adapt and work flexibly to engage people living in complex social circumstances and some people require support beyond the provision of basics such as food and housing. 
This is particularly pertinent given that government plans drawn up in 2014 suggested that people with depression would be required to engage in psychological treatment in order to continue receiving Employment and Support Allowance (Ross, 2014) – in short, they would be coerced into engaging with mental health services in order to be able to survive.
 
We are seeing clear examples of people experiencing emotional distress, primarily as a consequence of poverty and material deprivation. It is known, for example, that food insecurity impacts on a child’s whole life and experience. Children who experience food insecurities have poorer outcomes with emotional and physical health, socially, and academically (Harvey, 2014). Additionally, many families and children are currently living in temporary accommodation or have been relocated due to changes in, and scarcity of, affordable social housing (Chartered Institute of Housing, 2013). As a consequence, some have been required to move significant distances or are living in accommodation which is unsuitable for their needs. Not having a fixed place to live or being isolated from family and friends impacts on people’s overall sense of safety and belonging, which in turn impacts negatively on their emotional wellbeing (Credland & Lewis, 2014).
 
Our hope in writing this statement is to add to existing conversations, and to generate new ones amongst all citizens, be they service users, professionals, or policy makers. As mental health professionals, we are committed to playing our part in moving towards a more equal society and to addressing inequalities both locally and nationally:
 
  • We held a conference, open to all, in London in June 2015. Entitled ‘Clinical psychology: Beyond the therapy room, this event aims to  discuss ways in which clinical psychology can make an impact beyond 1:1 therapy, in order to build a better society  and a more psychologically-caring community;
  • We are working towards building increased presence within existing power structures, such as the British Psychological Society and the Division of Clinical Psychology, allowing us to provide a psychological perspective on current and proposed government policy;
  • As a profession, we encourage people with lived experience of social inequality, including multiple inequalities, to speak about their experiences and to increase awareness of the impact of inequality on their wellbeing;
  • We urge policy-makers to consider the wider systemic implications of proposed changes to health and economic policy;
  • We also call for the media stigmatisation of those in conditions of deprivation and poverty to end; and for welfare to be considered a safety net for the most vulnerable in society rather than a weapon with which they can be coerced.

References

British Psychological Society. (2013). Consultation on new accreditation standards for Doctoral programmes in Clinical Psychology. Leicester, UK: BPS.

Chartered Institute of Housing. (2013). Experiences and effects of the benefit cap in Haringey. London, England: CIH.

Child Poverty Action Group. (2014). Child poverty facts and figures. Retrieved from http://www.cpag.org.uk/child-poverty-facts-and-figures

Credland, S., & Lewis, H. (2014). Sick and tired: The impact of temporary  accommodation on the health of homeless families. London, England: Shelter.

Department of Health. (2012). Chief Medical Officer’s annual report 2012: Our Children Deserve Better: Prevention Pays. London, England: DoH.

Evans-Lacko, S., Knapp, M., McCrone, P., Thornicroft, G., & Mojtabai, R. (2013). The mental health consequences of the recession: economic hardship and employment of people with mental health problems in 27 European countries. PloS One, 8(7), e69792. http://doi.org/10.1371/journal.pone.0069792

Harvey, K. (2014). Children and parents’ experiences of food insecurity in a South London population. Reading, UK: University of Reading.

Inequality Briefing. (2014). The UK has become one of the most unequal countries in the world (No. 36).

Oxfam Scotland. (2014). Big rise in UK food poverty sees more than 20m meals given out in last year.

Ross, T. (2014, July 12). Tories discuss stripping benefits claimants who refuse treatment for depression. Retrieved April 16, 2015, from http://www.telegraph.co.uk/news/politics/conservative/10964125/Tories-di...

Shah, A. K., Mullainathan, S., & Shafir, E. (2012). Some Consequences of Having Too Little. Science, 338(6107), 682–685. http://doi.org/10.1126/science.1222426

Smail, D. (2005). Power, interest and psychology: Elements of a social materialistic understanding of distress. Ross-on-Wye, UK: PCCS Books.

Wilkinson, R. G. (1996). Unhealthy societies: The afflictions of inequality. London: Routledge.

Wilkinson, R. G., & Pickett, K. E. (2009). The spirit level: Why equality is better for everyone. London, England: Penguin.

World Health Organization. (1995). Bridging the gaps. Geneva: WHO.

World Health Organization. (2008). Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health : Commission on Social Determinants of Health Final Report. World Health Organization.

Values

There is a momentum growing amongst psychologists who are pressing for social inequalities to be addressed. Here is a statement produced by clinical & health psychologists, calling on policy makers to address the impact social inequalities have on mental health...

The Walk

100 miles - BPS Leicester to BPS London
5 days - 17th to 21st August 2015

3 causes - The benefits system / homelessness / Food poverty

Join us to walk from Leicester to London to raise awareness of social policies that are leading to psychological distress.

Contact us

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