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Covid-19: Helping our communities recover

We need to step up our efforts to tackle the social determinants of mental ill health

Factors largely beyond our control, such as the housing we can afford, welfare policy and the buoyancy of the job market, are hugely important in determining how well we are able to maintain our mental health.

Long before the pandemic hit, Porchlight services were already working hard to reduce the impact of the social determinants of mental health - deprivation, unemployment, housing instability and isolation - on communities in Kent.

However, none of us could have predicted the ways in which our lives would change in 2020; the new social and economic landscape has vast implications for the mental health of the communities that we serve.

Now, more than ever, we need mental health services that are person-centred, acknowledging the important part that social determinants play in an individual’s experience of poor mental health and their ability to recover.

The impact on those already experiencing poor mental health

People who already experienced poor mental health before the pandemic have been disproportionately affected by the crisis.

A survey by Mind found that two thirds (65%) of adults and three quarters (75%) of young people with experience of mental health problems said their mental health has got worse during lockdown and the British Academy reports that lockdown measures reduced access to mental health services.

In areas like Swale and Thanet where the estimated prevalence of common mental health disorders is higher than the national average, this poses a particular challenge. Mental health commissioners and providers like Porchlight have to step up our efforts to meet the increasing need within these communities.

Exacerbation of existing inequalities

The correlation between deprivation and poor mental health is well known with deprivation both increasing the risk of mental health problems and occurring as a consequence of mental ill health.

The national response to the pandemic has disproportionately impacted households who were already experiencing mental health inequalities because of deprivation. Recent research demonstrates that ‘individuals experiencing deprivation have been exposed to greater numbers of stressors during the pandemic, as well as having fewer resources to be able to cope with them’.

It’s a commonly held misconception that Kent, with its close proximity to London and rolling rural landscape, is a county where deprivation simply does not exist. Whilst it’s certainly true that there are affluent areas in Kent, there are also communities where deprivation impacts every aspect of individuals’ lives.

There are 50 small population areas in Kent that fall within the most deprived 10% of areas nationally; 34 of these are in Swale and Thanet. In Medway, where we’re expanding our Live Well Kent mental health service, there are 14 areas that fall into the most deprived 10%.

We’re already seeing the disproportionate impact of the pandemic on the mental health of these communities. We know we must step up our efforts, making sure our services can meet the growing need to prevent a legacy of declining mental health in the coming years.

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It’s a commonly held misconception that Kent, with its close proximity to London and rolling rural landscape, is a county where deprivation simply does not exist.

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Unemployment

There is little doubt that unemployment negatively impacts people’s mental health. A survey of mental health and wellbeing in England in 2014 found that unemployment was associated with suicidal thoughts, suicide attempts and self-harm in working age adults, with the highest rates seen in men who were economically inactive. The survey also found a worrying correlation between needing to claim welfare support and suicide and self-harm:

Two thirds (66.4%) of people in receipt of employment and support allowance had thought about taking their life, almost half (43.2%) had made a suicide attempt, and a third (33.5%) reported self-harming.

Rising unemployment as a result of the pandemic is a significant cause for concern. Unemployment rose from 3.8% in November 2019 to 5% in November 2020. It is expected to reach 6.5% in 2021.

Younger age groups and workers from black, Asian and minority ethnic (BAME) backgrounds were more likely to have lost their jobs during the pandemic. Areas in Kent and Medway with higher proportions of these populations will face significant challenges in supporting the mental health of those newly unemployed.

Individuals working in the accommodation and food and arts, entertainment and recreation sectors are likely to be most severely affected; none of these industries showed ‘resilience’ during the pandemic.

Areas with the highest proportion of jobs in these sectors are likely to feel the effects of rising unemployment and face greater risks to mental health.

Housing instability

Housing instability has a significant impact on an individual’s mental health. A 2017 report by Shelter identified that one in five adults in England said that housing problems had a negative impact on their mental health in the last five years. GPs also highlighted that housing issues were a common contributing factor to patients’ poor mental health.

Research has also found that for people with pre-existing mental health problems, having to move house frequently increases their likelihood of experiencing repeated crises and lengthens resultant hospital stays.

Housing instability as a result of the Covid crisis is likely to have significant implications for mental health services. In Kent, with rising unemployment and many households under considerable financial strain, people are having to turn to councils for help with housing.

In 2020, 8 out of 12 districts in Kent saw an increase in the number of households on their housing waiting lists compared to the previous year.

And we have yet to see the full impact of the pandemic on evictions. The lifting of the eviction ban on 31 May is likely to see large numbers of tenants facing housing instability, with six million people already more afraid of becoming homeless, half a million renters in arrears and 24% of private renters having had to borrow money to pay their rent.

The problem is likely to be particularly relevant locally; excluding London, private rental costs are higher in the south east (£895) than in any other region meaning that many renters were struggling to afford a property even before the pandemic struck.

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Excluding London, private rental costs are higher in the south east than in any other region

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Isolation

There are strong associations between loneliness and mental health problems including depression and anxiety. There is also correlation between loneliness and eating disorders, sleep disturbance and both suicidal ideation and suicide attempts.

A 2019 study found that lonelier young adults were more likely than their peers to experience mental health problems, engage in physical health risk behaviours, and to use more negative strategies to cope with stress.

The pandemic has left many people isolated, with levels of loneliness increasing since spring 2020 and areas with higher rates of unemployment having higher rates of loneliness.

In Kent, recent data shows that Shepway, Dover, Tonbridge and Malling, Thanet and Swale have rates of loneliness that exceed the national average which will have implications for both the prevalence of poor mental health as well as mental health service design.

The pandemic has changed the social and economic landscape beyond recognition and it’s little wonder that the nation’s mental health is in decline. The Royal College of Psychiatrists reports that the country is in the midst of a mental health crisis.

At Porchlight, we’re committed to meeting the challenges that lie ahead. We’re using the evidence – what we’re seeing every day – to provide and advocate for the holistic support we believe in; working to address all of the challenges people are facing to help them stay well and manage their own lives.