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Poverty and mental health

Poverty and mental health A review to inform the Joseph Rowntree Foundation's Anti- Poverty Strategy 1. P O L I CY R E V I E W AUGUST 2016. Poverty and mental health : A review to inform the Joseph Rowntree Foundation's Anti- Poverty Strategy Iris Elliott PhD FRSA. August 2016. Citation The recommended citation for this review is: Elliott, I. (June 2016) Poverty and mental health : A review to inform the Joseph Rowntree Foundation's Anti- Poverty Strategy. London: mental health Foundation. Acknowledgements Helen Barnard managed the delivery of the review for the Joseph Rowntree Foundation and co-ordinated input from her colleagues. Professor David Pilgrim, University of Liverpool; Professor David Kingdon, University of Southampton; Andy Bell, Centre for mental health ; and Sam Callan, Centre for Social Justice were insightful reviewers. Thank you to the mental health Foundation team who supported the writing of this report: Isabella Goldie, Director of Development and Delivery; Marguerite Regan, Policy Manager; and Laura Bernal, Policy Officer.

1 Poverty and mental health A review to inform the Joseph Rowntree Foundation’s Anti-Poverty Strategy POLICY REVIEW AUGUST 2016

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1 Poverty and mental health A review to inform the Joseph Rowntree Foundation's Anti- Poverty Strategy 1. P O L I CY R E V I E W AUGUST 2016. Poverty and mental health : A review to inform the Joseph Rowntree Foundation's Anti- Poverty Strategy Iris Elliott PhD FRSA. August 2016. Citation The recommended citation for this review is: Elliott, I. (June 2016) Poverty and mental health : A review to inform the Joseph Rowntree Foundation's Anti- Poverty Strategy. London: mental health Foundation. Acknowledgements Helen Barnard managed the delivery of the review for the Joseph Rowntree Foundation and co-ordinated input from her colleagues. Professor David Pilgrim, University of Liverpool; Professor David Kingdon, University of Southampton; Andy Bell, Centre for mental health ; and Sam Callan, Centre for Social Justice were insightful reviewers. Thank you to the mental health Foundation team who supported the writing of this report: Isabella Goldie, Director of Development and Delivery; Marguerite Regan, Policy Manager; and Laura Bernal, Policy Officer.

2 2. Contents Executive Summary ..4. 1. Introduction ..7. 2. Poverty and mental health : A Conceptual 3. Poverty and mental health Across the Life Course ..22. 4. Public Services ..32. Cross-Cutting Social Social Planning the Built 5. Growing the Evidence Base: Data and Research ..65. 6. Costings ..68. 7. Recommendations ..78. 8. Methodology ..83. Bibliography ..88. Glossary ..96. 3. Executive Summary Poverty increases the risk of mental discrimination; and policy development). health problems and can be both a at different stages of life and across the causal factor and a consequence of whole of the life course. Attention is mental ill health . mental health is shaped given to pressure points and transitions by the wide-ranging characteristics throughout life, particularly when (including inequalities) of the social, these are adverse experiences such as economic and physical environments homelessness, redundancy and family in which people live. Successfully breakdown, which can be traumatic and supporting the mental health and have cumulative impacts.

3 People with wellbeing of people living in Poverty , complex needs are discussed across the and reducing the number of people with review. mental health problems experiencing Poverty , require engagement with this In order to strengthen the evidence base, complexity. mental health must be addressed within Poverty data and research, and, likewise, The review presents a conceptual Poverty addressed within mental health framework for understanding the data and research. A mental health and relationship between Poverty and Poverty research agenda should be mental health , which draws together: co-produced with individuals, families a life course analysis; a discussion of and communities with lived experience the socio-economic factors (or social of these issues. This research agenda determinants) impacting mental health should include economic research that and Poverty ; the principles of human has proved persuasive in key areas such rights, equity, anti-stigma and non- as maternal mental health (see Costings discrimination; and the approaches section 6).

4 Implementation science of prevention, self-management, peer methodologies should be employed support, community development and to scale and test programmes and social movement building. interventions in order to ensure that they are appropriate and effective for people There are a number of imminent living in Poverty . opportunities for addressing mental health and Poverty across the UK, The review recognises the corrosive including the programmes for impact of stigma and discrimination government of the recently elected on people experiencing mental health devolved administrations in Scotland, problems and those living in Poverty . Wales and Northern Ireland. It proposes the integration of social contact approaches around mental Recommendations for action are health and Poverty within current anti- made across a number of cross-cutting stigma campaigns and initiatives. areas (data and research; stigma and 4. The development of mental health in treatment for claimants with mental All Policies (MHiAP) at national and local health problems across the social government levels is recommended security system.)

5 At a minimum, the Work for areas of public policy considered Programme needs to be completely within this review ( health , education, overhauled. employment, social security, advice and planning the built environment), noting In later life, the evidence base for that this is not an exhaustive list. effective interventions needs to be further developed, particularly for The life course stages are framed within initiatives that facilitate social and this report as: perinatal (pregnancy and cultural participation, enhance social the first year following birth), early years, connection and reduce isolation. The children and young people; working age; commissioning of systematic reviews of and later life (from 50 years onwards). evidence would be a valuable first step It is essential that the National Institute in identifying what works with regards for health and Care Excellence (NICE) to addressing mental health and Poverty perinatal care pathway is implemented in later life. Primary care screening for across the UK.

6 Recommended supports mental health problems (particularly for families, children and young people depression and dementia) is one way to are the Family Nurse Partnership, promote early intervention. evidence-based positive parenting programmes (including for families People experiencing Poverty and with a parent who has mental health mental health problems would benefit problems), the adoption of the whole- from a number of initiatives across the school approach, and particular supports life course. The creation of accessible, for vulnerable and excluded children, integrated public service hubs within many of whom may not be in education. deprived communities would provide individuals, families and groups with During working age, policy should timely, appropriate and local support and support people to enter and remain in care. A national programme of primary- work through the adoption of whole- care-based social prescribing within workplace approaches, a national these communities would facilitate individual placement and support (IPS) people's access to mental health , programme, and development of mental enhancing social, cultural and leisure health and wellbeing programmes for activities that are beyond their economic small and medium-sized enterprise reach.

7 (SME) owner-managers and employees. The social security system needs to be mental health problems can disrupt leveraged to ensure that claimants with people's education, training and entry mental health problems receive their into, and progression within, work. Local full social security entitlements, and opportunities for lifelong learning are are the beneficiaries of programmes an important way of addressing the such as Access to Work. There needs disadvantage and exclusion that this to be an improvement in the quality of leads to. 5. The use of parity within policy advocacy The Psychologically Informed Planned in order to advance fair investment Environments (PIPEs) approach has in mental health has magnified the been piloted within some criminal false dichotomy between mental and justice settings. PIPEs are a form of physical health . Addressing the mental Psychologically Informed Environment health of children and adults with (PIE). The evidence base is developing long-term physical health conditions but promising, and the report improves their engagement with care recommends the scaling and testing of and treatment, and their prognosis, as PIEs in services for people with complex well as their family members' and carers' needs.

8 mental health and wellbeing. Tackling the high levels of physical ill health and This review has synthesised evidence early death among people with serious across a considerable breadth of mental health problems is a priority. The public policy agendas. Although it is development of integrated pathways not a systematic review, the evidence across the life course for people has come from authoritative sources. with co- and multiple morbidities is Where the evidence base is developing recommended. but promising, this is noted (see Methodology). Concerns about the relationship between mental health and criminal It is intended that the review is relevant justice have been raised over many to policy, provision and people across years, each successive report building the UK. The type, quality and scope the case for a complete health and of statistical information and other justice pathway. This report recommends evidence about mental health and the development of such a pathway, Poverty varies across the UK.

9 These improved mental health provision variations are noted, but the review's across all criminal justice settings, and narrative and recommendations have a comprehensive national liaison and been written to be as relevant to each diversion programme. The needs of part of the UK as possible. Black, Asian and Minority Ethnic (BAME). community members, women, and older offenders require particular attention within this work. 6. 1. Introduction One in four adults and one in ten mental health and wellbeing of people children experience mental health living in Poverty and reducing the problems to some degree in any year;i numbers of people with mental health and the impacts of mental health problems experiencing Poverty requires problems ripple out to affect many more engagement with this complexity. people through their social networks of family, education, work and community. There is a growing UK policy consensus The 2015 Monitoring Poverty and that mental health requires substantial Social Exclusion' report's comparison attention and investment in order of data between 2005 and 2012 found to address the huge economic and that a greater proportion of women social costs to individuals, families, were assessed as being at high risk of communities and society.

10 This agenda mental health problems compared to encompasses addressing the range of men; within the lowest social economic social and economic factors that affect class, 26% of women and 23% of men mental health (referred to as the social were at high risk of mental health determinants of health '), challenging the Three-quarters of people stigma and discrimination that continue with a mental health problem do not to impact people with mental health receive ongoing Poverty1 problems and their families in all areas increases the risk of mental health of their lives, removing barriers to full problems, and can be both a causal participation within society including factor and a consequence of mental ill in education, employment and the mental health is shaped by the community providing public services wide-ranging characteristics (including in a timely manner, and developing inequalities) of the social, economic research and data in order to ensure that and physical environments in which policy and provision are evidence based, people Successfully supporting the and that progress is ,vi 1.


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