Focus on Mental Health

Focus is a UK forum, which was formed in 1993 and consists of some 25 representatives of leading UK mental health groups, working together on common objectives. In 2000/2001 Focus has been funded by the Department for Education and Employment to undertake a programme of work looking at issues around poverty and mental health. A sub-group on poverty and mental health was established to oversee this work (see note 1). This survey is one of the outcomes of this programme. A resource book detailing the relevant literature has also been published.

The survey

The survey questionnaire was designed by the sub-group and distributed via the networks of the respective organisations, to ensure the survey reached people who had experience of mental health problems. People were encouraged to photocopy and pass on the questionnaire, so it is difficult to determine the actual number mailed or to calculate the response rate. We did not target any particular geographical areas, although attempts were made to ensure that black and minority ethnic groups were represented by accessing targeted networks. All respondents were entered into a prize draw with a view to encouraging participation; first prize £100, second prize £50.

The respondents

556 people responded to the survey. The section for demographic details of the questionnaire was optional and so not all respondents gave their names or personal information. Of those who did:

51 % were male and 47% were female; 80% were White, 7% were Black, and 4% Asian.
47% were unemployed (58% male, 40% female); 26% were involved in voluntary work; 15% were in employment; 13% were in education; 11% were retired. (see note 2)
85% of respondents were in receipt of benefits (55% male and 44% female).
51% rented their home (51% male, 48% female); 19% were in a supported or residential home; 18% owned their home.

The findings

Do you think you are on a low income?

72% of respondents defined themselves as being on a low income; 74% of the total number of men and 71 % of the total number of women; 77% of people who were on benefits and 57% of people who were in work, full or part-time.

Do you think having a mental health problem makes it more likely you will have a low income?

81 % of respondents stated that having a mental health problem makes it more likely to have a low income; 12% did not think this was so. Figures for all demographic groups were similar.

Do you have difficulties making your income last all week?

66% of respondents said that they did have difficulties; this represents 68% of people on benefits. Females were marginally more ikely to find this task difficult compared with men. Interestingly, 69% of people in supported housing or residential accommodation said they had difficulties, compared with 57% of people who owned their own home.

Do you feel excluded from your local community due to your financial situation?

50% said 'yes', compared with 40% who did not feel excluded; this was highest for people who were retired (58% of retired people) and people who were unemployed (54% of the total unemployed). The figure is particularly high for Asian people (70% of total Asian respondents) compared with approximately half for all other ethnic groups.

Have you ever been unable to get help from a mental health service due to your financial situation? i.e. such as being unable to afford transport to attend a centre.

23% stated that they had been unable to get help from a mental health service for financial reasons; the majority of responses related to transport problems; other issues raised included problems paying for childcare. Some examples are given below:
- "Unable to attend a group due to taxi costing £8 return."
- "Many groups want to charge subs and I find sometimes I cannot afford this money."

If you are working, how does having a mental health problem affect your work and your relationship with work colleagues?

This question was answered by people who were not currently working as well as people in current employment. The response rate overall was relatively low for this question with only 34% of respondents completing it. Nevertheless, the responses given do provide a useful insight into the problems people experience. Interestingly, Asian people rated higher on most of the categories compared with other ethnic groups. Some of the issues raised are listed below:

Lack of confidence, feelings of stress and anxiety, isolation and exclusion resulting in poor work performance; fear of disclosing mental health problems, lack of understanding from others often leading to stigma and discrimination and bullying.
Feeling unable to cope with the social aspects of the work situation, problems communicating; being given demeaning jobs with little or no prospects.
On the positive side, people talked of people being very supportive. Some examples of experiences are shown in the following quotes:
- "Some colleagues have been hostile, and some supportive. It's an uphill struggle."
- "Employers tend to think that people with mental health problems would be a
  liability to their firm, difficult to work with, and unable to cope with any workload. This is unfortunately a view that is commonly held throughout society."

If you are not working, how (if at all) do you think having a mental health problem affects your prospects of getting a job?

This question was answered by 76% of respondents, 95% of which said that their mental
health had affected their work prospects and for some had made securing employment 'virtually impossible'. Interestingly, Black respondents were more likely to cite fear of disclosing their mental health problems compared with other ethnic groups. Issues raised were as follows:

Lack of understanding leading to stigma and discrimination.
Gaps in employment history and difficulties getting references; having to lie about mental health history, particularly on medical questionnaires; lack of confidence in applying for jobs.
Reoccurrence of mental health problems; lack of the skills required; need support and training to do a job, only get menial work.
Working will affect benefit payments:
- "Due to the gaps in my career through illness I have missed out on opportunities and fallen behind others in my field. Contacts were lost and I had to start again more or less from scratch. This has a much more subtle and long-lasting effect than people may be aware of."
- "I worry that lack of money will force me back to work before I am ready."

If you had an extra £10 a each week, what would you spend it on? (see note 3)

74% of respondents stated they would spend the additional money on food and other basics items such as toiletries, petrol, clothes, medicine etc. 31 % mentioned social and/or leisure pursuits. Other items mentioned by a smaller number included holidays and luxuries.

The experience of mental health problems and being on a low income

The survey included a broader open question asking people to describe their experiences. Three themes emerged: items or services that people could not afford due to their low income, feelings associated with this, and the consequences of poor mental health and a low income.

The results show that many people had to forgo basic items such as adequate good quality food or 'decent' clothes. People talked of not being able to pay their household utility bills or to afford bus or train fares. Social activities and holidays were also beyond the limits of many of the people surveyed. But what is perhaps more striking is the obvious effect that this has on people. Respondents talked of feelings of depression, and what some people referred to as the degrading experience of being on a very low income. The impact on people's mental health was clearly evident in terms of the high emotions in some of the responses.

"Out of the blue, your job has gone, and with it any financial security you might have had. At a stroke, you have no purpose in life, and no contact with other people. You find yourself totally isolated from the rest of the world. No one telephones you. Much less writes. No one seems to care if you're alive or dead."
"All in all I find the experience of being on a low income degrading. I feel I am being punished for being ill and as if it is all my fault which in turn makes me more depressed. You see others buying such lovely things and I can have none of it. It really hurts."

We also asked respondents what they thought should be done to help people with mental health problems who are on a low income. Five themes emerged: benefits, money, education, services and social issues. In relation to benefits, not surprisingly people talked about the need for an increase in benefits. Respondents also talked about the need to make the application process more accessible, particularly for Disability Living Allowance, as well as making the benefits system more flexible allowing for the fluctuating nature of mental health. Finally, people referred to the need for the earning level at which benefits are cut off to be altered. In relation to money, people talked about possible concessions for travel, food, clothes and access to interest free loans.

Education was mentioned in terms of the need for greater opportunities to access both education and training. Furthermore, respondents talked about the need for a programme of education on mental health awareness for everyone, which breaks down the stigma of mental illness across society. In relation to services, people talked about the need for more support services such as drop-in centres, and for services which offer a greater range of activities such as social and recreational events. Such requests further emphasise people's need to reduce isolation.

Conclusions

As the results from this survey show, people with mental health problems are doubly disadvantaged, both by their illness and their poverty They see significant hurdles in trying to escape from poverty by returning to employment, with many anticipating discrimination and ignorance. Expectations are low. Eight out of ten expect to have a low income. Only 15% of our respondents were employed, and of this small group 57% regard their income as low.

Significantly, one in four stated they had been unable to get help from mental health services through an inability to pay for transport or childcare, for example. Access to health care should be based on clinical need, but here is evidence that poverty is perceived as frustrating one of the fundamental rights of our citizens, one that is so essential to their well-being.

Asked how they would spend an extra £10 a week, 74% responded by saying it would
go on food and other basics, items that most of us take for granted. Respondents had practical ideas about what they need: an accessible and flexible benefits system that helps their return to work, and more access to education and support.

Without positive national and local action to provide specific and sustained help for people with mental health problems, poverty will continue to isolate and ensnare many of the most vulnerable people in our society.