For some years now, the United Nations has been calling for a paradigm shift within mental health, with the UN Special Rapporteur on the Right to Health memorably calling for “less focus on chemical imbalances and more focus on power imbalances”.

There are small but encouraging signs that ‘mental health’, or emotional distress as it should more accurately be termed,  is increasingly being viewed through the lens of inequality. As always, it’s people with lived experience, activists and forward-thinking academics who are leading the way.

New Script for Mental Health were delighted to take part in a recent symposium on health inequalities on the island of Ireland. The symposium, organised by University College Cork’s Institute for Social Science in the 21st century, was held online on 27 April. Among the various thematic panels was one on health inequalities relating to mental health.

New Script’s presentation focused on how inequality is causing and fuelling our mental health crisis, and why an entirely new paradigm for mental health is needed. One that de-medicalises and contextualises emotional pain within the social, political and economic structures that cause it.

Beginning with the global level, and the work of Wilson and Pickett which shows how more equal societies reduce stress, restore sanity and improve everyone’s well-being,  Barry Murray and Sara Boyce illustrated how these global patterns are replicated at the local level in the north of Ireland.

Image caption: The work of Wilson and Pickett shows how more equal societies reduce stress, restore sanity and improve everyone’s well-being

Official data demonstrates the stark correlation between inequality and poverty and significantly increased rates of mental ill health and suicide. Suicide rates are double the rate in poor areas compared to wealthy areas. Prescribing rates for antidepressants are a shocking 66% higher in poor areas. Drug related deaths, which have more than doubled in the past ten years, are five times higher in wealthy versus working class areas. By and large these are the same areas and communities most heavily impacted by the conflict, with high levels of unaddressed inter-generational trauma.

Yet paradoxically and disturbingly, these same areas with the highest levels of trauma and distress, receive the lowest levels of investment of funding and services. New Script activists have previously evidenced the post-code lottery that exists in relation to counselling provision, and how these disparities in access map onto socio-economic inequalities.

This is a pattern that accurately reflects Hart’s Inverse Care Law, a phenomenon identified by Professor Julian Hart in 1971 and described by him thus:

“The availability of good medical care tends to vary inversely with the need for it in the population served. This … operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.”

Or put another way, “to the extent that health care becomes a commodity it becomes distributed just like champagne. That is rich people get lots of it. Poor people don’t get any of it.”

At the same time as there’s been a parallel growth in private companies offering GP services, expanding the already existent two-tier health system. People are increasingly being forced to pay for mental health services, with their right to health care being denied to them.

Barry Murray from New Script spoke of how GP services are increasingly being withdrawn from rural, isolated communities in Co. Fermanagh, effectively shutting down the pathways to mental health care for people in crisis. At the same time as there’s been a parallel growth in private companies offering GP services, expanding the already existent two-tier health system. People are increasingly being forced to pay for mental health services, with their right to health care being denied to them.

Other panellists also focused on the casual relationship between systemic inequality and trauma. Eileen Burke, from Traveller Visibility Group Cork spoke powerfully of the collective trauma experienced by the 60,000 strong Traveller community in Ireland, as a result of racism, discrimination, exclusion and erosion of culture. She pointed out that their culture ‘was ripped away from us’ through oppressive laws and policies.  This is directly connected to the shocking levels of suicide among Travellers, with 11% of all Travellers dying by suicide. Eileen joined up the painful, destructive dots between state racism, trauma and suicide.

Increasingly, people from right across society are starting to join up the dots on mental health.  This movement is being led by people who have experienced the abject failures of the existing mental health system, as well as front line workers in mental health services and in the community and voluntary sectors. Important conversations are happening at grass-roots level, conversations that our politicians now need to become a part of.