RCPsych Wales - Mental health inequalities in Wales

From attending the local foodbank to not having enough money to cover your electricity bill – living in poverty can mean different things to different people.

Historically in Wales, we’ve always had a problem with people living at the lower end of the economic scale.

With the pits closing and large post-industrial areas missing out on regeneration opportunities – we have a large rural population which significantly differs from the prosperous cities and towns on our southern coast.

And I’m afraid that there is more bad news. As psychiatrists, we know that people living in our poorest communities often have the worst health outcomes and shortest life expectancy.

This was particularly noticeable during the worst days of the pandemic when deaths from Covid-19 were significantly more common in our most deprived areas.

As the World Health Organisation (WHO) describes it - poverty as the greatest cause of suffering on earth.

It affects all age groups. And most people who are poor, are born into poverty.

A report last year from Save the Children revealed as many as 200,000 children are living in poverty in Wales and as many as 90,000 live in severe poverty.

On both accounts, Wales has the highest rate of child poverty of any nation in the UK.

Startling figures, but what does it mean for the nation’s mental health?

Social factors and deprivation can have a very negative effect on your mental health throughout your life.

If you’re a child, social factors growing up such as living in a disadvantaged place – can have a huge effect on the risk of developing a psychotic illness as an adult.

And people living in poverty are more likely to have a mental illness such as depression, anxiety, phobias and especially schizophrenia – where the effects are huge.

This is especially true within our inner cities and in places where racism is rife.

In general, urban deprivation has a worse effect on children than rural deprivation.

However, suicide is more common in rural areas and is known to be affected by issues such as isolation, financial strain and the availability of weapons and pesticides.

But there are solutions. I’ve worked in psychiatry for 41 years and during that time all kinds of breakthroughs have been announced. Although none of them have reduced the rate of mental ill health we do know that reducing social inequality and improving social justice can prevent it.

That’s why RCPsych in Wales have recently responded to a Welsh government consultation on this very subject.

We’d like to see all governments work to reduce inequality by making provisions for those in financial difficulty.

Governments must also ask what poorer communities need to make life better – ask them first what would be most helpful instead of deciding for them.

Public services cannot prevent mental illness, but they can do a lot to influence and improve outcomes. People with mental illness do better if they can access support – both psychiatric and social.

Social infrastructure such as libraries, adult education and leisure facilities need to be freely available. Especially at a time when the cost of living is rising.

We know that wealthier communities often find it easier to access these services in some areas you’re not even offered them. This has to change.

The truth is - whether you live in an inner city or rural community – access matters.

As the headlines keep rolling out about rising gas prices and people finding it harder to make ends meet, we must make sure our poorest communities are looked after and looked after, now.

As well as targets set locally, there also has to be targets set nationally and internationally.

Above all decision makers must remember that when it comes to poverty - there is no health without mental health.

• Professor Rob Poole is a consultant psychiatrist and fellow of the Royal College of Psychiatrists.
• This article was written for The National (website now closed down) and issued on 4 October.