The Impact of Austerity on Mental Health Service Provision: A UK Perspective.

Ian Cummins

doi:10.3390/ijerph15061145

Abstract

This is a discussion paper which examines the impact of austerity policies on the provision of mental health services in the United Kingdom. Austerity is a shorthand for a series of policies introduced by the Conservative and Liberal Democrat Coalition government in the UK from 2010 onwards. In response to the fiscal crisis following the bail out of the banks in 2008, it was argued that significant reductions in public spending were required. The background to these policies is examined before a consideration of their impact on mental health services. These policies had a disproportionate impact on people living in poverty. People with health problems including mental problems are overrepresented in this group. At the same time, welfare and community services are under increasing financial pressures having to respond to increased demand within a context of reduced budgets. There is increasing recognition of the role that social factors and adverse childhood experiences have in the development and trajectory of mental health problems. Mental health social workers, alongside other professionals, seek to explain mental distress by the use of some variant of a biopsychosocial model. The extent of mental health problems as a one of their measures of the impact of inequality. More unequal societies create greater levels of distress. There is a social gradient in the extent of mental health problems—the impact of severe mental illness means that many individuals are unable to work or, if they can return to work, they find it difficult to gain employment because of discrimination. The paper concludes that austerity and associated policies have combined to increase the overall burden of mental distress and marginalisation within the UK.

Highlights

Two important works—Scull’s (2015) [1] Madness in Civilisation: A Cultural History of Insanity and Foot’s (2015) [2] The Man who Closed the Asylums—highlight the barriers that had to be overcome in the struggle to humanise mental health provision
There is an implicit danger that, in examining the current crisis in community mental health services, the failures and abuses of the past are assigned to history
There have been significant moves toward this but the continued dominance of medical and individualised approaches to mental distress prevents a full consideration of the impact of socio-economic factors (Shim et al 2014) [4]

Summary

Introduction

Two important works—Scull’s (2015) [1] Madness in Civilisation: A Cultural History of Insanity and Foot’s (2015) [2] The Man who Closed the Asylums—highlight the barriers that had to be overcome in the struggle to humanise mental health provision. Macintyre et al (2018) [3] emphasised the importance of a consideration of the links between social economic factors and the occurrence and experience of mental health problems. Macintyre et al (2018) [3] concluded that such an analysis that starts from a socioeconomic position can be the basis for a move towards a social justice approach for mental health This paper explores these debates within the context of the impact of the social and economic policies of austerity that have been pursued in the UK since 2010. Wilkinson and Pickett (2009) [7] noted greater economic equality generates wider social cohesion, lower crimes and more trust amongst citizens All these have an impact on mental health. Silva et al (2016) [11] outlined the potential impact of a range of socioeconomic factors on mental health These include income inequality, poor housing and living in communities with a lack of resources. There is a great deal of evidence that shows that growing up or living in poverty has long term implications for the onset of adult mental health problems

Austerity

The Impact of Welfare Reforms

Findings

Austerity and Mental Health Services in the UK

Conclusions