How poverty makes it hard to escape mental illnes

How poverty makes it hard to escape mental illnes
Staff reporterJuly 5, 2019

GUEST OBSERVATION

The poorer people are, the higher their chances of contending with domestic violence, crime, social conflict, homelessness and unemployment.

All these factors contribute to increased levels of psychological distress, which is associated with common mental disorders such as depression and anxiety.

In our research, of adults who recorded “very high” levels of psychological distress on what’s called the Kessler Psychological Distress Scale, more than three times as many (30%) came from the most socioeconomically disadvantaged fifth of Australian areas than from the most affluent fifth (9%).

Along with where you live, personal income is an important influence: among the poorest fifth of Australians, one in four people reported “high” or “very high” psychological distress when compared to about one in 20 people in the richest fifth.

To begin to tackle this problem, we need to see more equitable distribution of mental health care; that is, delivery of care proportionate to need. As it currently stands, socioeconomically disadvantaged groups very often do not get optimal mental health care.


This chart first appeared in an article published on The Conversation in 2018., CC BY-ND


The Royal Commission into Victoria’s Mental Health System has begun its public hearings this week in Melbourne. Hopefully, it will provoke improved collaboration between state and Commonwealth services, enabling better access to mental health services for those who need it most.

Socioeconomic disadvantage affects mental health from birth

Unintended pregnancy, being younger, experiencing intimate partner violence and having insufficient emotional and practical support can lead to mental disorders, including depression, among pregnant women and new mothers.

Babies of depressed mothers are often underweight, a risk factor for later depression.

One study showed the mental health of four-year-old children is affected by factors including family income, maternal education and neighbourhood disadvantage. The researchers followed children in this study until the age of 14 to 15 and found the effects persisted.

Children from low socioeconomic backgrounds are also more likely to do poorly in school, and are more likely to be suspended or expelled.

Financial difficulties have been highlighted as an important determinant of mental health for university students, too.

Adults with interpersonal, employment or financial stresses experience higher levels of psychological distress.

Job loss is associated with mental health problems, and this association becomes more pronounced with long-term unemployment.

Those on welfare support have a higher risk of mental disorders.

Poor people can’t access the best treatment

People in countries with greater socioeconomic inequality are more likely to have poor mental health than people in more equal societies. Australia is a high-income country, but there remains a significant gap between the richest in our society and the poorest.

Many health, educational, transport, housing, welfare and fiscal policy shifts could improve mental health in communities by addressing socioeconomic disadvantage and its impacts across the lifespan.

But while this issue persists, we need to look at what people from disadvantaged groups with mental illness are getting by way of treatment.

Most commonly, people with depression and other mental disorders will be prescribed medications, and/or receive “talking therapies” which might include sessions with a psychologist or other mental health professionals.

Importantly, evidence suggests antidepressants alone are less likely to be effective than a combination of antidepressants and cognitive behavioural therapy. So where antidepressant medication is recommended, psychological therapies should be available too.

But as we know, many Australians with common mental disorders such as depression live in areas of socioeconomic disadvantage. Here, despite the greater need, fewer psychological treatment services are delivered. Location of therapists and out-of-pocket costs can both act as barriers to accessing these services.

Ultimately, while poor people generally need mental health services more, rich people tend to access them at a much higher rate. So poorer people often receive only antidepressants, and alone, these may have only a modest effect, placing them on the back foot in terms of their recovery.

Much of this care provision rests with Commonwealth Medicare-funded services. State services, meanwhile, struggle to respond to needs left unmet.

The Commonwealth and the states must work together

Although spending on mental health has increased in recent years, so too has the system’s complexity and fragmentation. Delivering equitable mental health care for Australians is complicated by the federal structure and divisions of responsibilities.

For private provider services, there is a need for incentive structures that secure the delivery of free or lower-cost services for the people and in the places where there is greatest need.

The Victorian royal commission into mental health is asking about drivers of poor community mental health, and flagging the importance of community and economic participation in improving mental health.

Within state mental health policy, funding models should ensure that while all communities get a decent level of mental health care, there is more service availability in areas and communities we know have higher rates of mental health problems.

We’d also be well-served by adopting newer strategies to facilitate access. For example, some people in difficult circumstances may nevertheless have broadband internet sufficient for video links. Getting psychological therapies into people’s homes through this route may be one way around other access problems.

The Victorian royal commission should propose making state funding distribution fairer, but cannot fix these problems alone.

In a recent positive step, the Commonwealth and state governments have signed up to a set of tasks aiming to move towards better integrated mental health care planning.

The challenge for governments now is to cooperate with and support mental health service providers to ensure these services are better connected with each other, and importantly, more fairly and consistently delivered in relation to need.

Graham Meadows, Professor of Adult Psychiatry, Monash University

Anthony Cichello, Clinical Psychologist, Melbourne, and Adjunct Research Fellow, Monash University 

Anton Neville Isaacs, Senior Lecturer, Monash School of Rural Health, Monash University

Frances Shawyer, Research Fellow, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Submissions for the Royal Commission into Victoria’s Mental Health System are open until July 5.

If this article has raised issues for you or you’re concerned about someone you know, call Lifeline on 13 11 14.The Conversation

Editor's Picks

Spyre Group brings successful Queensland blueprint to Melbourne with Hampton Ltd
Saxon Street by Milieu to bring new housing and urban design to Brunswick’s cultural core
Construction begins at Fishermans Bend Innovation Precinct
Gurner reveals new plans for final Jam Factory stage
Tian An launches North Village, Auburn Square second stage

Related Projects

16-22 Maud Street, Newstead QLD 4006
16-22 Maud Street, Newstead QLD 4006
16-22 Maud Street, Newstead QLD 4006
Price
Contact agent
35-37 Mount Street, Prahran VIC 3181
35-37 Mount Street, Prahran VIC 3181
35-37 Mount Street, Prahran VIC 3181
Price
Contact agent
118-124 Benelong Road, Cremorne NSW 2090
118-124 Benelong Road, Cremorne NSW 2090
118-124 Benelong Road, Cremorne NSW 2090
Price
Contact agent
118-120 Matthew Flinders Drive, Cooee Bay QLD 4703
118-120 Matthew Flinders Drive, Cooee Bay QLD 4703
118-120 Matthew Flinders Drive, Cooee Bay QLD 4703
Price
Contact agent
26-62 Kinross Road, Thornlands QLD 4164
26-62 Kinross Road, Thornlands QLD 4164
26-62 Kinross Road, Thornlands QLD 4164
Price
Contact agent
9-11 Baroonba Street, Whitebridge NSW 2290
9-11 Baroonba Street, Whitebridge NSW 2290
9-11 Baroonba Street, Whitebridge NSW 2290
Price
Contact agent
18 Ransley Street, Penrith NSW 2750
Perle, East Side Quarter, Penrith - 18 Ransley Street, Penrith
18 Ransley Street, Penrith NSW 2750
Price
Contact agent
Ernest Cavanagh Street, Gungahlin ACT 2912
Raya, Gungahlin - Ernest Cavanagh Street, Gungahlin
Ernest Cavanagh Street, Gungahlin ACT 2912
Price
Contact agent
39 Browning Street, South Brisbane QLD 4101
39-41 Browning Street, South Brisbane - 39 Browning Street, South Brisbane
39 Browning Street, South Brisbane QLD 4101
Price
Contact agent
675 Gardeners Road, Mascot NSW 2020
Kiara North, Mascot - 675 Gardeners Road, Mascot
675 Gardeners Road, Mascot NSW 2020
Price
Contact agent
187 Salvado Road, Jolimont WA 6014
Jolie, Jolimont - 187 Salvado Road, Jolimont
187 Salvado Road, Jolimont WA 6014
Price
Contact agent
47 Maning Avenue, Sandy Bay TAS 7005
Grace Residences - 47 Maning Avenue, Sandy Bay
47 Maning Avenue, Sandy Bay TAS 7005
Price
Contact agent
Cove Lane, Narooma NSW 2546
Cove, Narooma - Cove Lane, Narooma
Cove Lane, Narooma NSW 2546
Price
Contact agent
52-56 Ramsay Street, Five Dock NSW 2046
Ava, Five Dock - 52-56 Ramsay Street, Five Dock
52-56 Ramsay Street, Five Dock NSW 2046
Price
Contact agent
2375 Gold Coast Highway, Mermaid Beach QLD 4218
The Alfred - 2375 Gold Coast Highway, Mermaid Beach
2375 Gold Coast Highway, Mermaid Beach QLD 4218
Price
Contact agent
129-131 Russell Ave, Dolls Point NSW 2219
ALLURE COLLECTION - 129-131 Russell Ave, Dolls Point
129-131 Russell Ave, Dolls Point NSW 2219
Price
Contact agent
62 Constitution Avenue, Parkes ACT 2600
The Eastbourne on Commonwealth Park - 62 Constitution Avenue, Parkes
62 Constitution Avenue, Parkes ACT 2600
Price
Contact agent
155 Old Burleigh Road, Broadbeach QLD 4218
Sandpiper, Broadbeach - 155 Old Burleigh Road, Broadbeach
155 Old Burleigh Road, Broadbeach QLD 4218
Price
Contact agent
33 Vulture Street, West End QLD 4101
33 Vulture Street, West End QLD 4101
33 Vulture Street, West End QLD 4101
Price
Contact agent
19 Governor Terrace, Murarrie QLD 4172
Park Hill Village Collection, Murarrie - 19 Governor Terrace, Murarrie
19 Governor Terrace, Murarrie QLD 4172
Price
Contact agent
122 Marine Parade, Miami QLD 4220
Nalu, Miami - 122 Marine Parade, Miami
122 Marine Parade, Miami QLD 4220
Price
Contact agent
34 Jacaranda Place, Indooroopilly QLD 4068
34 Jacaranda Place, Indooroopilly QLD 4068
34 Jacaranda Place, Indooroopilly QLD 4068
Price
Contact agent
167 Old Burleigh Road, Broadbeach QLD 4218
167 Old Burleigh Road, Broadbeach QLD 4218
167 Old Burleigh Road, Broadbeach QLD 4218
Price
Contact agent
21 Queens Way, Yeerongpilly QLD 4105
Yeerongpilly Green - 21 Queens Way, Yeerongpilly
21 Queens Way, Yeerongpilly QLD 4105
Price
Contact agent
445-449 River St, Ballina NSW 2478
Solhaven - 445-449 River St, Ballina
445-449 River St, Ballina NSW 2478
Price
Contact agent
52 Sunset Boulevard, Surfers Paradise QLD 4217
52 Sunset Boulevard, Surfers Paradise QLD 4217
52 Sunset Boulevard, Surfers Paradise QLD 4217
Price
Contact agent
6 Jack Brabham Drive, Hurstville NSW
Horizon Hurstville - 6 Jack Brabham Drive, Hurstville
6 Jack Brabham Drive, Hurstville NSW
Price
Contact agent
49 Seena Drive, Edgeworth NSW 2285
49 Seena Drive, Edgeworth NSW 2285
49 Seena Drive, Edgeworth NSW 2285
Price
Contact agent
Lot 118 Ocean Steamers Road, Port Adelaide SA 5015
Lot 118 Ocean Steamers Road, Port Adelaide SA 5015
Lot 118 Ocean Steamers Road, Port Adelaide SA 5015
Price
Contact agent
203 Ashmore Road, Benowa QLD 4217
203 Ashmore Road, Benowa QLD 4217
203 Ashmore Road, Benowa QLD 4217
Price
Contact agent
774 Ripley Road, Ripley QLD 4306
774 Ripley Road, Ripley QLD 4306
774 Ripley Road, Ripley QLD 4306
Price
Contact agent
6 Homelea Court, Rivervale WA 6103
6 Homelea Court, Rivervale WA 6103
6 Homelea Court, Rivervale WA 6103
Price
Contact agent
7002 Ripley Road, Ripley QLD 4306
7002 Ripley Road, Ripley QLD 4306
7002 Ripley Road, Ripley QLD 4306
Price
Contact agent
3 Delos Way, Sorrento WA 6020
3 Delos Way, Sorrento WA 6020
3 Delos Way, Sorrento WA 6020
Price
Contact agent
77 Sutton Street, Redcliffe QLD 4020
77 Sutton Street, Redcliffe QLD 4020
77 Sutton Street, Redcliffe QLD 4020
Price
Contact agent
119 Queen Street & 86 King Street, Bendigo VIC 3550
119 Queen Street & 86 King Street, Bendigo VIC 3550
119 Queen Street & 86 King Street, Bendigo VIC 3550
Price
Contact agent
181 Prospect Road, Prospect SA 5082
181 Prospect Road, Prospect SA 5082
181 Prospect Road, Prospect SA 5082
Price
Contact agent
593-595 Albany Highway, Victoria Park WA 6100
593-595 Albany Highway, Victoria Park WA 6100
593-595 Albany Highway, Victoria Park WA 6100
Price
Contact agent
1-28, 40 Civic Way, Rouse Hill NSW 2155
1-28, 40 Civic Way, Rouse Hill NSW 2155
1-28, 40 Civic Way, Rouse Hill NSW 2155
Price
Contact agent
93-97 Bay Street, Brighton VIC 3186
93-97 Bay Street, Brighton VIC 3186
93-97 Bay Street, Brighton VIC 3186
Price
Contact agent
22-38 & 27-31 The Avenue, Coburg VIC 3058
22-38 & 27-31 The Avenue, Coburg VIC 3058
22-38 & 27-31 The Avenue, Coburg VIC 3058
Price
Contact agent
1F Ashline Street, Wollert VIC 3750
1F Ashline Street, Wollert VIC 3750
1F Ashline Street, Wollert VIC 3750
Price
Contact agent
Lots 100 & 900 Kentucky Court, Cockburn Central WA 6164
Lots 100 & 900 Kentucky Court, Cockburn Central WA 6164
Lots 100 & 900 Kentucky Court, Cockburn Central WA 6164
Price
Contact agent
1260-1272 Malvern Road, Malvern VIC 3144
1260-1272 Malvern Road, Malvern VIC 3144
1260-1272 Malvern Road, Malvern VIC 3144
Price
Contact agent
472 Regency Road, Prospect SA 5082
472 Regency Road, Prospect SA 5082
472 Regency Road, Prospect SA 5082
Price
Contact agent
273A Gorge Road, Paradise SA 5075
273 Gorge Road, Paradise SA 5075 - 273A Gorge Road, Paradise
273A Gorge Road, Paradise SA 5075
Price
Contact agent
270 The Esplanade, Miami QLD 4220
270 The Esplanade, Miami QLD 4220
270 The Esplanade, Miami QLD 4220
Price
Contact agent
2 & 6 Austral Parade, East Bunbury WA 6230
2 & 6 Austral Parade, East Bunbury WA 6230
2 & 6 Austral Parade, East Bunbury WA 6230
Price
Contact agent
5 Charles Street, Charlestown NSW 2290
5 Charles Street, Charlestown NSW 2290
5 Charles Street, Charlestown NSW 2290
Price
Contact agent
59 & 69 Merthyr Road, New Farm QLD 4005
59 & 69 Merthyr Road, New Farm QLD 4005
59 & 69 Merthyr Road, New Farm QLD 4005
Price
Contact agent