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

      discussion
      International Journal of Environmental Research and Public Health
      MDPI
      austerity, mental health services, welfare reform

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          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.

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          Most cited references30

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          Social determinants of mental health: a review of the evidence

          Background and Objectives: The aim of this study is to present a non-systematic narrative review of the published evidence on the association between mental health and sociodemographic and economic factors at individual- and at area-level. Methods: A literature search of PubMed and Web of Science was carried out to identify studies published between 2004 and 2014 on the impact of sociodemographic and economic individual or contextual factors on psychiatric symptoms, mental disorders or suicide. The results and methodological factors were extracted from each study. Results Seventy-eight studies assessed associations between individual-level factors and mental health. The main individual factors shown to have a statistically significant independent association with worse mental health were low income, not living with a partner, lack of social support, female gender, low level of education, low income, low socioeconomic status, unemployment, financial strain, and perceived discrimination. Sixty-nine studies reported associations between area-level factors and mental health, namely neighbourhood socioeconomic conditions, social capital, geographical distribution and built environment, neighbourhood problems and ethnic composition. Conclusions Most of the 150 studies included reported associations between at least one sociodemographic or economic characteristic and mental health outcomes. There was large variability between studies concerning methodology, study populations, variables, and mental illness outcomes, making it difficult to draw more than some general qualitative conclusions. This review highlights the importance of social factors in the initiation and maintenance of mental illness and the need for political action and effective interventions to improve the conditions of everyday life in order to improve population's mental health.
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            The enemy between us: The psychological and social costs of inequality

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              Structural violence and schizophrenia.

              B. Kelly (2005)
              Despite clear evidence of a substantial biological basis to schizophrenia, there is also evidence that social, economic and political factors have considerable relevance to the clinical features, treatment and outcome of the illness. Individuals from lower socio-economic groups have an earlier age at first presentation and longer durations of untreated illness, both of which are associated with poor outcome. Individuals with schizophrenia are over-represented in the homeless population. Migration is associated with increased rates of mental illness, including schizophrenia, and this relationship appears to be mediated by psycho-social factors, including difficulties establishing social capital in smaller migrant groups. Individuals with schizophrenia are substantially over-represented amongst prison populations, and imprisonment increases the disability and stigma associated with mental illness, and impedes long-term recovery. The adverse effects of these social, economic and societal factors, along with the social stigma of mental illness, constitute a form of 'structural violence' which impairs access to psychiatric and social services and amplifies the effects of schizophrenia in the lives of sufferers. As a result of these over-arching social and economic factors, many individuals with schizophrenia are systematically excluded from full participation in civic and social life, and are constrained to live lives that are shaped by stigma, isolation, homelessness and denial of rights. There are urgent needs for (1) the development of enhanced aetiological models of schizophrenia, which elucidate the interactions between genetic risk and social environment, and can better inform bio-psycho-social approaches to treatment; (2) a renewal of emphasis on the United Nations' "Principles for the Protection of Persons with Mental Illness" and related legislative measures in individual countries; and (3) continued study and examination of the impact of social, economic and political structures on the clinical features and outcome of mental illnesses.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                01 June 2018
                June 2018
                : 15
                : 6
                : 1145
                Affiliations
                School of Health and Society, University of Salford, Salford M5 4WT, UK; i.d.cummins@ 123456salford.ac.uk
                Article
                ijerph-15-01145
                10.3390/ijerph15061145
                6025145
                29865157
                b816ff94-4188-429d-89c5-33a9c01702ea
                © 2018 by the author.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 07 April 2018
                : 30 May 2018
                Categories
                Discussion

                Public health
                austerity,mental health services,welfare reform
                Public health
                austerity, mental health services, welfare reform

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