Placing poverty-inequality at the centre of psychiatry

Byrne, Peter; James, Arthur G.

doi:10.1192/bjb.2020.85

Cited by 11 publications

(8 citation statements)

References 23 publications

(18 reference statements)

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“…If we accept the proposed notion of a casual association between inequality and mental health, several important implications emerge from our findings. Most fundamentally, they suggest that rising levels of inequality may drive increases in the incidence of mental health disorders, and arguably as a consequence, that inequality (alongside poverty and other environmental factors) should be placed at the centre of psychiatry and applied psychology [ 5 ]. For example, national guidelines for Early Intervention Psychosis services in the UK [ 119 ] state that commissioning “should be underpinned by estimated local incidence of psychosis, derived to incorporate a range of demographic features such as ethnicity, age, population density and deprivation” (p. 6), and to this we would add inequality as a further important factor for consideration.…”

Section: Discussionmentioning

confidence: 99%

“…Whilst this has led to calls for greater investment in psychological therapies [2], of which the UK's improving access to psychological therapies (IAPT) scheme is a prime example [3], such an approach, which (arguably) locates the problem as well as the solution in the individual, has had its detractors. Thus, many have proposed that such an approach fails to take into consideration the socioeconomic contexts in which mental illness, and distress more generally, occurs, and consequently, removes the onus on governments for broader social and economic reform [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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The association between income inequality and adult mental health at the subnational level—a systematic review

Tibber¹,

Walji²,

Kirkbride³

et al. 2021

Soc Psychiatry Psychiatr Epidemiol

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Purpose A systematic review was undertaken to determine whether research supports: (i) an association between income inequality and adult mental health when measured at the subnational level, and if so, (ii) in a way that supports the Income Inequality Hypothesis (i.e. between higher inequality and poorer mental health) or the Mixed Neighbourhood Hypothesis (higher inequality and better mental health). Methods Systematic searches of PsycINFO, Medline and Web of Science databases were undertaken from database inception to September 2020. Included studies appeared in English-language, peer-reviewed journals and incorporated measure/s of objective income inequality and adult mental illness. Papers were excluded if they focused on highly specialised population samples. Study quality was assessed using a custom-developed tool and data synthesised using the vote-count method. Results Forty-two studies met criteria for inclusion representing nearly eight million participants and more than 110,000 geographical units. Of these, 54.76% supported the Income Inequality Hypothesis and 11.9% supported the Mixed Neighbourhood Hypothesis. This held for highest quality studies and after controlling for absolute deprivation. The results were consistent across mental health conditions, size of geographical units, and held for low/middle and high income countries. Conclusions A number of limitations in the literature were identified, including a lack of appropriate (multi-level) analyses and modelling of relevant confounders (deprivation) in many studies. Nonetheless, the findings suggest that area-level income inequality is associated with poorer mental health, and provides support for the introduction of social, economic and public health policies that ameliorate the deleterious effects of income inequality. Clinical registration number PROSPERO 2020 CRD42020181507.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The association between income inequality and adult mental health at the subnational level—a systematic review

Tibber¹,

Walji²,

Kirkbride³

et al. 2021

Soc Psychiatry Psychiatr Epidemiol

View full text Add to dashboard Cite

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“…Carrying this knowledge has allowed psychiatrists to make bold observations on the very real impact of social inequality on people's mental health. 48 This ability to understand how influenced people are by their environments is also why psychiatrists should see the growing threat to nature as entwined with climate change and ultimately with mental and physical well-being for everyone.…”

Section: Discussionmentioning

confidence: 99%

The need for biodiversity champions in psychiatry: the entwined crises of climate change and ecological collapse

Krzanowski

2021

BJPsych Bull

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Summary The past 20 years have seen the disappearance and degradation of biodiversity on earth at unprecedented rates. This phenomenon shares similar drivers to those behind climate change yet requires its own solutions. The twin catastrophes of climate change and biodiversity loss demonstrate how our health is bound up in the vitality of this planet. There has been an increasing effort on the part of healthcare professionals to appreciate this relationship, as evidenced by the growing influence of planetary health as a discipline. However, the health impacts of biodiversity loss have been less focused on than those brought on by climate change. Psychiatry's appreciation of the interface between environments and our health, alongside the evidence for the connection between nature and mental health specifically, prompt psychiatrists to ensure that the institution of healthcare throws its influence equally behind solutions to climate change as well as biodiversity loss.

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“…The worst of his experiences were outside health services, and he set me on a path of learning about poverty and inequality. 36 Effective community mental health services require an understanding of the communities we serve. This goes beyond cultural and subcultural beliefs.…”

Section: Discussionmentioning

confidence: 99%