Austerity is shattering lives. How should mental health professionals respond?

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It is often assumed that mental health professionals work with people in distress on an individual level, and that the best place for this work is the consulting room (or, in this age of home-working, online). Some also claim, still, that mental health problems are best understood as lifelong ‘brain conditions’ [1]; stemming essentially from genetic mutations, chemical imbalances, and cognitive distortions, for example, and best ‘treated’ with ‘medication’, and CBT. Or by slogans instructing us to ‘keep calm and carry on’ [2], for that matter.

Such privileging of individual factors de-politicises human suffering; dictating to us that our distress is unrelated to the social and economic conditions in which we as individuals live; distracting us presently from a climate of widespread poverty, division, disconnection, deceit, denial, distrust, hatred, humiliation, and mass murder. When we consider Russia’s war on Ukraine, the threat of nuclear annihilation, bloodshed in Iran, Brexit, the cost of living crisis, the dehumanisation of refugees, Trumpism, Bolsonarism, and the continued destruction of nature in the face of climate and ecological breakdown [3], we might ask ourselves is it sane to focus on inner peace when Rome is burning [4].

The professional guidelines for my own discipline state that we have obligations not only to those we support, but to society, and that we should challenge those who devalue others due to their class, race, gender, sexuality, religion, and economic situation. Counselling psychology stands for social justice work; for challenging systemic policies that disempower, marginalise, and kill [5]. With this in mind, I will, in this piece, call into question the UK government’s austerity policies, highlighting their effects on the UK population. In essence, I will argue that austerity is a cover for a war by wealthy politicians and their backers on those less privileged than themselves; a class war, and an ideological war. I will then describe some challenges this analysis poses for the mental health professions.

Austerity in the UK

In 2010, in the wake of the global financial crisis, the newly elected Conservative-dominated coalition government in the UK unleashed an unprecedented austerity drive in support of ‘deficit reduction’, framing ‘the cuts’ as necessary to the UK’s economic recovery, and thus, unavoidable, and moral [6]. Contrary, however, to governmental claims “we’re all in this together”, the implemented changes to taxes and benefits, alongside cuts to local government, social services, and NHS budgets, meant that, as a whole, those worst impacted were in the bottom half of the income distribution; while those at the very top made huge gains. From the outset, in other words, austerity disproportionately affected, and continues to disproportionately impact, the poorest and most vulnerable people in society; a choice[7] that can be seen as avoidable, and immoral [8]. Indeed, while the UK Conservative Government have repeatedly framed austerity as an essential response to global financial crises, more recently blaming these crises on Covid and Russia’s war on Ukraine, the measures rolled out can be seen as a cover for a market-driven restructuring of social welfare policy, amounting to “class war conservatism” [9] – congruent with an ideology dominating policy development in the UK since 1979; a redistribution of wealth away from the poor, to the rich. Again, austerity can be seen as cover for a war by the wealthy upon those less privileged than themselves; an ideological war.

Austerity can be seen as a fundamental expression of the ideology of ‘neoliberalism’, a theory of political economic practices which casts competition as the defining characteristic of human relations. In the neoliberal world, social inequality is remolded as virtuous. Taxes and regulations on ‘entrepreneurial freedoms’ are minimised, public services are cut and privatised, and the rich tell themselves they gained their wealth through merit – ignoring advantages such as inheritance, class, schooling, influence, and profiteering from privatisation of public services, that typically secured it [10]. Proponents of neoliberalism inflict, mask, and legitimise inequality [11]; mainly via the major institutions of our societies – large corporations, the mass media, health, and welfare services. Orchestrations include cuts to local government funding, meaning, again, reductions in services on which the already disadvantaged rely, and marginalisation, supported by swathes of the media, which often operate hand in glove with the government, assisting politicians behind austerity policies in framing those worst affected as undeserving. Thus, people hit worst by austerity will be both materially disadvantaged, and stigmatised as work-shy, benefits-dependent, fraudulent, criminal, and immoral [12] – with messages such as ‘You are a burden on society’, strongly conveyed. From a psychoanalytic viewpoint, this process involves powerful institutions and people also projecting their shadow material onto those less fortunate than themselves; placing their ‘badness’ ‘out there’ [13]. Bombarded by these projections, the underprivileged often blame themselves for their plight, when there is often little they can do to escape.

Those worst impacted by austerity are, in a way, enslaved; their freedoms curtailed in manifold ways. On this level of society, ‘pathological’ behaviours on the part of the individuals, as opposed to structural, social factors, are emphasised, assisted by one of the most powerful forces within our mental healthcare system, biological psychiatry; described by one critical psychiatrist as being in a ‘marriage of convenience’ with neoliberalism [14]. Those who suffer at the hands of – and act outside of the norms of – society are likely to receive labels such as ‘schizophrenia’, ‘personality disorder’ and ‘bipolar disorder’ [15], typically framed in psychiatric publications and the media, again, as permanent ‘brain diseases’, inside individuals gone wrong. These kinds of diagnoses can be seen as justifying predetermined social responses designed to control and contain disturbed and disturbing behaviour [16]; the primary response being ‘treatment’ with powerful, and harmful, drugs. Such focus on individuals masks the role of systemic factors, including austerity.

On the micro-level, austerity policies have had a profoundly negative impact upon mental health across the UK [17], contributing, for example, to dramatic rises in the number of mental health appointments reported by GPs, antidepressant prescriptions, and male suicides. Austerity has increased, and continues to increase, the number of people living in relative poverty: now 22 per cent of the UK population – 14.5 million people. Present government policy is predicted, in 2023-24, to force 2.75 million more into poverty and 1.7 million more into ‘deep poverty’ [18].  This is troubling, to put it mildly. Poverty is seen as the “cause of the causes” of mental health problems, giving rise to a ‘context of stress’, increasing rates of depression, anxiety, psychosis, and addiction  [19]. Due to high stress levels among parents in poverty in the UK, they are likely to be less emotionally available to their children [20], shaping, in turn, their children’s attachments, relationships, and capacity to emotionally self-regulate [21]. Inequality more generally contributes across all of society, to increased obesity, crime, and interpersonal violence, and to reduced educational attainment, child wellbeing, social cohesion, and life expectancy [22] [23] [24]. Inequality produces ‘epidemics’ of phobias, eating disorders, and self-harm [25], and generates ‘affluenza’ and ‘status anxiety’, whereby high value is placed upon acquiring money and possessions, and being appraised positively by others. Such values generate shame. Indeed, the group Psychologists Against Austerity (now Psychologists for Social Change) identified five ‘austerity ailments’ mediating the link between austerity and mental health problems: humiliation and shame; fear and distrust; instability and insecurity; isolation and loneliness; and being trapped and powerless. These mediators are, they conclude, indicators of problems in our society, of weakened social solidarity, of inequalities in power and wealth, and of poisonous public policy [26].

Concerning most recent austerity policies, the United Nations present envoy on extreme poverty and human rights recently told the UK government that this is the ‘worst time’ for more austerity; that cuts in 2022 violate human rights laws, calling instead for higher taxes on the wealthiest in society, and on corporations. This call reignited conflict between the UN and the UK government on poverty after the previous UN envoy on extreme poverty and human rights concluded in 2018 that Conservative governments in the UK had inflicted “great misery”, with “punitive, mean-spirited and often callous” austerity policies driven by a political desire to ensure social re-engineering, rather than by economic necessity. The envoy described levels of child poverty in the UK as “not just a disgrace, but a social calamity and an economic disaster” [27]. These assertions have been dismissed by the UK government, which, in 2022, and 2023, ushered in new austerity budgets, choosing [28] again to hit low- and middle-income people with public service cuts and stealth taxes [29], while again bolstering the profits of big corporations and the wealth of the ‘one per cent’. The present cost of living crisis, so harmful to mental health [30], comes at a time when the number of billionaires in the UK rose by 24 per cent over the course of the covid pandemic, with the wealth of the UK’s billionaires as a whole rising by 22 per cent over the same period. Between 2019 and 2021, the average profit margins of the big FTSE 350 companies increased by 73 per cent [31], and the profiteering continues. Over the next two years, the UK Treasury estimates that energy firms, for example, will make £170 billion in “excess profits” [32]. A question arises, how do we respond to this?

Austerity’s challenges for the mental health professions

  1. Systemic power imbalances

The reproduction of inequalities in mental health services is commonplace. By pathologizing, and decontextualising human suffering, such services often mask and legitimise inequalities, assisting in perpetuating established power imbalances. Many contemporary approaches to the ‘treatment’ of human suffering prioritise standardisation, cost-effectiveness, and the authority of clinicians; they are neoliberal. Again, institutions of ‘mental illness’ which frame chemical imbalances, genetic mishaps, and cognitive distortions as the root causes – as opposed to mediators – of human suffering can be seen as being in a ‘marriage of convenience’ with the dominant economic ideology. While I certainly think CBT has a place at the table of approaches to human suffering, others see it as a codeword for the “scientificity” that defines the neoliberal era, with its indoctrination of people into a system of moral protocols for thought, under the assumption pathology lies in erroneous cognitions:

“We can think of [CBT] rather like the now disgraced attempts to use psychotherapy to “cure” homosexuals, except that, rather than a heteronormative goal being at the fore, the new aim is to produce subjects who conform to the alienated individualism of austerity capitalism; each person her own entrepreneur, manager, disciplinarian, panopticon” [33].

The quote “it is no measure of health to be well adjusted to a profoundly sick society” also springs to mind here. If we are to not collude with this sick society, if we are to not contribute to the problem of inequality, we should not obscure the ways in which power serves to maintain and deepen this inequality. Asking questions in mental health services throughout the engagement process, about systemic pressures in the lives of those we endeavour to support, can help to make the role of power more explicit. The Power Threat Meaning Framework offers one promising early alternative to the psychiatric diagnostic system.

  1. Getting political, shifting media narratives, coming together

Mental health professionals must engage not only with the political in the lives of those we meet with, but also be more politically active, as a whole. Again, mental health is not an individual issue; it involves the totality of the social and economic conditions in which individuals live. Societies and economies that are collaborative, equal, and cohesive, tend to promote good health, with key indicators of mentally healthy societies including agency; security; connection; meaning; and trust. The austerity policies of the UK Conservative government, in contrast, seem to have served for the past 13 years to foster poor mental health among most of the population, by causing people to feel trapped, powerless, unstable, insecure, isolated, lonely, humiliated, ashamed, fearful, mistrustful, and angry. Key mechanisms in all of this, again, are fear- and hate-fuelled media narratives which, unsurprisingly (and seemingly intentionally), increase fear, despair, a sense of helplessness, and contempt and hostility towards others. Such narratives, again, enable the projection of our shadow nature onto ‘enemies’, forcing them to bear our ‘badness’ for us [34]. A necessary evolution of consciousness requires that we connect with and integrate our shadow, if we are to navigate our way through these most treacherous of times.

The false idea that our fellow human beings are to be distrusted and feared is, also, a keystone of the free market economy. Take this keystone down and the whole rotten arch is liable to collapse. Presently, we in the UK must put all of our efforts into removing those who fuel fear and hatred with stories demonising ‘foreigners’, minorities, refugees, the working classes, and, most recently, essential keyworkers including nurses, from power. Now is the time for community-building; for coming together with striking nurses, doctors, teachers, transport workers, civil servants, and Unions, in order to force those presiding over 13 years of this mess, out. This is urgent as we move deeper into the climate crisis. On this score, the UN has said that the UK Conservative government’s focus on new fossil fuel extraction, despite warnings from the UN, the IEA, and 99 per cent of the world’s scientists, that this will bring about the collapse of human civilisation, is ‘moral and economic madness’ [35].

There are alternatives to this madness, and to more austerity, poverty, and all that these bring. The urgent priority is for the UK government to increase taxes on the wealthiest, and on corporations, and halt this shattering assault upon most of the rest of us [36] [37]. Because the present Conservative government remains ideologically opposed to this change, again, we must come together and make it happen. Or else, where will this war end?

 

References:

[1] Bentall, R. (2016). All in the brain? Retrieved March 13, 2023

[2] “Keep Calm and Carry On” was one of three key messages created by Britain’s wartime propaganda department, the Ministry of Information, made famous as the Ministry of Truth in George Orwell’s novel, 1984.

[3] Rao, M. (2022). Mental health impacts of the climate crisis: the urgent need for action. International Review of Psychiatry, 34(5), 439-440. Retrieved March 1, 2023

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[5] Goodman, L. A., Liang, B., Helms, J. E., Latta, R. E. Sparks, E., & Weintraub, S. R. (2004). Training counseling psychologists as social justice agents: Feminist and multicultural principles in action. The Counseling Psychologist, 32(6), 793-837. Retrieved March 13, 2023

[6] Afoko, C., Vockins, d. (2013). Framing the economy: The austerity story. London: New Economics Foundation. Retrieved March 20, 2023

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[8] McGrath, L., Griffin, V., & Mundy, E. (2015). The Psychological Impact of Austerity: A Briefing Paper. Retrieved March 13, 2023

[9] Hodkinson, S., & Robbins, G. (2013). The return of class war conservatism? Housing under the UK coalition government. Critical Social Policy, 33(1), 57–77. Retrieved March 10, 2023

[10] Monbiot, G. (2016). Neoliberalism – the ideology at the root of all our problems. Retrieved March 10, 2023

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[14] Moncrieff, J. (2008). Neoliberalism and biopsychiatry: A marriage of convenience. In C. I. Cohen & S. Timimi (Eds.), Liberatory psychiatry: Philosophy, politics and mental health (pp. 235-256). Cambridge: Cambridge University Press. Retrieved March 1, 2023

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[18] Legatum Institute (2022). Rising costs projected to push 2.75 million into poverty. Retrieved March 13, 2023

[19] Patrick, R. & Pybus, K. (2022). Cost of living crisis: we cannot ignore the human cost of living in poverty. British Medical Journal (BMJ). Retrieved March 14, 2023

[20] Nairn, A., & Ipsos MORI. (2011). Children’s well-being in UK, Sweden and Spain: The role of inequality and materialism. Retrieved March 14, 2023

[21] Harris, C. (2016). Austerity, wellbeing and psychotherapy. Psychotherapy Section Review, 58, 55–61.

[22] Wilkinson, R., & Pickett, K. (2010). The spirit level: Why more equal societies almost always do better. London, United Kingdom: Penguin Books.

[23] The Equality Trust (2013). Income Inequality and Crime: A Review and Explanation of the Time–series Evidence. Retrieved March 31, 2023

[24] The Royal Society of Medicine (2023). New global ranking for life expectancy shows decades-long UK decline. Retrieved March 31, 2023

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[27] Statement on Visit to the United Kingdom, by Professor Philip Alston, United Nations Special Rapporteur on extreme poverty and human rights. Retrieved March 6, 2023

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[31] Unite (2022). Unite Investigates: Corporate profiteering and the cost of living crisis. Retrieved March 13, 2023

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[35] United Nations (2022). Secretary-General Warns of Climate Emergency, Calling Intergovernmental Panel’s Report ‘a File of Shame’, While Saying Leaders ‘Are Lying’, Fuelling Flames. Retrieved March 15, 2023

[36] Lawson, M. (2023). The super-rich elite must pay their fair share to fight global inequality. British Medical Journal (BMJ). Retrieved March 15, 2023

[37] Oxfam (2023). Survival of the richest: how we must tax the super-rich now to fight inequality. Retrieved March 16, 2023