Who does poverty affect? The term is used to identify an individual’s social and economic position. An individual may find themselves in this situation for one of many reasons such as low social class, unemployment, culture, education and also the environment, these concepts may reinforce the problem of poverty. ( Baggott 1998)
Individuals with mental health problems are not immune from this situation, and in fact are one of the most impoverished and isolated groups in society that is, according to a survey which was published last year (An Uphill Struggle 2001). The survey illustrated the severity of the problems faced by these individuals, summarising that they are doubly disadvantaged by their illness and their poverty. Trying to survive on a low income is difficult enough, and when you have mental health problems, it is even tougher. Facing stigma and discrimination on a daily basis makes the mentally ill one of the most socially excluded groups in our society.
Whilst on placement, I was privileged to meet a variety of these deprived people who use benefits for everyday basics. Of the clients that I spoke to, it was clear that in every case, the social horizons available to them, and how they felt about their prospects, was related to the amount of limited income at their disposal.
Tessa (not real name) for example described her lack of social life, because the amount of benefit which she received did not allow her any. If she did decide to go out, then she would have to do without her cigarettes, which she considered as her luxury.
Paul (not real name) received enough benefit each week to cover his food, electricity, rent and gas bills, and only just managed to get by, but found it a struggle.
“I wish I could get a job I just want to work, I would be getting more money to live on than I do now, I’d do anything”
Benefits were used for basic essentials of food, heating and lighting, housing costs and transport, which to say the least is hardly enough, but to be without this financial assistance would mean that they would have a poorer diet, and would be unable to meet basic needs. The inability to visit family and friends through lack of funds would mean social isolation, which in effect would cause an adverse effect on the client’s mental health. (Welch, Lewis and Sloggett 1998)
The clients also relied on the benefits for attendance at the day centre as well as support groups – many would be housebound otherwise. A simple item such as a telephone is essential as no access would probably cause social isolation. There could be a link between people with mental health problems receiving benefits and staying well, as it helps them to maintain to some degree a quality of life.
It is evident that these clients have more to worry about, than merely having a disabling condition, they also have to deal with living on the edge and being stigmatised (Watkins 2000). This is due not only to the fact they have mental health problems but also are in poverty. So we can see from the start that they are oppressed and powerless, because as Thomas, Hardy and Cutting (1997) state, power is taken away from the client when they come into the system .
As healthcare professionals it is intrinsic that we are aware of benefit rights for our patients, and act as their advocates. We need to acknowledge and not neglect these distinct circumstances, as they are very important when addressing the needs of these clients (Watkins 2000). Suggestions made by Davis and Wainwright (1996) state that perhaps this neglect by us, is fuelled by the preconceived beliefs of healthcare professionals that their poverty is self-inflicted and even due to irresponsibility. This is one reason why clients do not seek advice from statutory services within the NHS to help them access the benefit system, and would rather get support from benefit advisors and independent advocates.
An example of the above was evident on my placement. Harry (not real name) found it very difficult to alert any of the team to his dilemma with housing. His powerlessness caused him to be passive and to not express his concerns of his housing crisis. He had preferred instead to remain silent through fear of being judged and being reprised. The result was that he incurred rent arrears and the threat of an eviction, this was due to tenancy agreement being broken.
He told me:
“They never listen anyway, they’re always in that office away from us, they never know if we’re alright or not ”.
This kind of scenario is echoed widely throughout every mental health institute. Thomas, Hardy and Cutting (1997) draws our attention to the fact that most mental health clients will never be given a choice, or very little choice of treatment, for instance if a consultant has a research running on a certain drug, then his clients are more than likely to be taking it. It appears then that due to the clients socio-economic and medical situation, that the health care professionals say whether they live or die.
To summarise, it is true to say that poverty is associated with deprivation and lack. The two categories of poverty which are relative and absolute poverty, have an important impact on an individuals health status (Chard, Lilford, Gardiner 1999).
Mental health clients are not exempt from poverty. For individuals with mental health problems, it is evident that poverty walks hand in hand with other excluding factors which they are unfortunate enough to have. Stigmatisation is then added to an already ostracised lifestyle (Field and Taylor 1998).
Many find themselves existing on welfare benefits. It would also appear that many clients may be eligible for a higher level of benefit which would give them a better standard of living, but because of stigmatisation by healthcare professionals caused by their illness, many prefer to either consult outside agencies or even remain in the poverty to which they have become accustomed to (Welch, Churchill, Lewis, Mann 1998).
As healthcare professionals it seems that being biased towards the client and his socio-economic and medical situation, presumably helps us to make up our mind in relation to the health care which they will receive. This is one of the reasons why clients remain passive, because professionals will treat them with values based on social assumptions (Chard, Lilford, Gardiner 1999).
Given that benefits are the main source of income of these individuals, healthcare professionals must acknowledge clients powerlessness which has been instigated by their disadvantage. We should make ourselves accessible to clients and act as their advocate. To this end, if we do our best to reduce health inequalities, then surely the health of the nation will improve.
References
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