The ‘Syndemic’ of Poverty and Mental Health in Young People 

The ‘Syndemic’ of Poverty and Mental Health in Young People

A higher number of poorer children are being referred for mental health support in England, compared to young people who live in the richest areas, new analysis shows

The rate at which children and teenagers in the poorest neighbourhoods in England are referred to mental health hospitals is far higher than in the richest neighbourhoods, according to a Byline Times analysis of Government figures.

Across England, the rate of referrals of under-18s in the poorest neighbourhoods to secondary mental health services was 57% higher in 2019/20 than in the least deprived neighbourhoods. In some local authorities, it was more than twice as high in the poorest neighbourhoods as the richest ones.

These inequalities have persisted over time. Across England, the referral rate was 59% higher in the poorest neighbourhoods in 2017/18 and 66% higher in 2018/19.

The analysis comes as reports emerge that new Health and Social Care Secretary Thérèse Coffey has scrapped the Government’s long-pledged white paper on health inequalities.

The impact of poverty on health is well established. Professor Sir Michael Marmot’s landmark 2010 report into the links between poverty and health found that people living in households in the lowest 20% income bracket were two to three times more likely to develop mental health problems than those in the highest 20%. 

Marmot’s follow-up report published in early 2020 found that “insufficient income is associated with poor long-term physical and mental health and low life expectancy”. 

“Overall, if you look at social deprivation and mental health problems, there’s a clear relationship with deprivation and the overall prevalence of these things,” David Taylor-Robinson, Professor of Public Health and Policy at the University of Liverpool, told Byline Times. “And it’s not surprising that also holds within local authorities.”

The referrals data is calculated based on ‘lower super output areas’ (LSOAs), which are the small geographical areas used in official deprivation statistics. Each LSOA includes 1,500 people on average. 

The rate at which under-18s were referred to secondary mental health services in the poorest fifth of LSOAs in Bristol was nearly four times as high as the rate in the richest fifth.

In North Somerset, the rate was more than three times as high in the poorest fifth of LSOAs, while in a further 20 local authority areas – including Stockton, Trafford, Northumberland and Westminster – the rate in the poorest fifth of LSOAs was at least double that in the richest fifth.

Secondary mental health services are those that generally require a referral – including mental hospitals but also some psychological wellbeing services, community mental health teams and other similar services.

“The more deprived areas need more funding for these services,” Prof Taylor-Robinson said. “And within areas, you need to consider equity of access according to social deprivation and make sure that the kids in the most disadvantaged areas are getting referred to those services.”

Research by Prof Taylor-Robinson and others published in the Lancet last year identified that a combination of persistent poverty and parental mental health issues is related to a heightened risk of mental health issues in children.

“It’s the combination of those two which is particularly responsible for the intergenerational transfer of children’s mental health problems,” he told Byline Times. “So 10% of kids grow up in families that are persistently poor and where their parents have persistent mental health problems. And those kids are about seven times more likely to develop a mental health problem than kids who aren’t exposed to poverty or parental mental health problems.

“Exposure to adversity is an important mechanism for a generation of later adverse health problems. So kids who are born into poverty, for example, they’re more likely to be exposed to parents who have a mental health problem. And parental mental health problems is an important risk factor for children developing mental health problems.”

The Lancet study concluded that measures to address adversities in childhood “may not be meaningful” if socio-economic factors such as poverty in childhood are not considered. The authors called for the Government to retain the Universal Credit uplift (which it subsequently axed) and reverse benefit cuts that increased child poverty, reinvest in support services and preventative services such as children’s centres, and improve access to mental health services for families.

“People call it a ‘syndemic’ of poverty coexisting with parental mental health problems,” Prof Taylor-Robinson said. “COVID was called a syndemic – COVID is the interaction of poverty and a virus that amplify one another and make the situation worse. HIV has been described as syndemic. But I think what we’re seeing here in the UK is a syndemic of social disadvantage and mental health problems. 

“So one of the reasons why kids have been so hammered by the pandemic is that parents’ mental health has deteriorated, especially those who were finding it hard and were experiencing poverty pre-pandemic. And those things have subtle effects on children’s early child development, which then have intergenerational impacts which won’t become evident for a while.”

NHS England did not respond to Byline Times’ request for comment.