Transcript - European Partnership for Supervisory Organisations in

The human cost of the economic
crisis:
A review of the evidence on economic
adversity and mental health
Rosemary Smyth
EPSO Meeting
Dublin
September 2014
Presentation Aim
 Introduction to Ireland & some features of the
recession
 Overview of Mental Health Commission Publication
“ The human cost of the economic crisis:
A review of the evidence on economic adversity and
mental health”
Ireland Population
The Recession – Some Features
 Swift and dramatic decline: negative growth, high
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unemployment, high national debt, banking crisis
Personal debt levels much higher than ever before
Personal debt combined with dramatic reductions in
property and investment values
Group of people who have never experienced economic
adversity before
Perceived effect of the recession more marked in Ireland
due to the rapid and steep decline from a period of
unprecedented growth - living standards increased by
1/3 in 10 years.
Inflation & Unemployment Rate
Public Debt
 Before 2007 the levels of Irish public debt were low
and declining.
 As a consequence of the very deep recession which
began in 2008, combined with significant levels of
public money injected into the Irish banking system in
2009, 2010 and 2011, the level of public debt soared.
 National debt increased from 20 % of GDP in 2007 to
84 % of GDP in 2012,
 The general government debt increased from 25 % of
GDP in 2007 to 117 % of GDP in 2012.
National Debt
Annual GDP Growth
Health Expenditure
 Following rapid increases during the first
part of this ten year period, a decrease of 11%
in total public health expenditure has taken
place since 2009.
 Capital expenditure, which accounts for
only 3% of total expenditure, was 32% lower
in 2012 than in 2003 and 41% lower than in
2008.
Mental Health Budget
 A Vision for Change (Government Policy on mental health) was
published in 2006, if fully implemented the mental health budget would
be expected to account for 8.24% of overall on-going health spending.
 Spending decreased from 7.2% in 2006 to 5.2% in 2012 - averaged 6.11%
of overall health spending.
 As a percentage of overall health spend, the budget for mental health
has always been lower than recommended for a developed country.
 In the UK, mental health is 12% of the health budget.
 The overall amount of funding for mental health services has dropped
from €937 million in 2006 to €733 million in 2013.
 Before the recession in Ireland, the percentage was down to 7%, and
since the recession has reduced to nearer 5%.
Mental Health Commission
 The Mental Health Commission (MHC) is an
independent statutory body.
 The principal functions of the Commission are:
 to promote, encourage and foster the establishment
and maintenance of high standards and good
practices in the delivery of mental health services;
 to protect the rights of individuals who are
involuntarily admitted.
Background
 The Commission was concerned about the impact of
the current economic situation on the mental health of
the wider population and on those with pre-existing
mental health conditions in particular
 The Commission was also concerned about the
resultant impact on the mental health services
 The Commission wished to propose helpful, pragmatic
actions that could be easily implemented and which
may help alleviate some mental distress and difficulties
 A review of evidence was undertaken and a workshop
convened
Who is affected?
 People with pre-existing mental health difficulties:
 Most are already ‘at the margins’ in terms of high unemployment and
high debt levels – 1 in 4 with mental health difficulties is in debt
(English study)
 Features of specific mental health difficulties can lead to/exacerbate
debt
 Stigma attaching to mental illness leads to a reluctance to engage
with financial institutions
 The rest of the population:
 Many with no experience of dealing with financial hardship and
hence few coping skills
 In the general population, 50% of those in debt have a mental health
difficulty compared to 14% of those with no debts
Mental health & public health
 Do not wish to ‘medicalise’ financial, social and
economic problems – no need to bring large
numbers of people into specialist mental health
services
 The most effective actions are those which will
change the social circumstances of those affected –
long term solution
 Workshop focused on actions that can occur in the
short term and are ‘resource neutral’
However... impact on mental
health services
 At time of increased demand, mental health
services (along with other health services) face
cuts
 ‘Hidden’ cuts – no staff replacement – 10% of
psychiatric nursing staff left the mental health
services in 2009
 Funds attaching to staff who leave are also lost
permanently
Poverty, unemployment &
mental health
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Strong inter-relationship between the three:
Poverty in itself related to psychological distress
(particularly deprivation of basic necessities)
Unemployment related to psychological distress
Poverty and unemployment obviously related but have
cumulative effects on mental health
Many people with mental health difficulties are
unemployed and reliant on social welfare
Debt/economic hardship &
mental health
 Debt and mental health difficulties related – 1 in 2
adults in debt has a mental health difficulty
 Debt can have indirect effects on household
psychological wellbeing over time as it impacts on
parental depression, conflict-based family
relationships and potential mental health
problems among children
Childhood adversity
 Strong evidence that the presence of factors which
adversely affect mental health in childhood can have
significant and long-term impacts on the child in many
life domains
 Economic adversity or poverty is one such factor which
has a strong association with mental health problems
in childhood
 In adolescents, awareness of financial difficulties in
their families has a negative impact on their mental
health
Suicide
 Relationship between economic
adversity/recession and suicide
 People who are unemployed are two to three times
more likely to die by suicide than people in
employment
 The suicide rate in Ireland increased from 424 in
2008 to 527 in 2009, an increase of 24%
Consequences for the wider ‘mental health
system’
 Community level – increased calls to Samaritans,
increased demand on variety of community support
organisations
 Primary care level – increase in allocation of medical
cards – increased workload on GPs and primary care
system, increased prescription of drugs
 Increase in self-harm leads to increased admissions to
psychiatric units, general increased demand on mental
health services
Proposed actions:
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Health and social care sector
Financial services sector
Within and across sectors
Actions by government
 Health and social care practitioners do not need to
become ‘financial experts’ and financial sector
employees do not need to become ‘mental health
experts’
Health and social care sector
C – consider debt as a possible underlying factor in
ill health – physical or medical
A – ask about debt – the person may be too
embarrassed to bring it up
R – refer consenting clients to a money adviser
E – engage with financial advisers
Share information and create tools to do this – Debt
and Mental health Evidence Form (England)
Financial sector
 Recognise the existence of consumers with mental
health difficulties and define best practice in dealing
with such consumers – progress here already
 Become ‘mental health aware’
 Be informed of sources of referral for people in distress
 Support staff who have to deal with unaccustomed
situations
Government policy
 Improving the practice of financial services:
 Mortgage Arrears and Personal Debt Expert Group
 Financial Regulator consultation on the Consumer Protection
Code – proposal to include concept of ‘vulnerable consumer’
 Longer-term actions:
 Actions to support employers to keep people with mental
health difficulties in work
 Take long-term view on health cuts/investment
 Action on the recommendations of the Report of the Mortgage
Arrears and Personal Debt Expert Group
Public Health & Wider Society
 Many of factors contributing to mental health
problems occur within a much broader context than
health
 Therefore actions within a public health or & wider
societal context was recognised.
 Actions identified in the workshop:
 –Training, communication and resources
Training
 Who?
 Frontline line workers
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Financial services
Charities/voluntary agencies
Government agencies
 What?
 Mental Health Awareness – MABS
 ASIST - Teachers, Gardaí, youth workers, volunteers,
family friends
 Safe talk - workshop - National Suicide Office
Communication
 The need for improved communication across sectors
 Training central to improving awareness and equipping
staff with appropriate and helpful communication skills.
 The development of Arrears Support Units in financial
institutions (January 2011) provided a locus for expertise
and training within banks.
 Establish secondment schemes
 Financial Regulator allow third party to engage with a
lender on behalf of vulnerable person.
Resources
 Information/Leaflets examples:
 Look after your mental health in tough economic times.
 Managing your mental health
 A Revised Consumer Protection Code from the Financial Regulator
 A published Code of Conduct on Mortgage Arrears (CCMA), a statutory code of
the Central Bank.
 Mortgage Arrears Resolution Process (MARP) established within lending
institutions for dealing with customers in arrears and pre-arrears.
 Lending institutions are required to establish an Arrears Support Unit to assess
arrears and pre-arrears cases.
 The Irish Banking Federation and MABS have developed a joint Consumer
Guide to Dealing with Mortgage Repayment Difficulties.
Available @ www.mhcirl.ie
Thank you
www.mhcirl.ie