Poverty and the Mind

Vikram Patel is a psychiatrist and a Professor of Global Health who works tirelessly to improve the mental health of people living in low and middle income countries like India and Ethiopia.

His recent research has found that all countries are ‘developing’ countries when you look at the low proportion of the health-budget they spend on mental health. Some wealthy countries may have better systems of care for maternal and child health but overall, mental health remains universally, at the end of the queue.

At present, COVID has overtaken all other agendas. However, now more than ever before, there is a recognition of the two-way relationship between poverty and mental ill-health. This may be a historic opportunity to get this right.

The relationship between poverty and mental ill-health is a complex one. How can we distinguish a normal response to poverty from a disease process? Poverty can increase the risk of poor mental health via multiple pathways, for example, poor physical health, high levels of noise pollution, violent neighbourhoods, insecurity and humiliation.

Can an increase in income improve mental health? Yes. It can but it needs to be sustained.

The fact that having a mental illness may induce poverty is less well recognised. It may affect one’s education and hence, employment opportunities. In low and medium income countries, health care is paid for by people. Due to the length of time it takes to find an effective treatment, much effort and money is wasted in doctor-shopping. Depression is inequitably distributed in society but not recognised as such because wealthy individuals also get it. We accept that long term expensive therapies cannot be delivered to the poor, so what’s the point in studying them?

After nearly a year of job-losses, the number of people below the bread-line all over the world will increase by tens of millions. In India alone, the gains made in economic growth over the last decade are predicted to be wiped out this year. The historically disadvantaged will fare worse, suffer more.

We can expect a surge in mental health problems like we did after the 2008 global financial crisis, mainly led by suicide and drug misuse. Sir Angus S Deaton, a Nobel prize winning economist wrote extensively about these deaths of despair. Economists and global health experts warn that this one will possibly be far worse.

In India, while the state is spending all its energies on the pandemic, livelihood-based organisations are finding very poor mental health in their members. Taking a broad, multidisciplinary approach to depression and anxiety rather than viewing it through the lens of a medical specialty is the need of the hour. Policies all over the world need to de-medicalise the emphasis on specialists and empower front-line providers and communities to enable them to foresee, identify and address this problem.

The bi-directional relationship between mental health and finances means that appropriate mental health interventions can improve finances. Can we persuade policy-makers world-wide to listen to global health experts and economists, look at this fast-approaching  avalanche and steer policies to protect those who are being and will be hit by it?

Talk: Poverty and Depression (https://voxdev.org/topic/health-education/poverty-and-depression-how-improving-mental-health-can-help-economic-wellbeing) – this talk was available till last night but has since disappeared.

Research Papers:

  1. Angus Deaton on the Financial crisis and the well-being of Americans (June 2011):

https://www.nber.org/papers/w17128

2. Vikram Patel on Causal evidence and mechanisms of Poverty, Depression and Anxiety (May 2020):

https://www.nber.org/papers/w27157

No flu this year?

Lock-down, we thought it would last a few weeks and then life would resume as normal. Then it was a few months and now it’s questionable if it’ll be a few years or for ever?

Confusing messages came at us from big people who made big decisions – the same people who then blatantly broke the very rules they made and yet, expected everyone else to follow them. First, we were doing it to protect the NHS and now we’re doing it to protect our loved ones. We are law-abiding citizens and want to do the right thing. We are considerate and we follow the rules, even when we know that they are not based on good science.

The government is working on the ‘worst case scenario’. Well respected scientists with a nuanced view on the validity of lock-downs, such as Sunetra Gupta(Oxford), Ivor Cummins(Dublin), Mark Woolhouse(Edinburgh) and Carl Henegan(Oxford) are rubbished by the media and subject to ad hominem attacks.

What about us, the common people? What drives our behaviours? Are we well informed or are we plain scared? The news doesn’t tell us that most people who get the virus get better. It doesn’t tell us that the average age of death in the UK is 82 with or without Covid. It doesn’t tell us that there is no ‘gold standard’ test for the virus and that if you test positive does not mean you have the plague.

Also, we need to have a grown-up conversation about death, which is the only definite fact of life.

November is the month we pay homage to all those who gave their lives to win us our freedoms but this November, we are seemingly, willingly giving our freedoms away.

Fear is a tool for manipulation. It overrides love. It can easily be transformed into hate. Despots throughout history, including Nazis and the Stasi used it effectively to make common people like you and me, enemies of each other.

George Orwell said, “In a time of universal deceit, telling the truth becomes a revolutionary act.” I, like many others, have been forced to consider how far I would be driven by my fear – snitch on a neighbour, not see a friend who might be recently bereaved or hurting for any other reason? Am I willing to live the rest of my life being told what I can do and what not? Is this the freedom for which those we remember died?

Now, the World Economic Forum in partnership with the global elite is setting out ‘The Great Reset’ on their website. At the same time BBC and New York Times are calling it a Conspiracy theory. Who am I to believe? This picture was taken from a short promotional video taken from a clip on Twitter, posted by the WEF. When I went back to look for it, it was gone.

Whatever the truth, I refuse to let fear rule.

In my world, love rules.

Let’s not … go back to ‘normal’.

Toilet signs designed by young people at Orygen. Australia. (https://oyh.org.au/)

When I first came to the UK, I thought of myself as nothing more than a human being, a doctor, a mother. I came here with one suitcase full of books, inappropriate clothes and lots of dreams. Over the years, slowly, through events good and not-so-good, I was made aware that I was a ‘female doctor from ethnic minorities’. Others may see me thus but I still see myself as a human, a doctor, a mother.

Before our world was invaded by a microscopic organism, we were divided. Identity politics dominated all conversations. ‘Vegans’ wanted to convert me to their religion. ‘Vegetarianism’ just wasn’t good enough. Fingers were being pointed at seemingly evil ‘middle aged white men’, as if they were all the same. I found myself defending them in public as I am on the inside. I am married to one of the nicest of them. The ‘transgender’ community was making its presence felt in a big way. The BME and the LGBTQ++ and the sexists and the racists, the liberalists, the socialists, the nationalists and the list is endless … were firmly rooted in their fenced off, defensive little territories.

Then came the virus and we were all united in the knowledge that we were fragile creatures and we needed each other to survive. We needed to look after ourselves and each other, in ways that were more meaningful and different from before. We learnt that the mind needed as much attention if not more, than the body. We found out that we are related to everyone else on the planet whether we liked it or not. We needed to rise above our little ‘Me. Me. Me’ voices and make decisions in favour of what was good for everyone.

We found out that small things are big things. My lovely neighbour, M, left a bunch of flowers outside the door for me every week. I arranged those flowers the best I could and sent her the pictures. I wrote hand-written letters to friends from my childhood with whom I was starting to lose connection. I discovered the joy of sleeping for a few nights in a row without setting the alarm. Si and I discovered the joy of being in the house together for days, doing normal things – baking, gardening, meditation, going for a walk, reading, watching ‘The Crown’.

I say, let’s not go back to our ‘normal’ divisions and our frantic passions. Let’s take this opportunity to re-invent ourselves and the way we meet the world. Let’s not be driven by our fears and insecurities but by a sense of deep connection with ourselves, each other and the planet. Let’s take this new learning into the world we want to live in. It’s up to us.

Nowhere to go.

On the 9th of March, I reached Melbourne for the second leg of the Churchill Fellowship. I had been looking forward to it for ages and just couldn’t wait to get started. I had the taken the whole month off. Despite the long journey I didn’t feel any fatigue. My AirBnB was homely and comfortable. After a good night’s sleep, I was ready for work.

The Beyond Blue Office was easy to find. After a brief introduction to the team, we all went out to get coffee together. I was already one of them and the coffee was great. The following days flew past with meetings, interviews, presentations and briefings. A trip to Headspace. Despite some background murmurings of a virus, I was having the best time, learning and exchanging thoughts and ideas. Then Australia closed its borders. Meetings and conferences started getting cancelled.

On the 16th, I took a return flight to London.  My trip shrank from 3 weeks down to one. I had to miss Sydney altogether. Now, I am back here with a blank diary for 2 weeks and I am loving it. I have volunteered myself to work and I am on standby.

I can now research and look up things I’ve been meaning to for a long time. I can clear out one cupboard every day and get rid of stuff I don’t need or use or get joy from. Unclutter and create space in my house and my head. I can go to bed without setting an alarm. That pile of unread books that’s been sitting atop my table, feeling ignored and giving me dirty looks, can now be tackled.

Part of me is rushing in to fill the time with a list of a hundred things to do but I am consciously slowing down. Having an easy routine. Fitting in things I love doing, like arranging flowers. Making time for friends. Cooking. Walking. Not getting hooked to the media but keeping an eye. Writing hand-written letters to loved ones. Sitting still. Enjoying our home. Truly appreciating the weirdness of our cat, Milkshake. Cherishing having breakfast, lunch and dinner with Si as he works from home.

Simplify. Make easy. Make plain.

The Way Back – supporting attempt survivors – an idea worth adopting.