How does inequality affect mental health?

Rising inequality is playing a large role, perhaps the central role, in the increasing mental health difficulties we are seeing in society. In this article, I will explore why this is the case.

Direct impact

At its most basic, inequality makes us feel worse about our lives.

Have you ever considered what the purpose of "happiness" is? Emotions are functional; they help us organise our behaviour. Fear organises us to seek protection, shame organises us to avoid anti-social behaviour, anger helps us protect our boundaries, etc.

Research shows that happiness is strongly correlated with levels of social equality. When we live in an equal society, we feel good, and when we live in an unequal society, we feel miserable (Wilkinson & Pickett, 2018). This means that if we choose to build an unequal society, we are condemning a whole section of the population to misery.

Some might argue that misery is good because it will motivate people to improve their lives. In fact, the evidence consistently shows the opposite effect. Where inequality is high, outcomes are dictated by class and luck, so effort feels pointless. In more equal societies, effort makes a difference, and people are more motivated because change is possible.

Therefore, an unequal society is doubly bad: we both condemn people to misery and strip them of the chance to change that.

Indirect impact

Inequality does not just make us feel bad. It also causes a huge amount of strain on those lower in the hierarchy, which negatively impacts people's mental health (Johnstone & Boyle, 2018).

To name just a few of these:

• Reduced access to healthcare leading to physical health problems, and increased levels of pain.
• Difficulties paying for groceries, leading to poorer physical and mental health outcomes.
• Having to work longer hours, causing more physical and mental stress.
• Breakdown of relationships due to increased stress and lack of availability for quality time together.
• Lack of opportunity to pursue interests and achievement outside of work.
• Reduced self-esteem for those who are not able to find work or earn enough to pay their bills.
• Increased likelihood of being a victim of crime or subject to traumatic events.

Impact across social classes

Those who are higher up the social ladder may believe they are exempt from these problems. However, inequality affects people at almost all levels. Here are five ways those who might use labels such as "middle class" are impacted.

Inequality directly affects our mental health. While it triggers self-esteem issues in those worse off, it also increases “status anxiety” in everyone else, in which we worry about our position. To deal with this anxiety, we consume more: designer clothes, flashier cars, bigger houses, exotic holidays, etc, and work overtime to pay for all of this. As a result, household debt levels rise, and it takes us longer to pay off our mortgage.

Inequality reduces our social circles, which is one of the most significant variables in happiness, because it is harder to maintain friendships across class differences. For example, we risk making friends feel uncomfortable, which can make conversation more difficult. Or maybe you want to go to a nice restaurant, but know your friends don’t have as much disposable income, forcing you to choose between the two.

Inequality increases addictive behaviours, including alcohol consumption and substance use, but also includes behaviours such as shopping or gambling. This happens at all levels of society, i.e., we become more vulnerable to these.

Inequality increases public spending costs. It creates an increased mental health burden (more NHS spending) and the number of people too ill to work (more benefit claimants). It is estimated that the UK could save £39 billion per year just by avoiding the problems inequality causes. That’s more public debt and less money for things we want the government to fund.

Inequality increases crime. We pay for this directly when our houses are burgled, our bikes are stolen, etc, through the increased costs of alarms and security systems, and mentally in the increased fear of being a victim of crime. We also pay for this indirectly: when shoplifting increases, businesses factor the losses into their prices, resulting in more expensive goods, such as groceries, as well as increased public spending on policing, courts, and prisons.

Political implications

What impact does inequality have on our mental health? The answer is everything. It has a significant direct and indirect impact on our wellbeing.

Whether we build a more equal society or a more unequal society is ultimately a political decision. However, if we want to make an evidence-based decision that is informed by psychology, the science is clear.

First, a more equal society would produce greater happiness. If wellbeing is your metric, a more equal society is the way forward.

Second, some worry that reducing inequality would be expensive. But the science tells us this is unlikely to be the case. Building a more equal society reduces both public spending and the need to consume to manage our status anxiety, resulting in lower household expenditure, too.

Conclusion

Holbeck College is on a mission to improve people's mental health. We do this by providing education for both individuals and clinicians looking to support others.

However, the evidence is becoming increasingly clear that poor mental health is not predominantly a result of difficulties within any one individual, but rather the result of the high levels of inequality within our society.

This does not wipe out the positive impact that can be made in helping people become more compassionate, more resilient, and more psychologically flexible. But it does mean that if we are serious about tackling the mental health crisis, policymakers, communities, and organisations need to see equality as a public health priority.

References

Johnstone, L., & Boyle, M. (2018). The Power Threat Meaning Framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis. Leicester, UK: British Psychological Society.

Wilkinson, R., & Pickett, K. (2018). The inner level: How more equal societies reduce stress, restore sanity and improve everyone’s well-being. London, UK: Allen Lane.