Stigma, poverty and mental health.
It’s important for me to note at the beginning that I am writing from an adult learned experience with input from friends and family who have lived experience.
What is stigma? The Cambridge Dictionary defines it as “...a strong feeling of disapproval that most people in a society have about something, especially when this is unfair.”
““Income isn’t always enough to avoid hardship. Poverty has social, emotional and psychological aspects. Being able to find connection, purpose and the right help at the right time are vital to protecting people from hardship.””
Stigma has been linked to poverty and mental health for many years and the Jospeh Rowntree Foundation have been leading the way with their research and expertise. With an HG lense, this quote includes some of our emotional needs, (community, intimacy, meaning and purpose) and innate resources (empathy, emotions). In the same way that astigmatism blurs our vision, so too stigma distorts our perception.
““Children and adults living in households in the lowest 20% income bracket in Great Britain are two to three times more likely to develop mental health problems than those in the highest.”
“Analysis of data from the Millennium Cohort Study in 2012 found children in the lowest income quintile to be 4.5 times more likely to experience severe mental health problems than those in the highest.””
I can find myself in what feels like a rock and a hard place when it comes to thinking about poverty and mental health. You see the research mainly from high income countries has for a long time recognised the correlation between poverty and experience of poor mental health and this definitely correlates with my experience both lived and learnt and yet it's not the whole story either. These stats ought to be shocking, they ought to call us to action and yet I often get frustrated when I read them and others like it because they don’t give the whole picture of those who face financial hardship.
Rapport and Information Gathering
Within the HG approach, language is seen as an important tool in the therapy room. These language skills enable us to do our best in entering the clients model of reality while still understanding the line between their story and our own.
I have heard countless stories of individuals who have tried to access mental health support and been judged before they have been listened to. Some of this may be down to lived experienced and the individuals own perception but definitely not all. Stigma can be experienced in so many areas of life. Did you know that on new housing developments, often social housing doors are a different colour to those privately owned? Or in order to access emergency housing you have to prove your financial position often through submitting years of pay slips to prove you're eligible for support? Any of us would be affected by these experiences causing our perception being blurred of the support offered, if any is offered at all.
As a therapist I work hard to build rapport and actively listen for 2 reasons, 1 it enables me to ensure I fully understand what the client is communicating but 2, it enables the client to potentially for the first time, truly explain what is going on for them and explain why they have sought out support.
Rapport and active listening can help provide a sense of clarity and in doing so counteract any stigma affecting either person.
““Here is what we seek: a compassion that can stand in awe at what the poor have to carry rather than stand in judgement at how they carry it.” ”
It’s important to recognise the bias and assumptions I have when working with any client. This quote from Gregory Boyle challenges me to show up in as honest a way as possible. I’m lucky in that my own upbringing has meant I have friends and family with varying levels of income but I am not immune from the messages society might want me to hear. There is a misconception that people on low income choose to not work but this simply isn’t true. Can we ask ourselves these questions: Do we hold compassion for the complex systems requiring navigation for someone who is on low or no income? What beliefs do I hold around why someone has no or low income?
““People distanced from the reality of the stigma of poverty may not prioritise it because they don’t fully understand the far reaching implications of it — because they’ve never lived it nor work closely with those who have.” ”
There is much more awareness of societal priviledge and yet for many communities there is still often a feeling of being ‘done to’ rather than listened to.
The truth is that the language yet alone the experience of therapy and mental health is still often reserved for those with financial and educational resources and there are many barriers in place to stop those facing financial hardship from accessing that which is available. It's important to recognise that those who hold systemic power can fail to ‘see’ the individual and therefore the stigma they may have experienced. A number of years ago I met a guy called Joe on a bus. I was in the process of developing some new community spaces and had a habit of asking as many people as possible, ‘what’s it like to live here?’ Joe looked at me and tears came to his eyes and his words have stayed with me in everything I’ve ever done. He said, 'do you know my dear, no one's ever asked me. Lots of people tell me, but no one has ever asked me.'
There are many organisations really committed to changing this narrative, The Poverty Truth Commission being the first that comes to mind, and yet the experience of many is still to not be included in conversations and initiatives that essentially are supposed to have an impact on them. ‘By and For’ is the name most commonly given to local projects where local people are able to take the lead.
How does the HG organising idea help?
Working as an HG therapist, the organising idea has given me a framework in which I can acknowledge the systemic barriers that exist to prevent individuals facing financial hardship from accessing mental health provision and at the same time acknowledging the many resources within these communities.
Living and working with friends who would sit in these categories, and whose life experience echos the stats, I can resolutely say that I have experienced more of the innate resources than from most other people I have spent time with. The empathy and imagination I have had the benefit of experiencing and working with I will be forever grateful for.
Through the HG approach we are able to both acknowledge the barriers that in isolation no one person can fix, at the same time as highlighting the resources that are available.
“Rarely, if ever, are any of us healed in isolation. Healing is an act of communion.””
In places poverty exists, emotional needs such as security and achievement can be hard to meet and not always because of personal barriers, we have to recognise the systemic ones in place. Research shows that after you're able to support your family including one holiday a year that money doesn't equate to happiness but up until that point there are still huge inequalities regarding poverty and mental wellbeing.
And yet, my experience of living and working in communities like this offered me so much hope, and taught me so much about life and myself. The HG organising idea gave me the framework to show that there are many emotional needs that are met, community, attention, meaning and purpose...
And the innate resources are vast and creative.
My commitment
I love the communities I've lived and worked in and feel so strongly that there is as much to learn as there is to teach. And so I come back to one my opening statements, I know the impact stigma has on many individuals households and communities and yet I also know the beautiful wisdom which can be found.
Can the HG organising idea change the way society thinks about poverty and therefore the stigmatisation that occurs? No probably not.
But can it inform the way front line staff respond to the individuals sitting in front of them and the way those individuals view themselves and their neighbours?
Well yes I believe it can.
I hope that stigma will not be the defining element of an individuals life and I can build my life and work around trying to influence the systems that hold the power.
