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Mental illness: cause and consequence of inequality

Mental illness is an important cause of social inequality, violence and unemployment as well as a consequence. Mental health problems in childhood and adolescence:

  • Reduce educational achievement and employability (37) (38) and also
  • Increase the risk of impaired relationships, drug and alcohol misuse, violence and crime. (39) (40)

The experience of mental illness further exacerbates social inequalities because of its impact on employment and housing status. Half of all mental illness starts by the age of 14 (41) (42) and 75% by mid 20s. (43)

Low income, (44) debt, (45) violence, (46) stressful life events (47) and unemployment (48) (49) are key risk factors for mental illness. The two-way relationship between mental illness and social inequality can prove difficult to unravel with common epidemiological approaches.

Although mental illness is unequivocally linked with income inequality at the level of countries or states, there is little evidence to support the belief that mental health is linked with overall GDP in Western nations, especially when measured by mental wellbeing or happiness. Reducing income inequality is therefore likely to lead to improvements in population mental health and wellbeing whereas increasing overall GDP may not.

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37) NICE. Promoting children’s social and emotional well-being in primary education. HN 12, 2008.

38) NICE. Promoting young people’s social and emotional well-being in secondary education. PH20 2009.

39) Fergusson DM, Horwood LJ, Ridder EM. Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood. Journal of Child Psychol olgy2005; 46(8):837-49

40) Richards M, Abbott R. Childhood mental health and life chances in post-war Britain. Insights from three national birth cohort studies. MRC unit for life long health and ageing. 2009

41) Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. . Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry 2005; 62(6):593-602.

42) Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R. Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective longitudinal cohort. Arch Gen Psychiatry 2003; 60(7):709-17.

43) Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S , Ustun TB. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry 2007; 20(4):359-64.

44) McManus S, Meltzer H, Brugha T, Babbington P, Jenkins R. Adult psychiatric morbidity in England, 2007. Results of a household survey. Health and Social information Centre, Social Care Statistics.Uk data archive study No 6379, 2009.

45) Jenkins R, Bhugra D, Bebbington P, Brugha T, Farell M, Coid J, et al. Debt, income and mental disorder in the general population. Psychol Med. 2008; 38(10):1485-93.

46) McCrone P, Dhanasiri S, Patel A, Knapp M, Lowton-Smith S. Paying the price. The cost of mental health care in England to 2026. London: The King’s Fund; 2008.

47) Melzer D, Fryers T, Jenkins R, Brugha T. Social inequalities and the distribution of common mental disorders. Hove: Psychology Press, Maudsley Monograph; 2004.

48) Healthcare Commission, Care Services Improvement Partnership, National Institute for Mental Health in England and Mental Health Services Act Commission. Count me in 2008: results of the 2008 national census of inpatients in mental health and learning disability services in England and Wales. Commission for Health care Audit and Inspection; 2008.

49) Higgins A, Barker P, Begley CM. Sexual health education for people with mental health problems: what can we learn from literature? J Psychiatry Ment Health Nurs 2006; 13: 687-97.

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