Heading back to university was meant to give Mark* more freedom.

Study hinted at an escape from meaningless work and a childhood education where he had always felt "dumb". His undergraduate course had been the first time Mark had felt able to express himself.

So when he began life as a post-graduate student in 2014, it was with high ambitions of gaining more skills and expertise, and eventually finding a fulfilling job.

Instead, it began what Mark describes as a "rapid spiral into poverty".

Just a few months into his Master's, Mark was told he was no longer eligible for Youth Allowance, which had provided a measure of relief from the daily grind. He learned of the decision too late to cancel the course.

"I thought I could grind my way through it," Mark said.

From then on, the search for money became a constant presence in his life, taking precedence over nearly everything else.

Between classes and study, Mark worked as a cinema usher and cleaner, picked plastic pollution off the nearby beaches, pushed a lawnmower around as a gardener and worked as a labourer in factories and on farms in Victoria.

In his downtime he would search Facebook buy, swap and sell pages for odd jobs or errands — anything to help pay the bills.

To make matters worse, he developed chronic stomach problems — pain so bad that on the worst days he couldn't think straight — and an injured Achilles that limited his ability to work.

He found that visits to doctors and specialists and expensive medication only drained his time and money. A GP referral to a psychologist didn't help.

Living paycheque-to-paycheque made it impossible to establish a routine, or plan ahead; his social life faltered as he turned down parties and family time in favour of work, or because he did not have enough money.

Trapped in the precariat class, Mark says his inability to exert control over his life had long-lasting effects.

"That [period] really kicked the shit out of me," he said.

"It sort of changed me quite a bit — mentally, emotionally, physically. I don't think I've really recovered."

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Class and mental health

Although mental health is complex and layered, researchers have found many common mental health disorders, just like other aspects of wellbeing, are shaped to a large extent by social, economic and political forces.

This includes a person's material resources like income and wealth, as well as their access to healthcare, healthy food and affordable housing, a clean environment and stable employment.

And class gets "under our skin and into our brain", according to ANU Professor of Health Equity Sharon Friel, in ways that go beyond material wealth and resources.

Pioneering research on the subject was undertaken by British epidemiologist Michael Marmot, who used two separate studies to track the health of 28,000 British civil servants over 40 years. He found those at the bottom of the organisational hierarchy were four times more likely to die than their superiors.

Marmot and his co-authors concluded that stress and status (a worker's position in the hierarchy), could be just as detrimental for health as smoking, diet and other common risk factors.

It wasn't that those at the top did not experience the strains of working life, it is just that they were better socially equipped to cope, he found.

Professor Friel says further research on the subject has shown that having a lack of control over our lives can destroy our mental and physical wellbeing.

"When you don't have those three things — material resources, control over your life, and voice in the decisions that affect you — then chronic stress really can be incredibly detrimental," she said.

And Professor Friel says it manifests in increasingly dire ways.

She cites what United States economists call "deaths of despair": the rise in suicides, overdoses and diseases among middle-aged non-Hispanic whites without a college degree since the 2008 global financial crisis.

Living the research

Mark* was studying the nature of poverty while he was living it ( ABC RN: Emily Bissland )

For Mark, there was a bitter irony in his spiral into poverty.

With his major in International Development, Mark was studying the nature of poverty while he was living it, and found himself in the unenviable position of recognising a condition he seemed to have little prospect of changing.

He says he often felt misunderstood by those around him. They failed to grasp the pervasiveness of his stress or how his work limited his social life.

Having a university degree, and a long career as a labourer, frustrated his efforts to find a job — and he began to suspect he was being pigeonholed as either over-qualified for his manual work, or as a labourer by the professional classes.

"I actually got the nitty-gritty, the technical aspects [of studying poverty]," he said.

"But I also got all those things you can't explain — the feeling of being trapped, the feeling of not being able to make any decisions or anything like that."

Class determines everyone's health

Marmot's research into the "social gradient" for health — where outcomes become worse moving from the top to the bottom of the class hierarchy — suggests everybody is affected by social inequalities.

Mental illness on the rise Around 4 million Australians deal with a mental health condition every year

Around 4 million Australians deal with a mental health condition every year Around 13 per cent of all visits to the local GP are for mental health reasons

Around 13 per cent of all visits to the local GP are for mental health reasons Nearly one-third of these visits are for depression — the most commonly managed problem

Nearly one-third of these visits are for depression — the most commonly managed problem Overnight hospitalisations for mental health issues have increased by 10 per cent in the past three years - Source: Australian Institute of Health and Welfare

Around 4 million Australians deal with a mental health condition every year, according to the Australian Institute of Health and Welfare, and the number of Australians having mental health-related GP visits or accessing Medicare-subsidised services has increased in the past five years.

The most disadvantaged people in Australia are far more likely to die from non-communicable diseases like heart disease, strokes, asthma and diabetes, according to Victoria University's Australian Health Policy Collaboration (AHPC).

The AHPC also reports that people in the most disadvantaged communities are 71 per cent more likely to suicide — even in the absence of disease.

Meanwhile, more than half of Australia's wealth is controlled by the richest 10 per cent of the population, a share that has increased since the 1970s.

Flinders University Professor of Public Health Fran Baum says reducing levels of mental distress, and closing health inequalities, will require a re-thinking of Australia's direction as a society.

"We have to think about what drives depression, and what drives people's anxieties," she said.

"I would have thought in the last 30 years, when rates of anxiety and depression have gone up in Western countries, there's some clear clues from the economic system and society we're creating."

Professor Fran Baum says class perspective should be added to policy decisions. ( ABC RN: Michael Dulaney )

This system includes a dramatic rise in precarious and casualised work, a trend Professor Baum says could exacerbate pressures of powerlessness and poverty.

She is writing a book on the subject of health inequality, and one of the unavoidable conclusions of her research is that health reform is political.

Her preliminary recommendations include reducing economic inequality, making public education free and available to all and providing more affordable and secure housing, to name a few.

It's not as controversial as it might seem at first blush.

After a multi-year study, in 2015 the government's National Mental Health Commission concluded that mental wellbeing went beyond the scope of the health system.

It recommended a "whole of government, whole of person, whole of life approach" encompassing stable housing and participation in education, employment and community.

Making progress on the issue may mean adding more class perspective to policy decisions.

"Politicians have a real decision to make," Professor Baum said.

"Are they governing for private profit, or are they governing for public health and wellbeing?"

Looking forward

After many years of living week-to-week, Mark is now at a point where he is able to save money and make plans for the future — and has even saved up for an upcoming move to Portugal.

The trip is something to look forward to, but it won't be easy. Mark doesn't feel as resilient as he once was; he's less able to "rolls with the punches".

If you or anyone you know needs help: Lifeline on 13 11 14

Lifeline on 13 11 14 Kids Helpline on 1800 551 800

Kids Helpline on 1800 551 800 MensLine Australia on 1300 789 978

MensLine Australia on 1300 789 978 Suicide Call Back Service on 1300 659 467

Suicide Call Back Service on 1300 659 467 Beyond Blue on 1300 22 46 36

Beyond Blue on 1300 22 46 36 Headspace on 1800 650 890

"In hindsight I guess, has my life got better? Yeah, heaps," he said.

"It was all these external things that were driving me down, it wasn't a chemical imbalance in my brain — I was just miserable because my life was shit.

"I knew as soon as my life was a bit better, it'd get easier. But those sorts of things take a toll.

"It's not a scar that just heals over, it really gets into your bones, into your soul."

He says the turning point came in 2016 when he was finally able to save enough to fulfil his long-held ambition to study abroad.

Saving for his six-month stay in the Netherlands was emotionally and physically taxing, but, in hindsight, he describes this period as "liberating".

There, he cold afford to catch the train or go out for the occasional beer without having to calculate how many labour hours it would cost him.

He came home to Australia with a new perspective.

"It was just what I needed, I was so glad I did it," he said.

"I could see things over there — that it's just the system that I live in, the situation I was born in, what my parents did, who they are where they're from, all that sort of stuff.

"It was like — 'oh, it's not my fault, thank God.'"

*Name changed.