Austerity pushes people to the edge

“This government will not cut [the] deficit in a way that hurts those we most need to help, that divides the country, or that undermines the spirit and ethos of our public services.” (David Cameron, in a speech in June 2010)

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“If austerity were tested like a medication in a clinical trial,it would have been stopped long ago, given its deadly side effects.... One need not be an economic ideologue – we certainly aren’t – to recognize that the price of austerity can be calculated in human lives.” (David Stuckler and physician Sanjay Basu, authors, "The body economic:Why austerity kills," 2013)

The mental strain unleashed by cuts:

Helpline caller number 1: ‘David’ is getting more anxious and more agitated the more calls he makes to the suicide helpline. He has mental health problems. He tells the volunteer manning the phone that he is finding it difficult to cope. He is terrified. His benefits ‘situation’ is causing him enormous distress. It is early March 2013 when he first calls after being told that from April he would have to pay the ‘Bedroom Tax’.There is no way he can find the money from his incapacity benefits. He doesn’t eat for days at a time.The benefits office doesn’t seem to take any notice of what he is telling them. He can’t sleep. It is the end of March.The call log ends.

Helpline caller number 2: ‘Geoff ’, a father who lives with his partner, their young son and her parents, talks of how the family has lost their home because they fell into debt after benefits changes and delays to payments. They now have mounting, unmanageable debts and no home of their own, he explains. He has made several suicide attempts. Helpline caller number 3: ‘Alison’ rings asking if the helpline knows how she can get a food parcel or if they can tell her where to get money to purchase some food. Her benefits have been stopped. She has no money left to buy food. She is afraid of what lies ahead.

I was given access to a summary of logged calls to a suicide helpline during 2013. The callers and their locations were anonymized to protect their identities. Scrolling through the summarized transcripts of plea after plea for help, the desperate circumstances of the people reaching out were laid bare.

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By their nature, calls to suicide helplines are always from people in crisis. However, the organization running this helpline told me that the calls they were receiving during austerity were different to those that had come before. Growing numbers of calls were from people who were under escalating financial strain, with many desperate callers saying they were at breaking point as a result of specific austerity measures such as the ‘Bedroom Tax’. A large proportion was distraught at the prospect of losing their homes if they could no longer afford the rent. In fact, the people calling were doing so for many of the same reasons people were turning to food banks – only by the time a person was picking up the phone to a helpline as a last resort, their circumstances had brought them to a dangerous precipice.

If there was one word to capture the mood during the months that I travelled the country, it was ‘fear’. I talked to people afraid of cuts that had yet to be fully felt, of losing their home, of disability benefits being snatched away, of being unable to take care of their children or sick or elderly relatives, of essential local services being eliminated – and of their mental health deteriorating.As the months passed, it was as if these fears had taken root deep beneath people’s feet.The more the shockwaves of austerity were absorbed, the more initial fears about what might happen mutated into a daily dread about how to survive.

This is how J.J.Tatten of the Goodwin Trust in Hull explained what he was seeing all around him as austerity took hold:

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“When Aneurin Bevan and his people were setting about the task of ensuring that we could all live in safe community their phrase was ‘in place of fear’. What we have returning now is fear – fear of the unknown, fear of destitution [and] fear of poverty. We are seeing increasingly anecdotal and hard evidence that this is the case.”

Also in Hull, this is what Tracy Dearing had to say:

“Are people losing hope? I think it’s worse than that. I think [many] people’s mental health is deteriorating very quickly and it could be because there’s a lack of hope....They see the economic climate worsening. They see the benefits safety net untangling. It’s more hopelessness impacting on their mental health. I think in Hull mental health services are going to be under huge amounts of strain.”

Throughout 2012 and 2013 there was little doubt about the degree of the mental strain unleashed by austerity across the UK. In its November 2013 report, Maxed out, even the right-wing Centre for Social Justice concluded that, as well as poorer people bearing the brunt of financial strain of increased personal debt, the corollary was an ‘immense’ impact on their mental health and wellbeing. The lead author of the report said: "The costs to those affected in stress and mental disorders, relationship breakdown and hardship is immense."

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In the summer of 2013, the UK’s largest mental health charity, Mind, reported an unprecedented 50 per cent rise in calls to its national helpline for the 12 months up to March 2013 (this was on top of a rise of 100 per cent in the previous year for money-related calls).The distinguishing feature of the calls was, first, that more of the callers said they were contemplating suicide compared with pre-recession figures and, second, that ‘severe financial worries’ were increasingly being cited. The charity said:

• Calls to the help line rose from 46,000 in 2011/12 to 68,000 in 2012/13.

• The number of calls relating to suicidal feelings jumped by 30 per cent in a year.

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Mind’s chief executive, Paul Farmer, summarized the trend thus: “Today many people face the stark reality of severe financial pressures – be it through employment worries, benefit cuts, increased cost of living, or a lethal combination of all three.”

The mental and emotional strain of austerity was everywhere. From as early as 2011, charities including Sane and the Depression Alliance were reporting concerns about links between financial woes and rising stress and depression. According to the Samaritans, the largest suicide prevention organization in the UK, by early 2013 one in six of its helpline calls was about escalating financial pressures. In June that year the charity warned that economic problems were highly likely to have an impact on the number of suicides, since people living in poverty were already at higher risk of suicidal behavior even without the additional tension wrought by an economic downturn as severe as that of 2008 or the unprecedented cuts of austerity policies after 2010.

Accurate trend figures for suicides can take a number of years to come through as the complexity of collating statistics and inquest rulings makes it difficult to gauge early impact. It is also important to note that the reasons behind suicidal behavior are complex and rarely down to a single ‘trigger’. That said, the Samaritans reported that there were already indications of a ‘significant increase’ in UK suicides between 2010 and 2011 (running at its highest level since 2004, up from 11.1 to 11.8 per 100,000). Such was the severity of what people in Austerity UK – and especially the poorest – were enduring that this is what the Samaritans concluded:

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Distinctive to the current recession are the simultaneous cuts to public spending and social welfare systems: to social security benefits, benefits for sick and disabled people, and any introduction of universal credit.Thus, in the context of extremely hard financial times and increasing economic stress, especially for those at the bottom of social ladder, there is simultaneously a rolling back, rather than investment in, welfare safety nets; as well as political and public discourse which is at best unsympathetic and at worst potentially vilifying of the poor and socially excluded.

In April 2012, in a move that reflected the role of job seeking and benefits changes on people’s state of mind, senior job centre managers took the unorthodox approach of warning staff to be alert to the risk of claimants attempting suicide.

There was also evidence emerging of a rise in the number of anti- depressants being prescribed.Figures for NHS England for 2011 showed a leap of 23 per cent in the number of anti-depressants prescribed since 2010 at a cost of £1 million extra a year to the NHS.(In November 2013 figures released by the OECD showed a surge in anti-depressant usage across richer nations in the previous decade.It concluded that rises of 20 per cent or more in countries such as Spain that had introduced a harsh austerity program could be down to the ramifications of the financial crisis.) And GPs were reporting more people coming to them for help with money and job insecurity worries – suggesting rising levels of individual desperation – while evidence was also mounting that older people were becoming progressively more isolated as support services were cut and they were turning to GPs for someone to talk to.

In their book, "The body economic: Why austerity kills," published in 2013 and perhaps the most comprehensive analysis to date of the health risks associated with austerity, economist David Stuckler and physician Sanjay Basu probed the health impacts of austerity globally.The book estimated that around 10,000 additional suicides in Europe and the US were attributable to government cuts introduced in the wake of the Great Recession. The authors mined decades’ worth of global data to assess the links between economic shocks and health.Writing in The NewYork Times, they explained why it was crucial to understand that it wasn’t merely the economic reverberations of recession that was devastating for health, but how governments reacted.They wrote:

If suicides were an unavoidable consequence of economic downturns, this would just be another story about the human toll of the Great Recession. But it isn’t so. Countries that slashed health and social protection budgets, like Greece, Italy and Spain, have seen starkly worse health outcomes than nations like Germany, Iceland and Sweden, which maintained their social safety nets and opted for stimulus over austerity.As scholars of public health and political economy, we have watched aghast as politicians endlessly debate debts and deficits with little regard for the human costs of their decisions.

They concluded: "If austerity were tested like a medication in a clinical trial, it would have been stopped long ago, given its deadly side effects.... One need not be an economic ideologue – we certainly aren’t – to recognize that the price of austerity can be calculated in human lives."

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Throughout the time I was interviewing people, news reports of mental distress, suicides or attempted suicides connected to austerity and cuts came thick and fast. Even taking into account the necessary caution about exaggerating causal links, it seemed that something extreme was happening as individuals affected and their families called on the government to acknowledge the pressures pushing people to a mental edge. In one horrific case, a man ‘doused’ himself with a flammable liquid and tied himself to railings at a job centre in Birmingham after being declared ‘fit for work’ and experiencing benefits delays. Luckily, the police arrived soon enough after he set himself alight to prevent really serious injury.

The London Evening Standard reported on the inquest of a woman who died two days after attempting to take her own life.The inquest heard from her doctor that a letter saying her incapacity benefits were to be withdrawn had precipitated her suicide attempt. The attempt failed, but she died two days later (the court ruled it was from natural causes). An unopened letter was found at the woman’s house after her death indicating that she might not lose her benefits after all. In other incidents, the Liverpool Echo reported on the story of a 31-year-old mother who attempted suicide following Housing Benefit cuts and ‘Bedroom Tax’ charges; and the Mirror reported on an inquest into the death of an older man, a pensioner in his 70s, who was believed to have taken his own life due to fears about the ‘Bedroom Tax’. Even though he was exempt because of his age, witnesses testified at the inquest that he had been frightened by the news reports of people possibly losing their homes. Another story in the Mirror told of a 53-year-old disabled former nurse who took her own life days before a second appeal against her benefits being stopped. These are mere snapshots.

In the background to all of this was growing concern around the state of mental health service provision. For decades seen as the ‘Cinderella Service’ within the NHS and deprived of vital funding year after year, mental healthcare (as with the rest of the NHS) had seen funding rise under the Labour administration after 1997. With mental health accounting for half of all illness for the under-65s, it was certainly not a marginal concern,yet 13 per cent of NHS budgets typically went towards mental healthcare when it accounted for 23 percent of the overall health burden. Even after the Coalition government came to power there were some encouraging overtures, including discussions around ‘parity’ of care and ensuring mental health was given equal status with physical health (especially from Liberal Democrat Health Minister Norman Lamb). Nevertheless, warning flares were being fired pretty soon after austerity came into force about how rising demand and ‘spending efficiencies’ within the health service were manifesting. Meanwhile, evidence accrued of cuts to one of the flagship therapy programs introduced under New Labour,IAPT (ImprovingAccess to PsychologicalTherapies), which had been improving access to psychological therapies.

One major issue of concern was around acute care – when people require a hospital stay if in crisis or when sectioned. Drawing on information garnered from a FOI request,an investigation by Community Care magazine and the BBC in late 2013 found that, by October 2013, NHS England actually had nearly 2,000 fewer acute mental health beds than in April 2011, and that most wards were running at 100 per cent occupancy. According to the investigation, patients in great distress were often being transported hundreds of miles in search of a bed. Problems with acute care combined with increased workloads for GPs and long waiting lists for other provision, such as psychological therapies, meant that the situation was reaching crisis point.

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Dr Martin Baggaley, medical director of the South London and Maudsley NHS Trust, who spoke to the BBC at the time, said pressure on mental health services was going up. He said: “There seems to be a genuine increase in demand.That’s partly explained by a reduction in beds, by resources coming out of the a life lived in fear is a life half lived 173 health system, the squeeze on social services budgets, and by the general economic situation.”

Marjorie Wallace, chief executive of the charity SANE, told the broadcaster: “It is all too easy to find the cuts demanded by NHS efficiency savings in mental health. If a patient has heart failure or is in a coma, a bed has to be found. But for a person in mental distress, this is not seen to be as necessary. Being turned away when seeking help only reinforces patients’ feelings of rejection and hopelessness and can in our experience drive them to suicide.”

People’s distress during austerity was predicated on multiple and often overlapping forces, with financial worries typically at the epicenter. Not everyone affected was reaching out to mental health services, of course, but that there were daily anxieties sapping people’s ability to cope was undeniable. It became clearer the more I moved around the country that some of the reasons people were crying out for support was directly related to a number of key austerity measures that were stoking a particular variety of fear – one rooted in a profound insecurity about what the future might bring.As many people repeatedly reminded me,as bad as things had been since 2010, with another wave of austerity cuts in the offing for 2014 and beyond, there was a widespread impression that ‘the worst was yet to come’. Indeed, similar unease about the future was identified by numerous studies over the first three years of austerity.

Reprinted with permission from "Austerity Bites: A Journey to the Sharp End of Cuts in the UK" by Mary O’Hara, published by Policy Press at the University of Bristol. © 2015 by Policy Press at the University of Bristol. All rights reserved.