The elephants that lumbered up and down Blackpool’s beach have long gone. Britain’s political parties have stopped decamping to the town for their annual jamborees. Even the deckchairs have left: the local government sold all 6,000 of them three years ago to a company in the affluent county of Cheshire. The one thing that hasn’t disappeared is the people.

Outside London, this resort on England’s north-west coast is one of the most densely populated places in the country. Rather than the classic downward spiral of a place in decline, Blackpool is stuck in its own strange dynamic. The more the economy rots, the more some people come.

People such as Chris Hopkins, 37, a lanky man with a curious mind and a quick tongue. Five years ago, he was living 40 miles away, working for temp agencies in unskilled factory jobs. One day, after he complained about the state of his flat, his landlord told him to move out. He went on property website Zoopla and set the filter to rank by “lowest price”. Blackpool topped the list, so that is where he went.

The first flat the estate agent showed him was a single room the size of a large rug, with a bathroom shared by three others. “Only if the other three are Swedish models,” Hopkins quipped. But the next place was a keeper: a living room, kitchen, bathroom and bedroom for £55 a week — £3 a week less than Zoopla’s listing for an underground parking space in central London.

A damaged seat on the Central Pier carousel © Christopher Nunn

In a country where affordable housing is hard to find, people are gravitating to coastal towns such as Blackpool, where the receding tide of tourism has left behind a surfeit of old B&Bs that have been turned into bedsits. But cheap flats are not the only draw. Many Brits have happy memories of Blackpool: the smell of salt and frying fish; the scream of the roller coasters; the thunder of the waves on windy days. Hopkins remembers sitting with his sister in the back of the car as his parents drove round the town at night, gazing up through the sunroof at the famous “illuminations”: miles of glowing decorations strung above the prom.

To hear Dr Arif Rajpura, Blackpool’s director of public health, tell it, this shabby seaside town has become, in effect, the nation’s halfway house. “People have a positive association from their childhood . . . When something’s not gone right in their lives, [when] there’s a problem, [when] they’re running away from something, then people do tend to come to Blackpool, and the cheap housing helps drive people here,” he says. One friend of Hopkins’ puts it more bluntly. “It’s a drop-out town.”

Blackpool is suffering from a highly concentrated dose of what seems to be going wrong in pockets of many developed countries. Economists in the US often contrast the dynamism of America’s coasts with the malaise of its heartlands. But in Britain, it is increasingly on the country’s physical edges, in its seaside towns, that you find people on the outside of the economy looking in. Blackpool exports healthy skilled people and imports the unskilled, the unemployed and the unwell. As people overlooked by the modern economy wash up in a place that has also been left behind, the result is a quietly unfolding health crisis. More than a tenth of the town’s working-age inhabitants live on state benefits paid to those deemed too sick to work. Antidepressant prescription rates are among the highest in the country. Life expectancy, already the lowest in England, has recently started to fall.

Doctors in places such as this have a private diagnosis for what ails some of their patients: “Shit Life Syndrome”. Rajpura laughs when I mention it. “Yeah, I’ve heard that from GPs in Blackpool.” The term isn’t meant to sound dismissive. People with SLS really do have mental or physical health problems, doctors say. But they believe the causes are a tangled mix of economic, social and emotional problems that they — with 10- to 15-minute slots per patient — feel powerless to fix.

The relationship between economics and health is blurry, complex and politically fraught. But it is too important to ignore. In America, white working-class people are falling prey to what economists call “deaths of despair” from opioids, alcohol and suicide. Populist politicians all over the world are making a potent appeal to those who feel the economy no longer works for them. Then there is the financial cost. In 2012, the UK’s official fiscal watchdog predicted that policy reforms would reduce government spending on benefits to people too sick to work from about £15bn a year to about £10bn by 2015. In reality, spending has barely budged.

The story of Blackpool is a story about the failure of national policies to support places on the edge. But it is also a story about how — in the face of necessity — people are trying new ideas to turn things around. “It’s fundamentally a hard problem, but that doesn’t mean that nothing can be done,” says Diane Coyle, an economics professor at Manchester University. “The idea it’s all God-given and can’t be changed is, I think, completely wrong.”

Blackpool’s fortunes rose alongside the factories that sprouted across the north of England in the industrial age. Cotton mills would shut down during holidays known as “wakes weeks”, when everyone would decamp to the seaside resort. It remained a popular place for family holidays for much of the 20th century, until the rise of budget airlines diverted tourists to sunnier destinations. Soon, fortnight-long holidays gave way to day trips and drunken stag dos. The town was left with an oversupply of B&Bs and an undersupply of decent jobs.

Blackpool resident Chris Hopkins © Christopher Nunn

The cheap housing that draws people here is often overcrowded and rotting. The flat Hopkins moved into was so damp he had to throw away a pair of trainers and jeans because they went mouldy. “No one wants to live in a hovel,” says Debbie Terras, who runs a youth charity here called URPotential. “There are some houses you’ll walk into and you will stick to the floor, or there’s dog faeces or human faeces.”

Meanwhile, many of Blackpool’s jobs ebb and flow with the tourist season, which begins at Easter and ends in early November, when the illuminations are switched off. Nobby Dawe, a taxi driver, averages £70 a day in summer but only £30 in winter. “In the season, there’s a lot of people doing 60 to 70 hours a week, it’s all go-go-go, yee-hah,” he says. “But when the season finishes, the money dries up and you get depressed.”

Hopkins has worked as a kitchen porter, in ­tele-sales and in a factory in the four years he’s been here. None of the jobs lasted. When he tried to find work at the Blackpool Pleasure Beach, he felt sorry for a fellow applicant who had worked there for four of the previous five seasons: “He knows what to do, he knows the routine, but he still had to reapply for the job with the newcomers.”

This combination of unstable seasonal work, inflation and a prolonged squeeze on benefit ­payments has helped lead people into debt. In the 12 months to the end of August, the local branch of Citizens Advice, a nationwide network of advice charities, helped deal with 3,624 debt problems. It was the second most common problem after benefits; together they accounted for three-quarters of the total caseload.

Graffiti on a footbridge © Christopher Nunn

A town built for day-trippers is also a town full of temptations: alcohol, betting shops, arcades, fried foods, sweets. The new problem is “spice”, a powerful synthetic drug that turns people into “zombies”. One woman, who did not want to be named, said that she was recently on Blackpool’s Central Drive trying to resuscitate an alcoholic man she knows, who had picked up what he thought was a cigarette off the floor. “He’s had two drags of this fag, dropped dead,” she said. When the ambulance came they “got a bit of a pulse, then it stopped, then they got him in the ambulance”. She never heard what happened to him. “You don’t get to know anything, do you?” she said wearily. “It’s just normal routine for Blackpool.”

Some of the most common health problems here are depression, stress and anxiety. Blackpool has the fourth highest rate of antidepressant prescriptions in the country. It is hard to say why anyone becomes depressed without oversimplifying, let alone a whole town. “You’ve got your own predisposition — your genetics, your body — then you have your past life experiences, then you have your current situation,” says Mark Brown, a mental health writer based in London. “A combination of any of those things puts you in danger of developing symptoms of what we recognise as mental illness.”

Antidepressants and poverty do not always go hand in hand; London has some very deprived boroughs with relatively low levels of antidepressant prescriptions. But looking at the geographical distribution of antidepressant prescription rates, it is hard to avoid the conclusion that economic and social environments play a role. The three places ranked above Blackpool for antidepressant use are all deprived areas too, as are the six below it.

Gary Phillips, 39, first decided to see a GP when, one night, he felt close to killing himself. Phillips, who was born and bred in Blackpool, had been working in an administration job for the pensions department but was grappling with alcoholism and depression. The doctor offered him treatment for his drinking and antidepressants. He spent months alone in his flat, only leaving to go to the shop.

Gary Phillips, a volunteer at Fulfilling Lives, an addiction project © Christopher Nunn

“I could have been on the strongest antidepressants known to man,” he says, “but I think the fact I was on my own all the time . . . they might have given me a little pick-up, but it was never going to be long term.” He wishes his GP had linked him to community groups as well as offering him drugs, but understands why he didn’t. “I don’t think GPs are given the tools. When you’ve got to tell the doctor everything, your suicidal thoughts, in 10 minutes, you can’t do it. The doctor’s got to make a decision, which is always going to be: let’s try these.”

GPs will often refer people with depression and anxiety for counselling — the government started a national programme called Improving Access to Psychological Therapies in 2008 — but they know these services are oversubscribed. In July 2017 (the latest month for which data are available), the median waiting time in England between someone being referred and entering treatment was 12 weeks. In Blackpool, it was 19 weeks.

“We get very frustrated,” says Mark Gabbay, a practising GP and a professor of health services research at ­Liverpool University. “So that’s partly why we end up using medication.” He says antidepressants help stabilise people who are struggling with low moods but, ideally, they shouldn’t be used in isolation. “They’ve come to you because they’re in distress . . . You don’t want to say, ‘Well, I’m really sorry but there’s nothing I can do.’”

Mark Brown bristles when people criticise high antidepressant prescription rates. “People say it’s treating a symptom rather than getting to the root cause. Well, yeah, that’s what medicine does, it treats symptoms. Setting a bone doesn’t get to the root cause of a broken leg — if you wanted to get to the root cause, your job would be to remove the slightly wonky paving stones that drunk people fall over on the way out of pubs on Friday night.”

Rajpura argues that the ultimate answer is to tackle the mental health equivalent of the wonky paving stones. He believes that, in places such as Blackpool, we sometimes end up medicating economic and social problems.

“That probably goes back to the fact that GPs only have 10 minutes with the patient. You can’t really solve the patient’s Shit Life Syndrome, as we’ve described it, in 10 minutes. That person needs support in a more holistic and wider way.”

In a small room in a GP surgery in a residential part of Blackpool, Jill Kerr plugs in her laptop and whips out a bright pink mouse shaped like a car. “My husband bought it for me!” she laughs. Kerr is a senior case worker for Blackpool Citizens Advice. One day a week, she sets herself up inside surgeries so that doctors can refer patients who have practical problems around housing, jobs, benefits or debt. The local branch has been doing this on a small scale for decades, but in the past few years the service has grown significantly and there are now plans to roll it out to every GP practice in the town.

Jill Kerr, a senior case worker at Blackpool Citizens Advice; she now holds weekly sessions at GP practices © Christopher Nunn

Today — as usual — most of the patients sent to Kerr need help with their benefits. Almost 13 per cent of working-age people in Blackpool are living on incapacity benefits — state payments of between £73.10 and £109.65 a week to those deemed too unwell to work. In the 1990s, these went overwhelmingly to older men in former mining and factory towns who had lost their jobs. But increasingly they are going to younger people with low levels of education in seaside towns. In 2000, Blackpool wasn’t even in the top 10 places in the country with the highest share of people who live on incapacity benefits. Now it is number one.

As such, the town has been particularly exposed to sweeping reforms of these benefits, first planned by the Labour government then fully rolled out by the Conservative and Liberal Democrat coalition after 2011. The idea was that the old benefit system was too binary and one-way: people were deemed well or sick, and once they were on incapacity benefits, many never worked again. Under the new system, individuals undergo regular medical assessments and are placed into one of three categories. If they are “fit for work”, they must search for jobs; if they are too sick, they are put into the “support group” and don’t have to look for work; and if they are somewhere in between — not totally well, but well enough to prepare for work — they must take part in “work-related activities” such as updating their skills.

In 2012, the Office for Budget Responsibility, the UK’s official fiscal watchdog, predicted the rollout of welfare reforms would cut the caseload by 21 per cent between 2010 and 2015/16. In fact, it only fell 4 per cent. Spending on these benefits was predicted to fall 27 per cent to about £10bn a year but actually rose 6 per cent. A day spent with Kerr in the GP surgery sheds some light on what has gone awry.

A woman with a blonde bob comes in clutching an A4 envelope full of letters from the Department for Work and Pensions (DWP), which manages the benefit system. She stopped work in a supermarket a year ago with depression and was given incapacity benefits, but a few months ago she was sent for another assessment and found “fit for work”. “They didn’t seem to listen to me right,” she sighs.

The Coral Island Amusements arcade © Christopher Nunn

Half of those who start claiming incapacity benefits now have a mental health problem (most commonly depression, stress or anxiety) as their main health condition, up from less than a third at the turn of the century. The trend is not unique to Britain. Mental and psychological problems represent an increasing share of incapacity benefit inflows in many developed countries, according to the OECD. But they are particularly hard for the government to evaluate, since they are not usually as visible as physical ailments.

Kerr goes patiently through the documents to see if she has grounds to appeal. The woman, who is about 60, speaks slowly, as if each word is taking something out of her. She says she had been trying to knit because she used to like it, “but I get angry with that, I pull it all out, I couldn’t concentrate”. She went to see someone at a charity who suggested she try to read a book. “But I couldn’t . . . I’d be reading a book plus something else in my head.”

After she leaves, Kerr reads from the report about her. “[She] can drive a car, indicating she can learn basic tasks . . . She drove for 25 minutes to the assessment, which shows she can start and finish a task, she also knits and reads novels.” To Kerr, the woman’s failed attempts to knit and read are a sign of her depression, not her healthiness, but this has somehow been lost in translation.

Another younger woman comes in whose doctor has put her on an array of antidepressants and tranquillisers. She says the healthcare professional doing her assessment had asked her: “If you’re depressed, why have you got your nails done?” The woman looks down at her glittery gold and red nails. “I’ve not had false nails off my hands for 10 years,” she tells Kerr. “I did these at three o’clock the other morning because I couldn’t sleep . . . Even when I took an overdose [and] sat on the railings in the park in the rain, I still had my nails on. D’you know what I mean?”

An empty B&B on the Promenade © Christopher Nunn

Kerr will help these two women file appeals; Blackpool Citizens Advice has an 80 per cent success rate at overturning the DWP’s decisions. The benefit system is swallowing up time for many local charities. Dave Flanagan, who works for the GMB union, chairs a charity called the Blackpool Centre for the Unemployed. “What it should be about is a one-stop shop for anyone unemployed, but it’s going into a rut where all we’re doing is welfare rights advice,” he says. Across the country, the system has been clogged with appeals. Between October 2013 and March 2016, 57 per cent of original decisions that were appealed were overturned, according to the IFS think-tank. “This is arguably suggestive of a system that is not working well,” it said.

If anyone was the face of these reforms, it was Iain Duncan Smith, a Conservative politician who was in charge of the Department for Work and Pensions between 2010 and 2016. When I go to see him in his office in Parliament, he is quick to point out the system was set up by his Labour predecessors. “The assessment levels were quite harsh and not very good on mental health issues,” he says. “Basically we softened and changed the criteria massively.”

When I mention that some in Blackpool still felt the assessments weren’t working well, he cuts in: “Well, the trouble is they’ve been sitting on this benefit and they’ve convinced themselves they’re not capable of anything.” He thinks the best way to redesign the system would be to remove the “worklessness barrier”, so nobody is put into a category that says they cannot work. “The assessment [shouldn’t be] just whether you’re fit for work; it becomes, ‘What’s wrong with you?’, ‘What can we do to put it right?’ and ‘How much work can you do?’”

No one disagrees with the notion that decent work is good for your health. Kim Melia, a manager at the Blackpool Centre for the Unemployed, knows that first-hand. “I find with my depression that because I’m at work, I can cope better,” she says from the small office hidden between the Subway sandwich shop and the Sea Chippy take­away. Her mental health fluctuates. “I can go several months where I’m fine, but when it hits me, and it takes me, I hardly even speak in here.”

The view from the Big Wheel on Central Pier © Christopher Nunn

Alan Reid, chief executive of the Blackpool charity Disability First, has suffered with mental health problems too. “Coming in here, seeing Lindsay’s smiling face” — he grins at his colleague — “that’s my prescription.” But he worries Blackpool doesn’t have enough jobs that can support people with health problems, who often need more flexibility at work. The supermarkets are good, he says. “But if you’ve got a local hotelier, amusement arcades — are they going to be that flexible?”

While national policy has been focused on pushing people from incapacity into the labour market, it is not clear that every local labour market is willing or able to absorb them. In Blackpool, the jobless rate is above the national average and Iain Duncan Smith admits places such as this are “the hardest nut to crack. You want many of them to get back into the world of work, but you can’t get them back into the world of work if there aren’t jobs there.” It’s a vicious circle, he adds, because when you have lots of people on incapacity benefits, “no business is going to set up in that area . . . They’ll go to somewhere else where there’s a more compliant workforce.” No one planned what happened to Blackpool, he says. “It’s the way it’s worked out.”

For Jonathan Portes, chief economist at the DWP between 2002 and 2008, the lack of a plan was, in retrospect, part of the problem. “There’s an argument for saying you can’t do [welfare reform] separately from having some sort of place-based economic strategy as well — and we never really had that,” he says. “Just telling them, ‘Well there’s 5,000 new jobs in London every week, and people seem to find it perfectly easy to move 600 miles from rural Romania to take one of these jobs, so why can’t you move 200 miles from Blackpool?’ — it’s true but it sort of ignores the social context.”

People in Blackpool can’t afford to wait for central government to fix their problems. Rajpura fizzes with energy as he talks about how the town is trying to break out of its vicious circle. First, the council is trying to force private landlords to improve housing in the worst parts of town. Second, it has set up a company to buy some former B&Bs and convert them into family homes. Third, it wants to tilt the tourist trade back towards family holidays, purchasing two key tourist attractions: the Winter Gardens and the Tower.

The other challenge is to improve education standards so that people are better placed when jobs do come along. According to Rajpura, when the supermarket chain Sainsbury’s built a store in the town, “the fantastic manager, Ian” worked with the council to try to get local residents into the jobs. “A lot of those people, if you put them in a competitive interview process, they may struggle,” he says.

Kim Melia, a manager at the Blackpool Centre for the Unemployed © Christopher Nunn

It says a lot about the director of public health’s approach that he is on first-name terms with the manager of the local Sainsbury’s. “I’ve not talked about health services at all, have I?” he exclaims, half an hour into our conversation. “[That’s because] 80 per cent of health is determined outside the health service; it’s things like whether you’ve got a job, whether you’ve got a decent home, whether you’ve got social connections and friends.”

When I ask Phillips what would make Blackpool better, he says getting a community together. He now volunteers at a project called Fulfilling Lives, helping other people with addiction problems. “I get a lot out of it . . . Some people we work with do bond with me because they know I’ve been through some of the stuff they’re going through.” He’s also in a community group set up by people in recovery, who meet every Sunday to go bowling or to the cinema. When he had a “really bad struggle” a few weeks ago, he met up with a friend for a tea and a chat. “And I was fine and done!”

He joined a “citizen inquiry” into health and wellbeing in Blackpool — a project that wanted to find out from people what would make their lives better. It was there he met Hopkins. After the inquiry ended, the two of them and a few others decided to stick together. They meet regularly to discuss how they can fix up a local park. “We need some kind of community, some sense of camaraderie,” says Hopkins. “You must have your colleagues, whether you get along with them or not. But with isolation, you fall into that deep despair pit.”

Rajpura wants to make all these social groups, charities, health services and council services aware of each other, so that GPs have more options when a patient such as Phillips sits down in their examination room. “A lot of GPs won’t know what’s out there beyond their doors,” he says. The idea of integrated services is gathering momentum nationally too; Blackpool’s stretch of coast has special “vanguard” status to test out new ways of doing things.

The willingness to co-operate and innovate here is born, in part, out of stretched resources. Places like Blackpool have suffered deep budget cuts since 2010, putting public services under pressure. But, says Tracy Hopkins, chief executive of Blackpool Citizens Advice, “It’s led us to be more creative about the solutions. There’s really positive things that have come out of — dare I say it — austerity.”

The government did start a “coastal communities fund” in 2012, which has so far provided £170m for 278 projects in seaside towns and cities. But Diane Coyle says central government should combine more money with devolved powers for places like Blackpool, so that local policymakers can invest in the skills and training, infrastructure and transport most likely to make a difference. The state’s “fundamental purpose” is to provide people with insurance against macroeconomic risks they can’t avoid, she says. “And it hasn’t been working since the early 1980s.”

For all Blackpool’s problems, there is something about it that seems to resonate deep in people. One evening, I walk to the end of the faded, ­paint-peeling North Pier and read the messages on the engraved padlocks, plastic flowers and greeting cards tied to the railings. They are all memorials to people who loved this place. Up above, black clouds of starlings seem to shimmer and vibrate in the air. “You like the starlings?” someone suddenly asks from over my shoulder, making me jump. It is the pier’s night watchman, just starting his working day. “They live under the pier, thousands of them,” he smiles. “You should see them at 5am. I get them to myself.”

Blackpool’s housing, its jobs, its isolation, its drugs, its booze, they wear people down and sometimes suck them under. But beneath all that mess, perhaps there is something therapeutic about the place as well. Kim Melia wonders if the town could make a virtue of the fact people gravitate here when they need help. “Let’s get some rehabilitation centres, not just for the junkies but for anybody — it creates jobs, and the people that have got the illnesses are being looked after.”

When I ask Chris Hopkins whether he would leave, he thinks back to life in his old town, where the shutters for all the shops came down at 5pm and he would spend the rest of the night alone in his flat. “But I’ve come to Blackpool and there’s always something on. At least I can walk out my door and go into the town and put 10p in the console machine, or go and sit on the beach. The other day, I went and sat on the beach and had a couple of cans, just playing my music, watching the tide come back in,” he says. “I enjoyed myself.”

Sarah O’Connor is the FT’s employment correspondent

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Statistical analysis and graphics by John Burn-Murdoch

Photographs: Christopher Nunn

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