Policies that mitigate the stress of poverty and promote mental health would more effectively reduce the welfare burden than scaring individuals into paying back debts they're unlikely to have, writes Erin Stewart.

There was a point where I figured, "I have a problem".

Sleeping for 12 hours a day was a clue. So was the accruing pile of important papers in dire need of my attention. The fact that I hadn't gone outside for the best part of the week, despite having work and study commitments, was another good clue.

Eventually, doctors agreed and I was tasked with getting my life in order through medication and coping strategies. I was diagnosed with bipolar disorder.

It's easy to think of mental health issues as individual. They feel personal. You wonder why you're the one who has trouble functioning and you berate yourself for not being able to be as happy as everyone else.

But these personal struggles are situated in a context far bigger than the personal. The policies that govern our society can have a huge impact on the devastating experience of mental illness.

We've recently been presented with an obvious example of the way policy impacts the mental health of individuals with the Government's move to "recover" Centrelink debts.

After a botched attempt at automatically reconciling ATO records with Centrelink records without human oversight, around 170,000 welfare recipients have received letters informing them — often erroneously — that they may owe debt.

Centrelink debt recovery operation 'terrifying Australians'

The potential impact on the mental health of those affected by this policy has been noted by independent MP Andrew Wilkie. Over 100 of his constituents have told him they've been frightened by the letter, Mr Wilkie said, four of whom he described as "suicidal".

Indeed, Twitter users who have disclosed their distress to the Centrelink account were instructed to call Lifeline.

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The social media hashtag #notmydebt has mapped out the realities of how it feels to be in debt through no fault of your own.

There's a lot of anger, frustration, and utter despondence being expressed.

One user, Charmaine Cole from Maroubra in Sydney, told me she had received a debt notice just before Christmas saying she owed more than $2,000 (she was on Sickness Allowance for eight weeks in 2011 during her hospitalisation for depression).

Because she had worked that year, the automated system assumed that she had taken a salary during a time when she hadn't.

Ms Cole called Centrelink to complain.

"The phone call I had with them was probably worse than the letter, because they made me feel as if I had done something wrong," she said.

"I couldn't understand why, after five years are they asking me to prove something they had already approved. I started crying towards the end of the call because it was overwhelming."

After the call, Ms Cole said, she had to take anti-anxiety medication.

"I didn't contact my employer for a few days because I couldn't mentally deal with it," she said.

The idea that a government agency would cause stress to the point of making people require anti-anxiety medication, or refer them to a suicide prevention hotline as a result of government policy, is shocking.

But it isn't the only example of policy being at least in part responsible for shifts in the mental wellbeing of the population. Research shows that the poorest people in our community are disproportionately affected by mental illness.

But rather than threatening those who are already among the worst off, implementing sensible policies to raise their quality of life is arguably a better way to reduce the welfare burden.

More equal societies = happier people

"The effect on happiness of living in different social systems is so great that it trumps the individual variations between us," said Oxford University professor of geography Danny Dorling at the university's 2016 Human Welfare Conference.

In particular, Professor Dorling argued, social inequality — which can be influenced by government policy — affects wellbeing.

His own research has found that "living in a country with higher levels of well-organised collective spending produces a happier population".

In Australia, 40 per cent of people with severe mental illness live in households below the low-income threshold. ( AAP )

Professor Dorling pointed to data from the World Health Organisation which shows that, among wealthy countries, the prevalence of mental illness is higher in places with greater social inequality.

In the US — the most unequal of the countries measured — 25 per cent of the adult population had a mental illness such as depression and anxiety disorders.

The modestly more egalitarian Australia and UK both had prevalence rates of above 20 per cent. Japan, which was the most socioeconomically equal country measured, had rates of mental illness below 10 per cent.

The WHO says stress is the reason for these disparities. Stress doesn't cause mental illness as such, but it loads the dice towards it.

The impact of that stress, it says, "is greater in societies where greater inequality exists and where some people feel worse off than others".

The poorest are disproportionately affected by mental illness

I learned during my childhood that feeling "worse off" is a specific kind of stress.

My father was retrenched as a result of reforms to privatise public utilities brought by then Victorian premier, Jeff Kennett.

The stress my family felt in the years after had nothing to do with buying luxuries and everything to do with instability.

Feeling "worse off" is the exhaustion of the impossible arithmetic of budgeting when there's not enough money coming in. It's working long hours for low pay. It's the fact that an unexpected expense could render your family homeless.

Anyone from any socioeconomic background can be affected by mental illness but the poorest are disproportionately so.

The OECD has found that in Australia, 40 per cent of people with severe mental illness live in households below the low-income threshold.

The WHO report states: "We will have to face up to the fact that individual and collective mental health and wellbeing will depend on reducing the gap between rich and poor."

In Australia, 31 per cent of people on the Centrelink Disability Support Pension have a mental illness — indeed, they make up the largest group of people who qualify for these payments.

Surely, then, policies which mitigate the stress of poverty, and promote mental health, would be a far better way of reducing the welfare burden than sending scary letters to individuals to pay back debts they're unlikely to have?

'Centrelink debt letters aren't a good way to recover public costs'

There are many things governments can do to improve equality and wellbeing. They can redistribute income through taxes and welfare so that national wealth is shared more evenly.

Other measures might involve fair industrial relations laws so people don't suffer the undue stress of underpaid, long work hours; investing in social inclusion with public spaces like parks, libraries and local programs to get people engaged with their communities; and promoting housing security by protecting renters better through legislation and making housing more affordable.

For those who are affected by mental illness, better health care cover would also be a welcome way to mitigate the damaging impact of stress.

My own pursuit of wellness, for example, came at an enormous financial cost — as well as a cost to my peace of mind.

Because of limited government funding for therapy sessions (only 10 per year can be rebated through Medicare), and because not all my medications were covered under the Pharmaceutical Benefits Scheme, my treatment put me into significant debt.

And yet entering into debt is the opposite of getting well. The negative numbers accruing next to my name made me feel worthless — a literal and figurative net loss for everyone around me.

I was afraid I'd be struggling forever; I didn't question government health policy as much as I wondered whether I even deserved treatment.

I am certain these feelings worsened my condition, and meant that my journey to a debt-free, productive life was much more convoluted than it needed to be.

Mental illness is complex

I imagine how I felt is similar to what many recipients of Centrelink letters are feeling right now (except that I actually did owe money, and it was to the bank rather than the Government).

But if I could go back in time I would reassure myself that my worth is not quantifiable, it's intrinsic. And then, as my quality of life went up, so do did my capacity to get out of debt, to earn a living, and contribute to my communities.

We're accustomed to seeing a person with mental illness as the issue, but in fact mental illness is far more complex.

An individual's genetic make-up, coping style, and environment all contribute to their mental health, but so does public policy.

This link between policy and mental health means that politicians have the opportunity to create the kind of society which loads the dice in favour of people thriving.

Centrelink debt letters aren't a good way to recover public costs. Better equality and inclusion are.