What has economics got to do with it? The impact of socioeconomic factors on mental health and the case for collective action

Macintyre, Anna; Ferris, Dan; Gonçalves, Briana; Quinn, Neil

doi:10.1057/s41599-018-0063-2

Cited by 84 publications

(65 citation statements)

References 39 publications

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“…Concern with safe staffing levels in mental health settings is not independent of other critique of ward care and levels of coercion (Baker et al, 2016;Gilburt et al, 2008;Jenkins & Elliott, 2004;Quirk & Lelliott, 2001). The causative factors of mental distress are complex but it is difficult not to take a view that the same economic inequalities squeezing the resources of welfare and health care are also implicated in increasing demand for mental health care (Macintyre, Ferris, Gonçalves, & Quinn, 2018;Stuckler, Reeves, Loopstra, Karanikolos, & McKee, 2018). It is also apparent that mental health services take on an increasingly coercive character when such economic conditions prevail, with, for example, levels of compulsion in England having increased substantially year on year since the banking crisis of 2008 and subsequent austerity (Care Quality Commission, 2017; Thomas, 2016).…”

Section: Discussionmentioning

confidence: 99%

“Catching your tail and firefighting”: The impact of staffing levels on restraint minimization efforts

McKeown

Thomson

Scholes

et al. 2019

Psychiatric Ment Health Nurs

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Accessible summary What is known on the subject? Mental health nursing in the UK and other countries faces an acute workforce crisis. Safe staffing levels are called for, and in some jurisdictions have been legislated for. The evidence base linking staffing levels and patient outcomes is limited. Staffing levels are implicated in adverse experiences of service users and staff within mental health ward settings, and they might contribute to levels of violence and aggression and the application of restrictive practices, such as physical restraint but there is limited research evidence to support this. Programmes such as Safewards, No Force First, the Engagement Model and the Six Core Strategies can reduce the use of restrictive practices. What does this paper add to existing knowledge? Staffing levels on acute mental health wards appeared crucial in the implementation of a restraint minimization project. Both staff and service users implicate insufficient staffing for deficiencies in the relational elements of care, such as lack of face‐to‐face contact between nurses and service users. Similarly, staffing levels are associated with perceived problems in the cause of violence and aggression and responses to it. Despite successes in minimizing restrictive practices in this project, difficulties implementing alternative forms of practice that would reduce use of physical restraint, such as de‐escalation, were also attributed to staffing levels. There is an irony that a project concerned with safety itself provoked concern over safe staffing levels. What are the implications for practice? Efforts to reduce restrictive practices will be hampered without adequate staffing levels. Restrictive practices may justifyably be framed as an employment relations matter. Organisations and policy makers ought to address environmental, contextual and resourcing factors, rather than identify problems exclusively in terms of perceived aberrant behaviour of staff or service users. Abstract IntroductionSafe staffing and coercive practices are of pressing concern for mental health services. These are inter‐dependent, and the relationship is under‐researched. AimTo explore views on staffing levels in a context of attempting to minimize physical restraint practices on mental health wards. Findings emerged from a wider data set with the broader aim of exploring experiences of a restraint reduction initiative. MethodsThematic analysis of semi‐structured interviews with staff (n = 130) and service users (n = 32). ResultsFive themes were identified regarding how staffing levels impact experiences and complicate efforts to minimize physical restraint. We titled the themes—“insufficient staff to do the job”; “detriment to staff and service users”; “a paperwork exercise: the burden of non‐clinical tasks”; “false economies”; and, “you can't do these interventions.” DiscussionTendencies detracting from relational aspects of care are not independent of insufficiencies in staffing. The relational, communicative and organizational developm...

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Section: Discussionmentioning

confidence: 99%

“Catching your tail and firefighting”: The impact of staffing levels on restraint minimization efforts

McKeown

Thomson

Scholes

et al. 2019

Psychiatric Ment Health Nurs

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“…The mental health of individuals is shaped by the social, environmental and economic conditions in which they are born, grow, work and age. [4][5][6][7] Poverty and deprivation are key determinants of children's social and behavioural development 8,9 and adult mental health. 10 In Scotland, individuals living in the most deprived areas report higher levels of mental ill health and lower levels of well-being than those living in the most affluent areas.…”

Section: Poverty and Mental Healthmentioning

confidence: 99%

Poverty and mental health: policy, practice and research implications

Knifton¹,

Inglis

2020

BJPsych Bull

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Summary This article examines the relationship between poverty and mental health problems. We draw on the experience of Glasgow, our home city, which contains some of Western Europe's areas of greatest concentrated poverty and poorest health outcomes. We highlight how mental health problems are related directly to poverty, which in turn underlies wider health inequalities. We then outline implications for psychiatry.

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“…The assumption being that such progress has been made that these issues are now resolved. Macintyre et al (2018) [ 3 ] emphasised the importance of a consideration of the links between social economic factors and the occurrence and experience of mental health problems. There have been significant moves toward this but the continued dominance of medical and individualised approaches to mental distress prevents a full consideration of the impact of socio-economic factors (Shim et al 2014) [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…There have been significant moves toward this but the continued dominance of medical and individualised approaches to mental distress prevents a full consideration of the impact of socio-economic factors (Shim et al 2014) [ 4 ]. Macintyre et al (2018) [ 3 ] concluded that such an analysis that starts from a socioeconomic position can be the basis for a move towards a social justice approach for mental health. This paper explores these debates within the context of the impact of the social and economic policies of austerity that have been pursued in the UK since 2010.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Austerity on Mental Health Service Provision: A UK Perspective

Cummins

2018

IJERPH

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This is a discussion paper which examines the impact of austerity policies on the provision of mental health services in the United Kingdom. Austerity is a shorthand for a series of policies introduced by the Conservative and Liberal Democrat Coalition government in the UK from 2010 onwards. In response to the fiscal crisis following the bail out of the banks in 2008, it was argued that significant reductions in public spending were required. The background to these policies is examined before a consideration of their impact on mental health services. These policies had a disproportionate impact on people living in poverty. People with health problems including mental problems are overrepresented in this group. At the same time, welfare and community services are under increasing financial pressures having to respond to increased demand within a context of reduced budgets. There is increasing recognition of the role that social factors and adverse childhood experiences have in the development and trajectory of mental health problems. Mental health social workers, alongside other professionals, seek to explain mental distress by the use of some variant of a biopsychosocial model. The extent of mental health problems as a one of their measures of the impact of inequality. More unequal societies create greater levels of distress. There is a social gradient in the extent of mental health problems—the impact of severe mental illness means that many individuals are unable to work or, if they can return to work, they find it difficult to gain employment because of discrimination. The paper concludes that austerity and associated policies have combined to increase the overall burden of mental distress and marginalisation within the UK.

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What has economics got to do with it? The impact of socioeconomic factors on mental health and the case for collective action

Cited by 84 publications

References 39 publications

“Catching your tail and firefighting”: The impact of staffing levels on restraint minimization efforts

“Catching your tail and firefighting”: The impact of staffing levels on restraint minimization efforts

Poverty and mental health: policy, practice and research implications

The Impact of Austerity on Mental Health Service Provision: A UK Perspective

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