School of Health

Mental Health in an Unequal World

The theme for this year’s World Mental Health Day is ‘Mental Health in an Unequal World’. For those of us preparing our students to care for those with mental health difficulties, it’s a pairing that feels both fitting and timely. 

Art style hands coming together

Whilst there has been debate amongst practitioners and educators regarding the origins and best treatments for mental health disorders, there is a general consensus that the circumstances we find ourselves in play a huge part in our sense of wellbeing, and can be predictors of the likelihood of poor mental health in the future. Some of these circumstances can appear subtle but have a highly influential role in our psychological development and mental state. 

The history of mental health literature is awash with theories that outline the impact of childhood experiences on how our personalities evolve. How consistently our needs are met by our caregivers in infancy and how we are valued by those who matter to us are at the root of the many ways in which we become who we are. The way we relate to our experience, according to many psychological models, sets the template for how we see ourselves within the world. It also influences how we relate to others and our environment, engage with ambiguity, frustration and perhaps most significantly, how we cope with adversity.

Conversely, some of the influences on our psychological development are not subtle at all. The impact of childhood traumas such as loss, neglect, or abuse on mental wellbeing is well known. But perhaps less obvious for some, are the more pervasive influences that impact negatively on mental health, which can be linked to inequality in very concrete ways. 

We learn from experience, but many of the messages we retain from those experiences about who or how we ought to be can be extremely damaging. Messages that make you doubt whether you are somehow deficient because of your appearance, your physical ability or who you love can be powerful forces that shape your view of yourself and others. They can also turn into a persistent source of anxiety. 

When these judgments are reinforced through the instruments of state it becomes increasingly difficult to escape the labels that are used to define our identity or the pain it may cause us personally.

So when we stop to really acknowledge the inequalities that exist for many of us across the world, it’s hard to be surprised at the substantive link between inequality and poor mental health. Restricted life choices, poverty, or simply discrimination in all its forms can have such a detrimental impact on our wellbeing. 

Perhaps now as we are still adapting to life in the shadow of the pandemic, we are starting to truly recognise the delicate balance of conditions needed to make protecting our mental health possible. The shared trauma of the last 18 months has been a daily constant in our lives. And the enduring inequalities in our societies have highlighted a real connection between economic status and our ability to cope collectively and individually.

The overriding question is then, what can we do about inequality? According to Thompson’s Personal-Cultural-Structural model (2006), our laws begin with us. Our personal views are our own, but if enough people agree on an idea, then it becomes a cultural movement that can then become law. 

We can never prevent the flow of experiences that shape us, nor all the negative messages that affect people and their sense of wellbeing as they journey through life. But perhaps by recognising inequality in all its subtle and not-so-subtle forms, we can pass on that awareness to others. 

Keeping the systemic inequalities that contribute to poor mental health always on the agenda for those who have the power to do something about it is a strong first step towards much-needed change. 

Paul Nicholson

Course Director / School of Health & Community Studies

Paul Nicholson is a BACP accredited relational psychotherapist, training supervisor, senior lecturer and course leader. He has worked in mental health since 1997 and as a therapist in the NHS, voluntary sector and in private practice since 2005.