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03. Why Mental Ill-health is Increasing (Part 2)

Why Mental Ill-health is Increasing – Part 2

Economic and social change and the reasons for it.

When we speak of economic growth, we normally refer to Gross Domestic Product or GDP. That is, the total value of goods produced and services traded in a country in a year. The UK Government website states that “Rising GDP means the economy is growing, and the resources available to people in the country – goods and services, wages and profits – are increasing.” Emphasis is often placed on the risks of falling income, lower consumption, and job cuts if GDP falls. However, there is little talk of the relationship between GDP and profit.

Capital is necessary for the establishment and provision of large-scale communal enterprises. The vast majority of us own insufficient capital to enable us to establish such enterprises independently. So, we must pool our capital to make large-scale services possible. Whether this pooling of capital is via private enterprise or via government is a matter of political debate. There are arguments for and against each. However, the reality in the West is that private enterprise plays a very large part.

Capital investment by private enterprise is itself a form of service. In return, investors expect payment, i.e., a profit. If GDP is rising, then this is an indicator that investors can, on average at least, make a profit on their investment. If it is falling, then this is an indicator that on average they can expect to make a loss. If the latter is the case, then they will be reticent to invest in a nation, and thus, a vicious circle leading to a depression can ensue.

However, entrepreneurs supported by private investors can be ingenious in their pursuit of profit. It is this, rather than GDP per se, that is steadily changing the nature of our economies, and thus, our societies. It could be said that GDP, in part at least, reflects this ingenuity. However, the changes wrought do not necessarily benefit the general population, and there is strong evidence that they are contributing to the rise in mental ill-health. These changes and their impact on society are described below.

We produce and consume three things:

  • material goods such as cars, food, housing, etc.;
  • services such as healthcare, education, plumbing work, electrical work, gardening, entertainment, accountancy, legal services, and so on; and finally,
  • goods and services hired in return for rent, such as apartments, vehicles, software, etc. I will refer to this as “hybrid consumption”.

Economies pass through stages dictated by the ability of investors to make a profit.

Firstly, material goods are produced and consumed. Investors provide the necessary capital to establish factories, finance initial operating costs, etc. In return they expect a profit in the form of dividend payments, a premium on the sale of their shareholding, etc. In essence, in return for providing the resources to organise production, they are taking a share of the value traded between the actual producers and consumers. To maintain this return, in the face of competition, production efficiencies are sought. Typically, this means driving down labour costs via offshoring, automation, the outsourcing of administrative tasks to customers via the internet, and putting obstacles in the way of post-sales customer contact. Growth in turnover is also sought via advertising and expansion to overseas markets. It can also be obtained in less ethical ways, for example by the encouragement of debt, the encouragement of unnecessary social competition, advertisements that create unnecessary wants, the excessive use of sugar in foods, and so on.

Nevertheless, there is an upper threshold to the quantity of material goods that we can consume. So, in pursuit of profit, investors move on to organizing the consumption of services and hybrid consumption.

In the case of hybrid consumption, material goods are offered for rent. The organisation of hybrid consumption has been triggered by improved long-distance communication over the internet. Originally, private individuals and small local enterprises offered hybrid services. However, investors have now begun establishing large organisations to offer them. They are, for example, moving into the private rental market, and even building apartments for rent rather than sale. Unless there is government regulation, the logical conclusion of this ongoing economic change is that individuals will ultimately rent everything and own nothing. Competitive pressures will, of course, still demand increasing efficiency, the driving down of labour costs, and automation.

In the case of service consumption, our individual physical and mental skills are offered to others in return for payment, e.g., gardening, plumbing, cooking, legal knowledge, accountancy, artistic skills and so on. However, investors are also moving into this area and establishing organisations to oversee the provision of these services, e.g., Uber, Deliveroo, and so on. Those who originally provided an interpersonal service are either becoming contract staff or are being replaced. Again, the logical conclusion is that all services will be provided by large organisations, all service providers will be employed by them, and labour costs will be driven down. New services will also need to be found and marketed. What will they be?

So, unless these economic changes are regulated by government, then, taken to their logical conclusion, all who do not own capital will :

  • own nothing and rent everything;
  • do nothing for themselves but employ large organisations to do everything for them;
  • be self-employed and working for the same large organisations;
  • have no employment rights;
  • earn a minimum wage; and
  • be unable to afford the goods and services they need without running up large debts.

Does this sound familiar? Clearly, this situation is free market driven, unsustainable in the longer term, and it is for governments to steer society towards a more equitable and sustainable model.

In the meantime, a growing number of people are finding themselves impacted by these changes. The resulting insecurity, uncertainty, and frustration are leading to the growing incidence of mental ill-health.

Toxic Workplace Cultures

This is compounded by the toxic culture to be found in many large organisations.

Claire Smith, Editor of New Civil Engineer magazine stated in August 2023, that “…people working in the construction sector are three times more likely to commit suicide than those in the general population…” and  “…Those working in the trades are eight times more likely to take their own lives.” In the same magazine, the trade union Unite’s national officer for construction, Jason Poulter, estimates that “over 500 construction workers died as a result of suicide last year [2022] and rates are rising.” He goes on to say that “most workers feel unable to raise mental health concerns because of the toxic macho culture that pervades our industry. This is entwined with a fear that if you admit to a problem, you are likely to be given your cards [i.e., fired] and removed from site especially if you are officially self-employed”. Mr Poulter and Unite are, of course, lobbying for mandatory regular mental health work-related risk assessments, cultural change in the industry, and the powers and resources for government agencies to investigate all work related suicides.

I can confirm from personal experience, that toxic macho cultures do indeed exist in industry, and have considerable insight into how and why they form. Such cultures have always existed but for them to contribute to the growth in mental ill-health, they also need to be impacting on more employees or to be worsening. Research by Culture Shift, shows that 40% of interviewees from a sample of 1000, have witnessed problematic behaviour, such as bullying, harassment or discrimination at work, growing substantially from the 22% that their 2020 survey uncovered.

Unfortunately, there are no statistics providing longer-term evidence of an increase. However, as services are increasingly centralized and brought under the control of large organisations that experience the pressures of competition and profitability, the number of people exposed to such cultures, and thus, their impact on mental health is likely to grow.

References

https://www.gov.uk/government/news/gross-domestic-product-gdp-what-it-means-and-why-it-matters

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02. Why Mental Ill Health is Increasing (Part 1)

Why Mental Ill-health is Increasing – Part 1

The Problem

From the results of a 2014 survey (McManus et al. 2016), the Mental Health charity MIND says that 1 in 6 people in England report experiencing a common mental health problem in any given week. These problems comprise:

  • mixed anxiety and depression, 8 in 100 people;
  • generalised anxiety disorder, 6 in 100 people;
  • post-traumatic stress disorder, 4 in 100 people; and
  • depression, 3 in 100 people.

However, these statistics include only those aged over 16, living in private housing, and living  in England.

Suicidal thoughts and self-harm are not mental health diagnoses. But they are related to mental health. Over the course of someone’s lifetime (McManus et al. 2016):

  • 1 in 5 people have suicidal thoughts,
  • 1 in 14 people self-harm, and
  • 1 in 15 people attempt suicide.

Women are more likely to have suicidal thoughts and make suicide attempts than men (McManus et al. 2016). But men are 3 times more likely to take their own life than women (Samaritans, 2019).

Unfortunately, these numbers have been increasing. MIND also report the following.

  • The number of people with common mental health problems went up by 20% between 1993 and 2014, in both men and women (McManus et al. 2016).
  • People reporting self-harm went up by 62% between the years 2000 and 2014 (McManus et al. 2016).
  • People reporting having had suicidal thoughts within the past year went up by 30% between the years 2000 and 2014 (McManus et al. 2016).

There is also evidence that some minority groups are more likely to suffer mental ill-health problems than others. For example:

  • LGBTQIA+ people are between 2 and 3 times more likely than heterosexual people to report having a mental health problem in England (Journal of General Internal Medicine, 2015).
  • 23% of Black or Black British people will experience a common mental health problem in any given week. This compares to 17% of White British people (McManus et al. 2016).
  • 26% of young women aged between 16 and 24 years old report having a common mental health problem in any given week. This compares to 17% of adults. And this number has been going up (McManus et al. 2016).
  • Around 40% of people in England who have overlapping problems including homelessness, substance misuse and contact with the criminal justice system in any given year also have a mental health problem. This is sometimes called facing ‘multiple disadvantage’. (Lankelly Chase Foundation, 2015). According to the BBC report at https://www.bbc.co.uk/news/uk-49317060, police in the UK have been dealing with ever more mental health incidents.

The MIND report can be found at https://www.mind.org.uk/information-support/types-of-mental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mental-health-problems/.

This rise in mental ill-health seems to be occurring particularly among the young. US statistics on hospital emergency department visits at https://www.aau.edu/research-scholarship/featured-research-topics/teens-young-adults-drive-increase-mental-health-er show a clear link between age group and a rise in the proportion of discharges with a mental ill-health diagnosis. The rise has been most severe among those aged 10 to 44 and least severe among those under 10 or over 64.

The Causes

The question is, of course, “what is causing this rise?”. Clearly, the disruption of COVID has had a recent impact. However, the rise was apparent long before 2020. Economic shocks, such as the financial crisis of 2007 and 2008, have also played a part. However, I would argue that the main factors are functional differentiation, progressive changes in our economy and toxic workplace cultures. I will discuss the former in this part and the latter two in the next article.

Functional Differentiation

Functional differentiation is a steady and persistent growth in specialisation, and thus, in the complexity of society. Many economic shocks can be attributed to this trend.

Complexity is itself a cause of stress and anxiety as we struggle to understand the society that we live in. However, functional differentiation leads to an increasing number of interactions between individuals and organisations. It has also led to globalisation and an increasing number of interactions between national cultures. Finally, it leads to increasing migration and interactions between the minority and majority cultures of a nation.

These increasing interactions have resulted in an increased risk of conflicting values or beliefs. If the parties to an interaction select the option of holding firm to their conflicting values or beliefs, then there is a risk of negative competition and conflict, both of which are major causes of anxiety and depression. Alternatively, for the two parties to interact effectively, one or the other must wear a mask, i.e., hide their true values and beliefs and create an appearance of holding the same ones as the other. As Karl Rogers has pointed out, the effort of maintaining such a mask can lead to mental ill-health. So, whichever alternative the parties choose, there will be an impact on the mental health of at least one of them.

The fact that minorities are at greater risk of mental ill-health supports this argument. In their interactions with the majority culture, there is a greater risk of conflicting values or beliefs, and thus, they either face the risk of social conflict or must wear a mask. The recent rise in minority rights groups has meant less pressure for minorities to do the latter. However, it has transferred the pressure to wear a mask to members of the majority. Where neither party is willing to hide their true values and beliefs, there is also a greater risk of conflict.

The rise in mental ill-health amongst the young is often attributed to smartphones and social media. However, these technologies are a product of functional differentiation, as well as probably also contributing to it. Smartphones and social media increase the number of interpersonal interactions, and thus, the potential for conflicting values or beliefs.

In summary therefore, functional differentiation leads to increasing social complexity and an increasing number and diversity of social interactions. The increasing number of social interactions leads to an increasing risk of conflicting values or beliefs. The increasing risk of conflicting values or beliefs, no matter how we deal with it, leads to an increasing risk of mental ill-health.

References

Journal of General Internal Medicine (2015), Sexual Minorities in England Have Poorer Health and Worse Health Care Experiences: A National Survey.

Lankelly Chase Foundation (2015) Hard Edges: Mapping severe and multiple disadvantage.

McManus S, Bebbington P, Jenkins R, Brugha T. (eds.) (2016). Mental health and wellbeing in England: Adult psychiatric morbidity survey 2014.

Samaritans (2019), Samaritans Suicide Statistics Report.