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Mental Health in an Unequal World - A privileged perspective

Painting credit: fark (@farkfk)

The theme for this year's World Mental Health Day is "Mental health in an unequal world", reflecting the many divisions and inequalities existing, in many cases growing, between people across the world, and often exacerbated by the impact of the pandemic over the past couple of years. Drawing from my own experience, I wanted to reflect here on experiences of mental health challenges for those considered to be in positions of privilege, with access to help, treatment, and a support network, what inequalities exist, and what should bring us all together .

Privileges and mental health

I was diagnosed with depression in 2007, and after a few years got to a point where I am now able to effectively manage it. I told my story in a little more detail in an article I wrote a year ago (my "mental health coming out") To bring to life where privileges and inequalities may come into the picture, it is helpful, certainly in my case, to look at two different aspects of mental health challenges:

Emergence and symptoms

For this first part, which in my case I would consider to cover all the years that led to 2007, I would see myself as having an experience reflecting a less privileged position. Here is why:

  • The culture I grew up in: a farming community in a small village in the East of France, where history perpetuated values of hard work and internalised feelings. A culture where "it's all in your head" is a way to dismiss a problem with an expectation to snap out of it. Where it would as a result be difficult to even consider opening up about enduring feelings of sadness and hopelessness. Saying this, I am mindful that at that time, in the late 80s and 90s, this culture wouldn't have been exclusive to my little village, and that many will have experienced it. Fortunately though, awareness and appreciation for mental health conditions have developed, even if there is still a long way to go. Yet, we cannot ignore that in some parts of the world, this recognition is still lacking, and that people will not feel in a position to open up, seek support, and will be stuck with the aggravating feeling that what they experience is of their own making, and somehow their own fault.

  • Being a gay man. Or rather being a man, and being gay, as there are points to make with each of these traits, and indeed the way they intersect. First, the complex relationship between men and mental health. According to CALM, 75% of the 125 lives lost every week to suicide are men. This doesn't necessarily mean that men are disproportionately affected by ill mental health (and by no means looks to minimise the impact ill mental health has on women), but it reflects that men are more likely to avoid addressing their challenges and seeking help, leading to them considering that these extreme actions are their only way out. There too, progress is slowly happening in raising awareness and taking action, with for example public figures speaking out, sharing stories, and showing that vulnerability is ok. And there too, progress remains unequal, and many men still grow up developing unhealthy expectations on themselves, to the sound of "be a man", "grow a pair", or "man up".

  • Mental health and LGBTQ+: According to a study by Stonewall reported by the Mental Health Foundation, half of LGBTQ+ people have reported experiencing depression. As Mind explain in very simple terms, being LGBTQ+ in itself isn't the cause of ill mental health. However, the many challenges, mostly from social contexts, faced by LGBTQ+ can be significantly aggravating factors, being the feelings of rejection, fear of coming out, discrimination, or as above the comparison against social expectations. It is easy to see how this may exacerbate the issues mentioned in the previous point, which is certainly what I have experienced, and how this could trigger feelings of worthlessness, where people may feel they do not deserve to seek help. Of course the picture is way more complex than this within the LGBTQ+ community alone - a recent review of research on mental health amongst LGBTQ+ populations (Mongelli et al., 2019) shows the specific focus research has put on subgroups such as older LGBTQ+ people, the black LGBTQ+ community, or transgender individuals, to gain a better depth of understanding in particular issues faced by these groups, and inform public policy decisions.

Diagnosis and treatment

As we have seen above, finding yourself in a place where you even consider seeking help is half the battle. Still, once you do, inequalities remain, and probably even so to a greater extent. And it is in this situation that I would consider myself as having been - and still being - in a privileged position.

First, because when I was ready to speak, someone was there to listen. My partner, first - I nearly wrote "of course", but am very mindful that it isn't something I should take for granted and that everyone experiences. Indeed for people living on their own, the feeling of isolation can be more than just a lack of support, an aggravating factor in itself. Similarly, people in relationships with someone who isn't showing empathy, or is dismissive of the feelings they share, will make matters worse, causing the person who suffers to feel isolated , and, even worse, to question themselves about the seriousness, or legitimacy, of what they experience.

Next was my GP. He may not have been the warmest or most talkative, yet has been of tremendous help over the years. In fact the warmth he was lacking in his demeanour gave him a (perhaps intentional?) neutrality over the situation and my condition which removed any fear of judgement, and kept things factual in a way that was easier to talk about; in this way, from my perspective answering questions about suicidal thoughts wasn't much more difficult than talking about a dodgy knee. This also helped framing the issue, treating it as an illness, which had been diagnosed and was going to be treated. And this is how we then worked together to find the treatment which would work for me, involving medication, some counselling, and general advice on a healthy lifestyle. This in itself took years of trial and error, and checking in every three months to review and adjust, to reach the point I am in now where I know how to manage my condition - luckily I got there just as my GP decided to take retirement (unless I exhausted him...).

And alongside all of this was the support and accommodation from my employers. Since 2007, I have worked for a few different companies, however have been able to benefit from the support I needed to look after my wellbeing. With a few caveats, in the sense that it isn't until recently that I have felt ready to talk openly about my depression to my employer and other colleagues - reflecting a mix of evolution in my working environment and my own readiness to open up; and also that I didn't always manage my own workload, or prioritise my wellbeing, effectively, but there too feeling that I have now learned to improve. That said, in the early days when I was figuring out how to manage my condition, I was able to take time off without losing income, I benefited from medical insurance when I decided to take up counselling support, and I had access to gym facilities to help manage my condition with exercise.

All these things do not necessarily scream of privilege, and in fact to many may seem quite mundane. After all, most people have access to a GP, and ability to take time off for sickness, etc. However, considering the entire population of the UK to start with, according to the ONS just over 15% of the working population is self-employed. Most of these will not have access to the same level of financial and practical support than those of us working for larger companies enjoy. This in turn may add to any hesitations of seeking help for mental health reasons, and a temptation to just "push through it". In addition to this, access to GPs can be unequal; a few years ago, the NHS recognised challenges regarding unequal access to GP services, and set out an improvement plans to reduce these inequalities, which had a variety of reasons ranging from information on individual rights, to increased reliance on internet-enabled services. Unfortunately, the last 18 months will have seen some of these challenges worsen during the pandemic, and probably undone some of the progress that had been made.

Looking further out, beyond the UK and across the entire world, it is easy to see that some of the support and benefits I have mentioned aren't equally available to all, and that the range of inequalities becomes vast. Both access to medical support in a broader sense, and to decent employment conditions remain things that some are struggling with and fighting for. And with this type of concerns, mental health is not only likely to be adversely impacted through additional stress, but also not to be acknowledged and supported. So, yes, despite my own challenges, especially earlier in life, the supportive environment I find myself in now, and access to help to manage my condition make me consider myself to be in a privileged position.

With privilege comes responsibility

Acknowledging a position of privilege is a first step, even if, to some managing a mental health condition, it might feel slightly counter-intuitive. One trap to try and avoid with such consideration is to develop feelings of guilt. This isn't about questioning anyone's condition or legitimacy because of their background, economic situation, or other characteristics. It isn't a case of "you've got everything to be happy, you shouldn't be depressed", which many will have already told themselves countless times.

Acknowledging a position or privilege, is understanding that there is an opportunity for action, that for the help and support we may be getting, others continue to suffer in isolation. That we should take any chances to help redress the balance. But what does that mean in practice? Just beginning to think about what we can do, as one individual, to help such a significant challenge can be overwhelming. And that's the next trap to try and avoid: taking the weight of the world's issues on your own shoulders, or giving up doing anything because of the size of the task. And for those with mental health conditions, considering your own wellbeing should remain the priority - think about the usual plane analogy of securing your own oxygen mask before helping anyone else.

Taking action doesn't have to mean that we should all start chaining ourselves to public authority buildings. It can be as easy as speaking up, raising awareness, talking about inequalities when you get a chance, to help educate, and take opportunities of creating snowball effects. It could be helping someone in a vulnerable position, or helping them seek support. Seeing how you can get involved with a relevant charity, in whichever way you can. Just looking out for opportunities, and when a platform presents itself, taking it.

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