Martin Knapp is an economist and policy analyst whose research, teaching and consultancy activities are concentrated in the areas of health and social care. As well as being Director of the Personal Social Services Research Unit at the London School of Economics (LSE), he is Professor of Social Policy and Chair of LSE Health and Social Care. We have interviewed him to talk about the impact of the current economic crisis to people’s mental health.

  • What effects does the economic crisis have on the population’s mental health?

There is a number of ways in which we can see effects. The most direct effect is how much money people have to buy things which will improve their mental well-being and their mental health, and how much money countries have to invest in health care systems. We have seen reductions in spending on health in many countries across the world, particularly in Europe. I think mental health might well have been particularly disadvantaged compared to other areas of health, because I think some people see it less life-threatening.

For individuals themselves, we know that there is a link between unemployment and mental health problems, not so much in generating new mental health problems, perhaps, but certainly worsening the situation of people who are already under strain. People with a history of mental health issues are more likely to lose their jobs than people without mental health issues.

I think it is a very important impact, going through that what is known as unsecured debt. So, people get into debts during the economic crisis—many people get into debts. Some people, like me, don’t worry about it because we have a good job, and we know our income is gonna be fine for the next few years. But for people that don’t have that security, that don’t have that reassurance, debts—even a relatively small debt—can cause a lot of stress. Those are some of the consequences that we have seen. Economic crisis has directly or indirectly impacted upon government spending, and has impacted upon the economic and other circumstances of individual people and their families.

  • And what are the effects in young people?

What is especially problematic for young people is that, as we are having an economic crisis which is going on for a long time, it is challenging for them to see positive prospects for the longer-term. And they haven’t got by definition a big reserve of resilience, perhaps, compared to older people. So they are particularly vulnerable and in many countries, like in Spain or the UK, we are seeing an increase of suicide rates, which is a very extreme measure of poor mental health—it’s a very bad measure too, but it is just the only thing we can measure easily. That has been particularly worrying, I think, among younger people.

  • By 2020, according to the World Health Organisation, depression will be the main cause of disability, how aware are governments of the need of investing on mental health?

We know about the stigma around mental health problems, about the discrimination people experience, and that has many sources. One of the challenges that we face is how to change the attitudes of key decision-makers, governments and others, so that they don’t see mental health problems as somehow less important than other problems. I think that in low income countries, where there is terrible death from HIV/AIDS, from Malaria or other contagious diseases, people understand why mental health might be a low priority. But I think that in high income countries, as in Europe, I don’t understand why mental health is still sometimes seen in a very negative light.

Another thing is that it has been realised now that many people whose main health problem is a physical problem, like diabetes, cancer or coronary heart disease, have a very high probability of depression. And there is evidence that among diabetes patients, for example, if we are better at treating their depression, then, that will also improve their management of their diabetes. So, reminding people that mental health problems don’t sit in a quiet and separate silo and tackling those multiple problems together is necessary on the grounds of their wellness, but also it can be very productive in terms of how health system manages the resources.

Martin Knapp

  • How could the integration of physical and mental health contribute to a more cost-effective health system?

At least in the UK, we are seeing non-mental health doctors becoming more aware of the possible mental health issues that their patients have. Maybe ten years ago a doctor might have said to a cancer patient: “Well, of course you are sad, you’ve got cancer, and cancer is a scary disease, it makes people sad”. Today, I think they’re more likely to say: “Ok, you’ve got cancer, probably that is making you clinically depressed and we can treat your depression, and if we treat your depression at least that might improve your quality of life a little bit, even if it doesn’t change the underlying cancer”. So, I think it doesn’t have to be a very expensive or difficult change in the way that health service works but I think it can make a big difference in terms of how people feel about themselves.

  • The issue of a rapidly expanding elderly population is becoming a priority in the political agenda. Where do you see mental health trends going within the next fifty years?

I think that in many countries, certainly in the UK, the mental health needs of the older population are not being as widely recognised as they should have been. We’ve got much better in the last five or ten years at recognising that dementia is growing very rapidly in prevalence, and trying to do something to improve the diagnosis and the treatment. And again, I think that sometimes there has been a tendency in the past to label that as: “Well, you know as you get old you get sad, that is just what happens”, rather than perhaps investigating whether, in fact, that sadness might be a treatable condition. So, we know that there is a growing risk of a whole range of long-term conditions as the population ages, and mental health is one of those conditions, and it is very likely to be comorbid with any other long-term conditions in that population.

  • In the UK, the government announced that it is going to provide more funds for mental health in the next few years, do you think this will have an impact on this group of the population?

On the research side, there is a huge amount of money going into trying to find a cure for dementia, and that is good, but it won’t change anything for the rest of the population for ten years, or twenty years—that’s how long it takes to get a new medication out, to everybody. Between now and then, we have to do a lot to improve the care systems that we have for people. Care should be the main focus about short-term efforts, and with a growing number of people with dementia and other long-term conditions, that’s a big challenge. So interesting times are ahead, I’m afraid.