Nathan Hodson: We should prepare for the mental health impact of mass unemployment

Thousands of people will be exposed to the adverse mental health effects of unemployment, housing instability, and debt, warns Nathan Hodson

The upheaval of the past six months has had an adverse effect on the mental health of the population, but unless we act now there are indications that worse is yet to come. Despite the collective challenges people in the UK have faced over recent months, some key stressors were deferred by government intervention: career uncertainty was delayed by the furlough scheme and precarious housing propped up by the pause on evictions. However, over the coming weeks the government will dramatically reduce this support. The health system must be prepared for the ensuing mental health consequences as the economic shock of the pandemic fully kicks in.

Evictions resume this week, after a reprieve of almost six months. The total impact of this will be delayed by the last few weeks of the furlough scheme. Almost 750 000 people have already lost their jobs but when the end of October sees the furlough scheme wrap up, another wave of unemployment is expected, with predictions that it will almost double to 7.5% by the end of the year. While the chancellor’s new subsidy for retaining workers part time may stem the flow into the job market, Torsten Bell of the Resolution Foundation suggests “the end of January is the new end of October cliff-edge.” Over the coming weeks and months, these rising waves of unemployment will combine with a backlog of eviction threats to put many people under huge financial stress.

Although it can be hard to measure the link between mental health and economic recession, evidence suggests that past economic crises have led to a rise in people seeking care for mental health problems. UK data from 2008 to 2010 concluded that every 10% increase in unemployment among men was associated with a 1.4% increase in male suicide.

Even during times of relative economic stability, financial difficulty is linked to poorer mental health. Data from the US found that homelessness and debt are independently associated with increased suicide risk. While the UK’s system of Universal Credit has been shown to exacerbate depressive symptoms—and is more harmful to mental health than previous welfare benefit systems.

All of this suggests that it is prudent to anticipate a coming mental health crisis. The furlough scheme has temporarily masked the underlying rupture in the economy caused by covid-19, but its withdrawal will leave many people—especially those who won’t benefit from the chancellor’s new subsidy—without occupation or income.

Doctors who run clinics and those who discharge patients from hospital should be alert to the risk that financial stressors could exacerbate or precipitate mental illness, and now is the time to begin preparing solutions. Local money advice and crisis debt services are expert in offering hope to those facing deep financial trouble and many doctors are already prepared to signpost patients to them. Housing provision by local authorities has also stepped up during the pandemic and in some areas has become easier to access over recent months.

People who have lost jobs may benefit from social prescribing options, but these have been affected by the pandemic. Although there has been some investment in social prescribing during the pandemic, people’s ability to access local options may also be hindered by their own personal circumstances and financial situation during the pandemic—for example, when it comes to having appropriate equipment and childcare. An awareness of local offerings and what will be feasible for individual patients will continue to be  crucial. Similarly, church services have rapidly evolved to include online meetings and social distancing in buildings. During a time of uncertainty (as well as particularly upsetting circumstances of bereavement), many patients will wish to know what local faith groups have on offer, allowing doctors to point patients towards this alternative source of support and connection.

Of course, the government’s intervention this week will benefit some people who would otherwise have lost their jobs. Nevertheless, the end of furlough still cuts loose those working in certain sectors, such as nightlife and theatre, who are unable to return to work. The chancellor has provided a relatively modest intervention, deferring some of the financial stressors planned for November until 2021, but notably doing nothing for those now facing eviction in the middle of an escalating pandemic.

The new policy may save some jobs, but the chancellor has acknowledged that many will be lost, leaving potentially hundreds of thousands of people exposed to the adverse mental health effects of unemployment, housing instability, and debt. Frontline doctors seeking to mitigate the predictable mental health consequences for our most vulnerable patients have a crucial role over the coming months.

Nathan Hodson is an academic clinical fellow at Warwick Medical School. Twitter @nathanhodson

Competing interests: None declared.