‘GOT NOWT LEFT’ – the impact of inequalities on public mental health

Gillian Samuel

On a recent visit to the now gentrified Northern Quarter area in Manchester, I had just left a cool neighbourhood café and gorged on wild mushrooms on sourdough toast and strong Americano coffee (black with hot skinny milk on the side). Happy me. Lucky me. Clever me.

And then it yelled at me from across the street: ‘Got Nowt Left’! It punched me in the stomach with its intent. I was instantaneously jolted: Got Nowt Left! Got Now Left! Got Nowt Left! Like a chant, those words bore down on me and triggered thoughts of a past best forgotten.

I was thrown back to a time when, as a single parent with three children, I had no food. With no money to buy, I was scared and alone. The feeling of how I would feed the children overwhelmed me; I would steal if necessary.

Luckily, by chance (and by secret miracle), my neighbours invited them in, and they ate. But I remained next door, miserably hungry, cold with fear and silently ashamed; struck down by poverty; depression creeping its way in and wearing me down. A hole in my stomach. An empty bin of a life.

Using my lived experience in research

It is little wonder why memories of food insecurity were so vividly revealed by the sight of the graffiti. Inequality has been on my mind – and for good reason.

As a Peer Researcher with the Public Mental Health team at McPin, I am involved in discussing and exploring this subject. For example, we recently launched a study on inequalities and their impact on public mental health and are currently asking people to take part.

Our project sits within the England-wide Public Mental Health Research Programme, funded by the National Institute for Health Research, School for Public Health Research.

Our overarching role is to bring the voice of the public into public mental health research, and our aim is to ensure that what we do on the programme is timely, relevant and meaningful to people’s lived experience of mental health.

Inequality – a common theme

We began by having conversations with the public in face-to-face workshops during 2019, where people had the chance to say openly what they felt influenced their mental health. We were not surprised to hear that, amongst others, poverty, discrimination and poor housing were common factors.

Some people thought such issues were the cause of poor public mental health and, for others, the consequence.

All in all, and in one way or another, structural and systemic inequalities repeatedly surfaced. They often acted as a connector between many of the factors that influence population health, such as social fragmentation, housing, or employment insecurity.

Yet, as their role is complex, they do not fit neatly into research processes and therefore can sometimes become lost from focus.

To help give inequality the place it deserves in this conversation, we are inviting the public from two London boroughs to express how they feel about unfairness and mental health.

This is being done creatively, by asking people to take photographs on what inequality means to them. These photos are then used as a basis to have conversations, the results of which will form the dataset for the study.  This method is called ‘PhotoVoice’.

What we want to understand

The purpose of the project is to:

• Understand how people experience inequalities
• Understand how inequalities affect people’s mental health
• Understand what people’s priorities for change are
• Build capacity for public involvement in public mental health research

We hope we can have conversations with people to reflect a diversity of perspectives, including people from groups such as LGBTQ+, BAME, homeless individuals and care givers.

As part of the project, we have spent time reflecting on our own lived experiences of inequalities and their impact on our mental health. Here is an example from another member of the Peer Research team, Oli.

Oli’s story

Several years ago, I was sitting in an emergency department side room with a psychiatrist and a mental health nurse, feeling scared and alone. After talking for a while, the nurse leant forward and said:

“Many people wish for what you have.”

At the time, those words really stung. How could she say something like that to someone in a moment of crisis? I was at my limit and my mind and reality was rapidly deteriorating.

It was only years later, after a sustained period of recovery, that I’ve come to appreciate and fully understand what she meant.

My recovery was enabled by my supportive family, good school grades, access to nature, books, hobbies and the internet and a fantastic support worker.

I had healthy food to eat, a safe place to live and enough savings that I could afford to take time away from work and study to do voluntary work instead, which enabled me to focus on rebuilding my confidence.

For sure, I worked hard to regain what I had lost, but on reflection it’s clear that without these resources and opportunities it would likely be a different story.

Understanding inequality involves exploring what is negative and harmful to mental health, but it also is about learning from experiences to find positive, protective factors that can improve wellbeing and mental health.

It also involves boldly asking the question: how could things have been better?

My hope is that this project will give us a rich and broad picture of experience from which we can draw from, and truly understand and transform public mental health.

Looking closer at inequalities

Now, take a closer look at the picture at the top Got Nowt Left. You will see, just legible, it is graffitied on top of ‘Money’.

Money! Got Nowt Left; Got No Money; Skint; Poor.

Perhaps it is a visual metaphor to explain the underpinnings of many inequalities; for example, low paid work, unemployment, insufficient funding for mental health services or social housing.

For me, it was lack of money caused by high childcare fees, and resulting in not enough money for food.

I did however find my own solution, by hosting an overseas student who helped with childcare, and gaining a new job delivering sandwiches to offices. And guess who got to take home the unsold sandwiches?

Want to get involved? Have YOUR voice heard!

We’re still recruiting for our study, so if you are a resident or a have a strong connection with the London boroughs of either Harrow or Lambeth, we’d love to hear from you.

Please refer to the green poster above and contact McPin Senior Peer Researcher Alex Lewington if you’re interested.