Moving very cautiously and softly, she stretched out her greedy hand. She drew a mug into the bed, and sat for a while considering which of the two bottles she should choose. Finally, she laid her insensate grasp upon the bottle that had swift and certain death in it, and, before his eyes, pulled out the cork with her teeth.
from Hard Times, by Charles Dickens
It looks like a medium-sized bedroom, which is probably what it once was. But today it houses a little bank of four telephones. Each one is cocooned by glass partitions, to create an acoustic of intimacy for those calling in. But the back of each is open, so that those handling the calls know that what they say is being monitored by colleagues.
This is the switchboard of the Samaritans’ suicide helpline in Sheffield. It is open 24 hours a day, 365 days a year, for anyone experiencing feelings of distress, despair or at risk of suicide. The volunteers who staff it take around 3,000 calls a month from the residents of the former steel town – and anywhere else in the country, as calls are patched through when lines in other towns are engaged.
But recent months have seen a significant change to a number of the cries for help they receive.
A wide range of problems prompt the calls. Prominent among the triggers are broken relationships, bereavement, loneliness, alcoholism, drug abuse, debt and mental health problems. But the recession has given a new prominence to calls about financial worries among callers to the Samaritan offices on the first floor of an unprepossessing Victorian terrace next door to a gaudy orange painted Carpet Warehouse and over the road from big new cut-price Netto supermarket.
“I’ve never before had a businessman ring to talk about money worries,” says the branch director, Anne Nettleship, who was on the 8-11pm evening shift. “But it’s happened three times in the space of a week.”
Each man, she said, told a similar story. “The banks won’t help them. Their money is all tied up in buildings and the banks are going to foreclose. They can’t move money around between accounts any more. They’ve lost control. The people who work for them are angry. They’ve never been this scared before. They have so many commitments. It’s touch and go. All the money’s used up. There’s no light at the end of the tunnel. They’ve no-one to talk to. They can’t tell their wives”.
Nationally, one in ten of the three million calls the Samaritans receive each year are now rooted in financial anxieties. Of those, 47 per cent are worried about unemployment, 21 per cent about their housing and 25 per cent about debts from which they can see no way out. The details tell an unnerving tale. Agitated callers speak of the loss of their job, or demotion, or cuts in their pension or declines in sales in small business or short-time working.
When Anne Nettleship has gone home the calls continue. On the night shift the really deep-seated fears come out, says another volunteer, Isabel Blincow, who has been taking calls for the Samaritans for over two decades. “They can’t sleep because they have really wound themselves up and they can’t shut their brain down. Their anxieties crowd in one on another. The financial stress just seems to them to accelerate the whole downward spiral of their life.”
Do they talk of suicide? “People I have spoken to have said they were ‘not at that stage yet’ but that the idea has crossed their mind,” Anne says. There are still nearly 6,000 suicides a year across the British Isles but that number looks set to rise, as suicides always do during times of economic trouble.
Recessions have always been bad for the psychological and emotional health of the nation. They are not good for its physical health either. In 1853, just twelve months before Charles Dickens wrote his state of the nation novel Hard Times, mortality figures among the male population hit a peak. So did suicide figures. Leaving aside world wars and the 1918 flu epidemic, they peaked again with the Wall Street Crash in 1929, with the depression in 1936 and thereafter mirrored the UK’s economic downturns in 1970, 1981 and 1994. Elsewhere the picture was similar. The Asian economic crisis in 1997/8 prompted 10,000 suicides in Japan, South Korea and Hong Kong where 24 per cent of all those who took their own lives were in debt.
Each recession saw the same combination of poor health, alcoholism, drug abuse and suicide which Dickens brought together in his novel. Two of its characters, Tom Gradgrind and the constantly inebriated wife of its plodding hero Stephen Blackpool, fall into “complete oblivion” through the use of alcohol and other soporifics. They render the young Gradgrind so destructive to his family that, the novelist says at one point, his suicide in the filthy waters of Coketown’s ill-smelling river would have been the nobler act.
There appears to be a clear link between unemployment and poor health. Studies looking at the closure of factories have shown that almost everybody who lost their job saw a deterioration in their health of some degree regardless of how healthy they were to start with. Alcohol is one of the indicators.
Today Britons affected by redundancy are hitting the bottle in a big way. A recent survey for the charity Drinkaware showed that 39 per cent of us had either been made redundant or knew someone who had lost their job in the last six months. Of that group one in ten admitted that they are drinking more alcohol to them cope with the stress. Half said they were consuming alcohol during the day. It is a vicious circle. The more hard-up we become, all the statistics show, the more we tend to drink. Long-term unemployment increases problematic alcohol-use and excessive drinking increases the risk of suicide.
And recession also increases other compulsive behaviour, like gambling, binge-shopping and over-eating. There are even recession foods – sales of comfort products like chocolate, baked beans and curries rise with particular increases in popularity of stress-busters like madras, vindaloo, jalfrezi and pasanda dishes which release endorphins thanks to their chilli content and top up mood-enhancing serotonin from the tomatoes they contain. “Eating too much, or spending too much,” says Cary Cooper, Professor of Organisational Psychology and Health at Lancaster University, “is a classic inappropriate coping strategy – like shouting at your wife and kids.”
Given the origins of the current recession in the banks and services sector you might expect the Samaritans in Edinburgh to be getting more calls from individuals in financial distress. The Scottish capital is – or was – the second biggest financial sector in the UK with banks, insurance companies and investment managers handling £500 billion of funds managed, before the banking crash, directly from Scotland.
Yet Rosie Allister, the 29-year-old vet who is vice-chair of the Edinburgh branch of the Samaritans, insists that the branch has had no perceptible increase in callers citing finance as the source of their emotional disturbance. Stephen Platt, Professor of Health Policy Research at the University of Edinburgh and a Samaritans’ Trustee, has a possible explanation for that.
“The risk of suicide increases statistically by between two and three times if you’re unemployed,” he says. University of Sheffield studies of Margaret Thatcher’s monetarism-induced recession in the early 80s have proved a casual relationship: job loss actually triggers a deterioration in metal health (and re-employment reverses that). The unemployed are also 20 times more likely to end up in hospital from self-harm, according to Platt’s own research. “But when you ask people why they tried to kill or harm themselves money worries and unemployment come low down the list than issues like the breakdown of a relationship.”
Some issues in suicide appear straightforward. When the tv medical drama Casualty ran a storyline involving a drug overdose hospital admissions for self-poisoning increased by 17 per cent in the week after the broadcast and by 9 per cent the week after. Some 20 per cent of them admitted the programme had influenced their suicide attempt. And 17 per cent said it had influenced their choice of drug.
But unemployment and other kinds of financial distress, Professor Platt suggests, do not necessarily prompt individuals to suicide directly. Rather they interact with other factors to create psychological distress.
“If you are unemployed long-term you make a mental adjustment. It becomes a chronic background factor rather than an immediate trigger but it leads to a whole series of vulnerabilities,” Platt says. Those frailties – like anxiety, low self-esteem, a lack of options and feelings of hopelessness – all increase the likelihood that someone will think that life is not worth living. Stress comes from responsibility without power. “Unemployment produces that; it also robs people of the structure that work brings to their lives. Work fills out our day, provides friendships and offers meaning. In our world you are what you do.”
Back at the Edinburgh Samaritans switchboard Rosie Allister has been joined by the branch chairman Geoff Burgess, a retired banker, and John Lawrie, a former national chairman of the organisation who describes himself as “a semi-retired investment manager – when it was respectable job”. Despite their former professions they look beyond the money to deeper psychological issues.
Pinning down causes for mental turmoil is notoriously difficult, says Lawrie who has been a Samaritan since 1975. “Did the marriage break up because he drank, or did he drink because the marriage was breaking up?” he asks rhetorically. Questions about motive are classic circular conundrums. “Most people have mechanisms to cope with financial worries but people of low self-worth may find that a financial crisis impacts on that,” he adds. “Or being unemployed may impact on their sense of identity.”
Rosie Allister, who is beginning a PhD on why her fellow vets are the social group most likely to kill themselves, has also become accustomed to looking beyond the obvious. “A lot of the triggers for calls are indirect,” she says. The London bombings, she recalls, brought back for one caller vivid memories of the death of a relative many years earlier. The death of Princess Diana, remembers Geoff Burgess, touched a wide range of callers who had lost somebody young, or who had a broken marriage, or an unhappy childhood.
“If there’s been a distressing programme about abuse on the tv we might get calls from someone in whom it has triggered the recall of how they were abused decades earlier. That kind of delay is very common,” says John Lawrie. The causes of psychological suffering are often far more complex and oblique than is popularly assumed.
The classic media image of a recession-induced suicide is the City of London banker jumping from the ledge outside his office window. But that is the exception, which is probably why it is news. The typical recession suicide is more likely to be a young man in his early 20s in Blackpool who left school with no qualifications and never had a job.
Suicide rates in most of the population have been falling in recent decades. They are now at their lowest level on record. But in one group they have rocketed. Among men under 45 suicide is now the most common cause of death after accidents. A soldier is more likely to kill himself than die in combat. And a young man aged 16-24 is more likely to take his own life than be killed crossing the road.
But age is not the only risk factor. “The lower down the social hierarchy you are the more likely you are to take your own life or self-harm,” says Professor Platt. So the risk of suicide rises among those from an unskilled background who are unemployed and whose parents and grandparents were also unemployed.
“The change began during the 1980s recession,” says Professor Danny Dorling, professor of human geography at the University of Sheffield. “Unemployment for young men reached 40-50pc in some areas. People felt they weren’t valued.” And the evidence shows that that the kids who went on so-called Youth Training Schemes suffered the same degree of psychological damage as those who were unemployed in terms of the proportion going on to develop clinical depression.
That is not a sense which has much ameliorated. The Prince’s Trust earlier this year published an index, based on 2,000 YouGov interviews with young people across Britain. In it 47 per cent said they are regularly stressed; 27 per cent claimed that they are “often” or “always” down or depressed; and 12 per cent insisted that life is meaningless. The most negative attitudes were found in the group known as Neets, an acronym for those Not in Education, Employment or Training. Neets were consistently more unhappy and less confident in every aspect of their emotional well-being.
What will make matters worse is that – for all the media talk about this being a middle-class recession – all the evidence is that the brunt of the current economic crisis will be felt by the poor and the younger generation. If unemployment reaches three million, as predicted, almost a half of that total are expected to be under 25.
“As employers across the country tighten their belts it is often the young that suffer most,” says Prof Dorling. “Everyone moves down the employment staircase: the top candidate who would have become a banker becomes a teacher; the graduate destined for teaching works in a call centre; the one who had hoped for a call centre becomes a cleaner, and the one who previously could have got a cleaning job goes on the dole. Teenagers who leave school without 5 A-Cs will go straight on the dole and face the prospect of spending a lot of time there for most of the next 40 years.”
There is no talk any more, as there was in the Thatcher years, of unemployment being “a price worth paying” to curb inflation. “What we have learned from studying those days is that an early spell of unemployment can damage people for life,” says the health policy expert, Stephen Platt. “It affects not just your CV but your sense of your place in the world. Young people lose the chance to develop the soft skills – like how to interact with other people – that you learn when you have a job.”
A lack of such skills is only one of the disadvantages which plague jobless young men – bogged down in a world of benefits dependency, the black economy and the fringes of criminality. “There’s a whole raft of things which make them more prone to suicide,” says the Edinburgh Samaritan Rosie Allister. “What makes them more vulnerable is their [reluctant] attitude to seeking help, their perception that talking about emotions is a sign of weakness, their sense of who they are and what they are worth, their lack of hope for the future, their poor coping skills, their lack of social support, their lack of older male role models and a range of pressures it’s hard for the rest of us to understand.”
Women are better at all that. But that is not the only reason their suicide rates are much lower. Impulsive behaviour is a big element in many suicides and men chose methods that are more violent and lethal. By contrast women are more likely to chose techniques that go wrong, like overdoses. The advent of anti-depressants you can’t overdose on, like Prozac, have helped, as have the marketing of potent medicines in blister packs which reduce the prospect of those in distress swigging down a bottle of pills.
But it’s more than that, as Anne Nettleship discovers when she visits schools in Sheffield to talk about the work of the Samaritans. “Today it’s the women who get the better jobs and the girls aspirations are reflected in that,” she says. “When we go into schools it’s striking how limited the boys’ ambitions are. Ask what they want and they say to meet a girl, have a baby and get a house. They never mention the word job. They are often the third generation of no-workers. They can see no future beyond a life on benefits. Their routine assumption that this is what the rest of my life is going to be like.”
Recession is taking its toll on relations between the sexes. A quarter of families admit to arguing more because of the pressures on family finances, according to Relate, the UK’s largest provider of marriage guidance. Two thirds of its centres have seen an increase in calls over the past six months, with the Midlands and South of England most affected.
“We have had a 30pc increase in calls,” says Sarah Curtis, director of Relate’s centre in Rugby. “Hard times can be the final straw in a series of problems in a marriage. Increasingly we are being approached by high-powered business people.” But whereas the social attitudes are increasingly accepting of men quitting work to look after the children – with Britain’s stay-at-home fathers up 80 per cent in the last year to a total of 350,000 – the redundancy of highly qualified working women is throwing up new problems.
One high-powered female executive went to Relate after finding that, not only could she not get another job, but she couldn’t even get interviews. The situation had been a blow to her sense of being an equal partner in her relationship. “The uncertainty had made her very needy,” one Relate counsellor said. “It has dramatically changed the dynamics of the couple’s relationship and even affected their sex life.”
More routine is the extra stress financial crisis throws upon shaky relationships. “Some marriages which aren’t particularly strong are held together by each partner doing their own thing and spending as a way of compensating for emotional sterility,” says Linda Jones, the lead divorce lawyer at Brethertons solicitors in Rugby. “When
financial constraints can reduce their ability to do that they spend more time at home together and argue more. Affluence can put a sticking plaster on weak relationships;
financial strain exposes that.”
When the recession began to bite a lot of couples who came in to Brethertons for advice on divorce decided not to proceed because they knew they would not get a good price for the family home. “It forced people to stay together because they can’t afford two homes and because the value of their businesses and assets are falling and so are their incomes,” says Linda Jones. “But once a couple get to the stage where they realise they can’t do that any more, the quicker they split the better chance they can remain on amicable terms for the care of their children.”
Instead what is happening is that the are staying together but with increasing acrimony. “It’s the worst of all worlds because the resentment is building, there is more to argue about and they have stopped biting their tongues,” she says. “And the children are stuck in the middle.”
Increasing numbers of her clients are turning to a pioneering scheme which Brethertons have imported from the United States. Called Collaborative Law it strives to promote fair and conciliatory settlements. “Divorce is a sad fact of life,” says Jones. “The important thing is how people handle it. The quicker it is addressed the better the chances a couple can come out not exactly friends but united in the parenting of their children. Under this collaborative scheme couples enter into a contract not to go to court, to put the children first, to treat each other with respect, to adopt a problem-solving stance and put the interests of the family as a whole before their own individual interests.”
The scheme is gaining popularity as economic times get harder. Divorce is expensive and the litigation route is rigid. A couple can spend £40,000 on legal fees which would be better spent on a deposit for a new home for the husband. “This is much more controlled emotionally,” Brethertons’ head of family law says. “As lawyers we don’t make as much money from this as from litigation but we make up for that because we’re handling more cases this way.”
Recession has given the approach a real boost. “Women like it because it feels emotionally better,” she adds, “and men like it because it gives them more control and it’s cheaper. And its better for the kids.”
The nation’s children are the most hidden victims of the physical and emotional costs of recession. Four out of ten parents say that financial strain and insecurity has affected their children’s quality of life in recent months, according to a survey by the telephone helpline Parentline Plus last week. Half of those also say they are spending less time with their children because they now have to work longer hours to make ends meet.
Some of it looks comparatively trivial. “Kids have been told them can’t have new trainers, or they’ve had their dance class or sport activities cancelled,” says Sarah Curtis of Relate. Maybe in the long-term that will teach them the value of money but the reason it comes up with couples seeking help with their relationship is that the lack of money is causing more family rows.
“In the short-term it affects their confidence, their self-esteem and their relationship with their peers,” she says. And parents feel guilty they can’t provide things that the children have always seen as normal, like top-ups for mobile phones or money for school trips. “Children who haven’t seen these things as luxuries before can find it unnerving that things they considered a normal part of life are being taken away.”
But it is youngsters at the lower socio-economic end of the scale who are already suffering most. “The children of the poor will be hit worst by recession because it is still the low paid who lose their jobs most,” says Martin Narey, chief executive of the children’s charity Barnardo’s, who previously ran the Prison Service in England and Wales. The evidence gathered by his charity shows that unemployment exacerbates child abuse and suggests indicates that in a recession that will increase.
Most poor parents, of course, do not maltreat their children but the incidence of maltreatment, particularly neglect and physical abuse is greater among the poor. Four million children live in such needless poverty. Rises in problems like childhood obesity are linked to that. “Poor kids will get fatter because people with no money buy crap food,” says Narey bluntly. “I went to the supermarket the other day and 500gm of ordinary mince with 35 per cent fat cost £1.30; by contrast the same amount of lean mince with 5pc fat cost £3.90. One with overweight kids said to me: ‘I know I should give them celery when they ask for a snack but custard creams are cheaper’.”
Sudden life changes, including loss of income, can be a significant catalyst for abuse. “Physical abuse increases as families are put under more and more financial stress,” Narey says. “Recession will only make that worse. Our levels of child poverty are shameful for a country of our affluence, for despite the recession this is still the fifth richest country in the world.
“Many children find themselves in a vicious cycle of neglect and abuse, underachievement, exclusion from school, and involvement in drugs and crime,” he continues. “The costs of failing to help are, particularly in the case of those children who end up in custody, spectacularly expensive.” The youth justice system in England and Wales costs the public purse more than £600m a year and yet is a massive failure: more than 80 per cent of children released from custody re-offend again within a year. “That this the thing that links my old job [as head of the nation’s prison service] and my current one. Recession will make all this worse.”
There may be another reason why the Samaritans in Sheffield report an increase in calls from people hit by recession while their colleagues in Edinburgh do not. Recession does not just fall disproportionately on some individuals and social classes. Its impact varies enormously according to geography.
Britain is a massively unequal country. Life expectancy on the tough Scottish housing estate of Easterhouse is 66. In the comfortable southern seaside of resort of Eastbourne it is 80. A clear north-south divide remains, says Professor Danny Dorling of Sheffield University who is one of the country’s leading figures in statistical sociology. He has drawn up and atlas of death which shows significant differences on a whole range of indicators.
The poor don’t just have shorter lives, they have worse outcomes on everything from education to employment and alcohol abuse and suicide. People living in Britain’s poorest neighbourhoods are six times more likely to be murdered than those from the most affluent areas. And those poorer areas are still chiefly in the north of England and west of Scotland.
Over the past three decades the number of murders in most population groups have fallen. “But they have risen astronomically among young men, so enormously that it has doubled the overall murder rate,” says Dorling. “The rise in murder in Britain has been concentrated almost exclusively in men of working age living in the poorest parts of the country. The poorer the place you live, the more likely you are to be murdered.”
This increase in murders among such a specific social group, like the increase in suicides, has its roots statistically in the recession of the early 1980s. “A pattern was set then which has persisted. Mass unemployment and the feelings of hopelessness and a lack of opportunity it creates all breed fear, violence and murder,” Dorling says.
And all the international indicators suggest inequality is one of the most profound causes of all this. “The more unequal a society is the more murders it has. So the United States – where the pay gap between the top fifth of the population and the bottom fifth is 8:1 – is one of the worst places for murders. And, Japan which has a pay ratio of just 3:1, is one of the best. Mental health problems follows the same pattern, places like the US are highest. These are longer-term trends but they could all be accelerated by recession.”
Dorling agrees with Martin Narey that it will be the poor who are hardest hit in today’s hard economic times. “Unemployment will hit the periphery worst,” he says. “Places far from London, like the North East, are seeing most job losses and bigger drops in house prices. Head offices are in the south; branch offices – which are the ones you close – are in the North. Recessions have the least effect on managers and those higher-up; it is the managers who decide who to sack and they rarely sack themselves.”
As a nation, he says, we have a choice to make. “We can make the same choice we did in the Thatcher years and vote to abandon the poor and the North. If things get really tough, as in the 30s, public servants like teachers and policemen could be forced to take a pay cut. The government could just let manufacturing industry wither completely. David Cameron will be well-placed to do all that if the wins the general election.”
But there is an alternative. “Risk factors aren’t inevitabilities,” as Rosie Allister of the Samaritans puts it. “We can and must work to break the cycle at all stages, beginning with children,” says Martin Narey of Barnado’s. “I certainly don’t think we should see the regional divide as being inevitable – quite the reverse. I think we should be doing something about it,” the government minister, and Northern MP, Yvette Cooper, now the Secretary of State for Work and Pensions, has said.
Those involved in improving the psychological and emotional state of the nation offer a number of policy prescriptions.
Evidence from previous recessions shows that government policies can offset the adverse impacts of economic downturns. Stephen Platt of Edinburgh’s Centre for Population Health Sciences insists that the 80s and 90s recessions, which contrasted the approaches of the governments in new Zealand and Finland, showed that suicides could be reduced by a better welfare system. In the UK statistics have shown that there are fewer suicides under Labour governments than Tory ones – on average one a day less – reflecting Labour’s more generous welfare policies. Thanks to the minimum wage that differential has been maintained even under New Labour which has generally presided over a rise in inequalities.
Increasing the numbers of places at university would greatly help, says Professor Danny Dorling, the human geographer from Sheffield. “A 9 per cent increase in university admissions – which we know the system has coped with before – would be the cheapest way to take 3 per cent of 18-year-olds out of the job market for three years,” he says. “Other young people could then take the jobs the students would have taken, which would knock three percentage points off the dole queue. And there would be fewer youngsters to compete with older workers who have recently been made redundant.”
Changes lower down the education ladder are needed, according to Martin Narey of Barnado’s. “We need better education for 16-17 year olds, not just garaging them in classrooms, but something vocational for young people who don’t do well academically – led by old-fashioned avuncular tradesmen who will also offer the kids the good adult male role models they so often lack at home. And we need a proper alternative education system for excluded pupils – not just a few hours a week at pupil referral units but a whole new school, which may have to be residential to take them out of the chaos of their lives.”
Other policy changes might include introducing a “right to sell” comparable to the “right to buy” of the era of Thatcherism. When householders fall into mortgage arrears they should be able to transfer ownership of their property from a bank to the local authority, says Dorling, to allow people to continue to live there but renting from the council rather than evicting them and then finding that the local authority has the obligation to house them elsewhere. It would be kinder, says Dorling, but cheaper too.
The fear is that we are now only just beginning to see the start of the emotional and psychological toll that recession could exact. “We won’t know for another six months whether this is going to be a short recession like those in the 70s, 80s or early 90s or a fully-blown depression like that in the 1930s which lasted for years and plunged the nation into deep despair,” says Professor Dorling. “We could yet be on the brink of something much more gloomy.”
The mere fear of that is problematic. Studies of the long-term consequences of factory redundancies show, says Stephen Platt, that “the period most damaging to psychological health is the period of rumour, before any announcement about redundancies is made”. Recession damages those who are not yet economically affected by it. “Fear of losing one’s job and pressures caused by a downturn in business, demotion or pension plan cutbacks can all be bad for mental health.”
Evidence that this is already happening is what the increased calls to the nation’s helplines reveal. At the Samaritans switchboard in Sheffield Isabel Blincow has spoken to a number of people who are off work with stress. “The problem is,” she says, “that they are supposed to be at home trying to recover. But they are spending all their time worrying that, when the redundancies come, they will be the first to go”.
Whether or not the axe falls upon those callers, some real psychological harm has already done. “This is the busiest I have known it in 25 years,” says Isabel Blincow. And there is almost certainly more damage yet to come.
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