Fair’s fair?

The long-term negative psychological, physical and societal impacts of austerity (low/negative public investment) are well established in the academic sociological and epidemiological literature (e.g. Barr et al., 2015). Political choices are understood to impact the health and wellbeing of those in society. 

'Health in all policies' is an approach that recognises the impact that every government policy has on its citizens, importantly emphasising that it is not only health policies that affect health (LGA, 2016). Policies on transport, education, and trade, for example, also affect how people live and die, and who thrives and who does not. To this extent, when we see poor health, it then follows to some extent that we can recognise this as the outcome of policy choices.

Because of the many ways that government policies shape the lives of people who live in society, the broad-ranging issues that people experience can be seen in all aspects of psychological practice. The impacts of austerity policies, in particular, affect people in ways that psychologists encounter regardless of the domain in which they practice or research. For example, educational psychologists might see effects of austerity in poor concentration in students from homes where hunger is experienced (Passmore & Harris, 2004). 

For clinical psychologists, austerity's effects might be seen in rising suicide rates due to low employment and workfare policies (Haw et al., 2015). For health psychologists, the effects of austerity are evident in cuts to addiction services, resulting in patients being absorbed by emergency or psychiatric instead of outpatient services (Drummond, 2017). 

For forensic psychologists, the effects of austerity might be seen in the lack of funding for policing, proposed to be linked to increases in violent crime (Dodd, 2018). Austerity shapes psychologists' everyday work on a macro-level – yet many of the people we encounter may not use these explanations for the problems they face (Smail, 2005).

Although poverty is a leading determinant of mental and physical health (Marmot et al., 2020), many people do not understand the links between these factors, and instead blame individual choice and lifestyle factors for poorer health outcomes in those on the lower end of the socioeconomic spectrum (Bullock et al., 2001; MacDonald et al., 2014; McKendrick et al., 2008). 

The way the public understands poverty is presumed to be an important factor in the perceived legitimacy of state welfare and the provision of basic needs (Chung et al., 2018). It is therefore imperative that the general population understand the pernicious effects of austerity on individuals, communities and the nation. 

Yet there are many psychological barriers which make the disparate and multi-causal ways in which austerity impacts health particularly difficult for the public to understand. These implications are cognitively problematic to grasp due to their abstractness, complexity, competing political narratives and lengthy time horizons (cf. Markowitz & Shariff, 2012).

Common or divided identities

Carl Walker, writing for The Psychologist earlier this year, asked how it is possible that communities have rallied to help those affected by the Covid-19 pandemic, but have done little whilst many more died from austerity. He suggests that the experience of an emergency and a sense of shared fates can create a common identity, which brings people together to fight adversity. 

Arguably, the deaths of 120,000 people in this country from austerity policies is such an emergency. But where the COVID-19 emergency was portrayed in a way that brought people together, austerity has been built out of splitting the 'haves' and 'have nots', and its language is one of blame and undeservingness. 

In social psychology, it has been posited that the way one makes sense of the reasons for another person's need for help determines their affective and behavioural responses towards addressing this need. The terminology, or framing, used to describe a phenomenon has, for example, been shown to affect the way in which people appraise subjects and situations. In line with this, the perceived legitimacy of welfare benefit schemes relates to the extent to which members of a group are viewed as personally responsible for their own needs (Forma, 1997; Mau, 2003; Albrekt Larsen, 2006, and van Oorschot, 2006). 

When poor people are viewed as responsible for their plight due to a lack of ambition, lack of budgeting, problems with substance abuse, or similar, welfare tends to be seen as a reward system for those who have chosen to do nothing (Robinson, 2011), leading to stigmatisation of the poor. Examining the psychological processes that underpin these views, and exploring the factors that might influence them, is important for understanding how the public view welfare policy and spending. We want people to understand that these discourses around austerity divide us, and that this is detrimental to us all. 

It has been frequently evidenced that austerity affects those at the bottom end of the social gradient most, with the biggest cuts to programmes that helped people remain within the social safety net (Stuckler et al., 2017). In addition to its egregious effects on the most vulnerable, austerity breaks up our communities and pits individuals and groups against each other for access to funds and resources. 

Most people will have experienced some form of cuts due to austerity. Many will have experienced our children's schools having to reduce hours, GP and nurse shortages, and/or lack of access to social care. The lack of PPE that our NHS experienced was nationwide, challenging efforts to control the Covid-19 crisis, along with reports that this lack of supplies was due to austerity measures (Booth, 2020). 

Exploring whether people understand that austerity has affected them as well as those who are more vulnerable, across a range of social and health-related domains, is important in understanding how to motivate people to agitate for change.

False narratives and false economies prevail in an austerity policy environment. Changes to welfare provision in the UK have increased general levels of poverty as well as the myriad attendant effects of poverty (such as feeling low and being unable to afford food or eat healthily; Stuckler et al., 2017). This in turn has created greater demands on an already beleaguered state welfare system (Jones et al., 2015), which has only partly been met by an expansion of third-sector provision for specific needs, such as is documented in the dramatic rise in foodbanks across the UK (The Trussell Trust, 2016). 

It is necessary to explore whether the public understand that stagnating wages and cuts to benefit programs do not actually result in savings, but instead move the costs to other social and health services. The experience of not getting support when and as needed often intensifies the problem, resulting in more complex (and costly) interventions being needed subsequently. 

Make My City Fair Birmingham

We have observed and are working to challenge these issues in our local 'Make My City Fair' (MMCF) project. MMCF Birmingham started through a set of relationships which had been developing for a number of years. Two members of the team knew each other through their membership of a political party. One of them was already a local councillor and cabinet member and had already coined the phrase 'austerity divides'. 

The other was a newly retired clinical psychologist with experience of working in the Department of Health and with links to the West Midlands Psychologists Against Austerity group (WMPAA). WMPAA included two academics from Birmingham City University, with research interests in public health and the impact of inequality on human development, and a clinical psychologist with a focus on the impact of austerity on communities. 

We came together over a period of weeks to share thoughts about the situation in the city and decided to collaborate, taking as our starting point a document produced by the Equality Trust called Make My Council Fair (Equality Trust, nd). In order to broaden these discussions and start developing collaborative acts to combat austerity, we launched a seminar in June 2019, where we brought together city council members, health and social care staff, police and crime commissioners, union representatives, along with those who have been subject to some of the worst austerity measures. 

A key driving logic of the seminar was the need to bring people from very distinct services across the city together, to hear and recognise the commonalities of the stories of the effects of austerity on services, and to join this with stories from those whose lives have been most impacted by austerity. Although there are many anti-poverty initiatives in the city, we were motivated by the role of austerity in particular because of the political choices inherent in adopting the model and because of the divisions and hardship it causes. 

Silo-type thinking can be challenging at the best of times, but our experience is that cuts and the constant reactive mode of working within stripped-down services causes professionals to become even more inwardly focused. We hoped to create a space to overcome this and focus on the shared aspects of different experiences. 

 Three key themes emerged during the seminar. Firstly, there was a call from participants to really understand what austerity means for people whose lives are damaged by it. We heard powerful testimony about what it is like to live a life challenged by the effects of austerity, including a speaker for whom statutory services were of no help, where serious health and social problems were overlooked by both the health and social care system. We heard about the constant undermining struggle with the Department of Work and Pensions. In the end, it was a voluntary day service run by an ex-plumber and entrepreneur than helped our speaker turn his life around. 

Secondly, attendees wanted to know which services have been lost and the actual cost impact of this. Subsequent discussions with city council members enabled the scale of the costs to the council to be tabulated so we could identify that the total cuts required by Birmingham City Council since 2011/12 were £736,456,000. Moreover, we could break this down to demonstrate that £95 million of these cuts were to the Place and Neighbourhood Directorates, £91 million to the Adults and Communities, £67 million to Children Young People & Families and £44 million to Adult Social Care and Health. 

Thirdly, there was a strong sense that much more should be done to counter prevailing narratives which hold the council, NHS, Education and Police and Crime responsible for cuts when in fact these were forced upon them by national policy. Attendees wanted to challenge false economies and false narratives around austerity. In particular, there was a desire to show how austerity 'savings' are 'false economies' that shift costs to other services, store up greater costs for the future, or effectively pass costs back to the (often poorest) people of Birmingham. 

As a consequence of these discussions, we refined the specific aims of Make My City Fair (Birmingham) to:

• Challenge austerity: We are clear that austerity is unethical as a political approach, unsuccessful as an economic policy (McKee et al., 2012), and inhuman in its application. We reject it absolutely.
• Mitigate the impact of austerity: We will work together to develop and support different approaches to avoid damage being done to people, for example by pressing all agencies to pay the living wage, and encouraging statutory agencies to buy services and goods from local businesses and social enterprises.

We have since been working towards this in a number of ways. We are exploring how to encourage our local council to fully engage in alternative models of local government which enable investment in what matters to people locally, for example building on the 'Preston Model' of local investment. The Preston Model is an example of community wealth building, which has five main tenets. 

In general, it serves to organise a local community's economic structure so that wealth is recirculated through the community (for more information on the five principles, see CLES, 2019). We are identifying and developing city-wide community/service networks which build a common will to counter the impact of austerity on services, alongside anti-poverty and environmental groups. We are working as part of the local Health and Wellbeing Board to take forward these joined-up programmes to mitigate the impact of austerity.

Narratives surrounding austerity in Birmingham

As a first step towards challenging and re-framing the existing narratives around austerity in Birmingham, we asked frontline services about their experiences working with those affected by austerity policies. Specifically, we asked those who work in affected services (e.g., Pathfinder, Social Work, City Council, Learning Disability Services, Homeless Shelter) to participate in a focus group which was also visually recorded using live illustration from local artist Jim Rogers. 

Our first question was, what do those working on the frontline want the public to know about austerity? Secondly, we asked how best to communicate this. Thirdly, we asked whether the social determinants of health rainbow (Dahlgren & Whitehead, 1991) might be a useful visualisation of this. A summary of the preliminary results of this research can be found in Box 1 and the infographic at the top of this article.

Box 1.  City Service Provider Perceptions of Austerity in Birmingham

Question 1: What do you think the public need to know about austerity?

• Austerity is a false economy – there are no 'savings'
  • Cutting non-statutory services results in more need and uptake of statutory services which become overwhelmed.
  • Private companies are able to cherry-pick who they serve – often leaving the most difficult and costly cases for government services. They are for-profit only.
  • People need to understand the nature of preventative services – that sometimes investment is needed at the front to save further down the road.
  • Austerity was caused by the financial crash – people have forgotten.
• It's not acceptable and it's not fair – it disproportionally affects those in the lowest income categories
  • Those in the lowest income categories feel disempowered and worn out, which makes it easier to blame other people.
  • Frontline staff have historically been expected to go above and beyond in their roles, but now an everyday expectation.
  • Budgets for services have been shrinking, management structures have been increasing. This puts extra demand on the frontline staff left.
  • Many frontline workers are also experiencing poverty due to a decade of nearly frozen wages and inflation.
• People need to understand that they might also be in need of care someday. 
  • It would be more difficult to justify low pay and lack of esteem for care positions, which in turn contribute to a shortage of care staff.
• The lack of community spaces, which have been closed down due to austerity makes it difficult for people to come together.
• It is reversible – we can do something about this
  • People need to understand valuing more than financial aspects of how a society functions – happiness index, for example.
  • There is good work happening in some communities and there are good things happening. People need to know this so that they don't feel like nothing can be done.

Question 2: How do you think this can most helpfully be communicated?

• Money talks
  • People need to see examples of how it impacts them and their family.
  • It may be helpful to create a 'balance sheet' of the real cost of savings to an individual's wellbeing and the financial costs to their town.
• Find a way to bring people's stories to the budget holders 
  • Budget holders need to understand that people aren't just numbers.
• People in the private sector just aren't aware of the extent and impact of cuts in the public sector.
  • Participants felt that their friends would be shocked to hear some of the stories of cuts and the lives affected by them.

Question 3: Does the social determinants rainbow provide examples of the impact of austerity on mental wellbeing?

• Participants felt that demographics are important for understanding the levels of austerity impact, but not necessarily communicating this.

Moving to flourishing: Making our future city fair

Make My City Fair (Birmingham) continues to be an opportunity to bring together people from a range of backgrounds within the community. But it is also an opportunity to reflect on the role and value of psychology and psychologists in combatting austerity. We have used the term 'citizen psychologists' – a demonstration of engagement in one's community (APA, 2018) – to understand this role. 

The broad definition is appealing because it is accessible and allows for engagement at any level. For those of us who are too familiar with evidence showing increasing health inequalities over years of austerity and have seen the impact on services we work in and communities we live in, citizen psychology means taking an active stance against austerity. 

We can do this at multiple levels. At the broadest level, psychologists can help inform debates on framing and communicating the impacts of austerity and challenging current narratives. One of our focus group participants expressed concern about the fluctuating nature of 'truth' in current narratives:

'The problem for me right now is "what is the truth?" The truth seems to be a real bendable commodity right now… in my community … conversations are all the time about "I don't know who to believe"… so if we talk about austerity it's gonna be a real battle for them to really understand … a different truth to the one that they've already been sold.' 

This is likely to become a particularly pressing issue in the next months and years. In August 2020, the OECD forecast that the UK is likely to be the worst hit of any developed nation under a single wave of Covid-19 infection scenario (OECD, 2020) was realised. GDP fell 20.4 per cent, further than any other G7 nation, entering the UK into the deepest recession since records began. 

There is now a very a real risk of the austerity narrative returning with even greater force, following the necessary yet insufficient increases in Government spending required to stave off the worst economic impacts of the current Covid-19 crisis. We are already seeing this in the battle over the termination of the furlough scheme in October, which has supported 10 million people since March 2020. 

Psychologists can also draw on their professional insights to ensure that wellbeing is at the centre of all decisions within public, private and voluntary institutions. Our focus group participants highlighted concerns that peoples' stories weren't being brought together to allow decision-makers to see the problems as a whole: 

'If you take an extended family, there's gonna be old people in it, … babies in it, … schools in their lives… if everyone is cushioned financially then they may not see it… and I'm not knocking people for that because you don't quite realise, do you?' 

Psychologists come into contact with people affected by austerity in a range of contexts, and can help facilitate conversations across silos; working with councillors, PCC, third sector organisations, etc. We can help councillors see the big picture, to integrate health and psychological health in all policies from housing to procurement. At the service-level, we were struck by how many people suffering under austerity received 'support' that was ad hoc and disjointed. There is need for organisational psychologists to work with service users and consider how stripped-down services might collaborate, making support more coherent.

And finally, there are individual contributions we can make, both as citizens and citizen psychologists. There are many concrete local actions that can help offset some of worst impacts of austerity, such as donating to foodbanks and helping the homeless. Many people perceive a lack of agency in combatting systemic problems and this can be a significant block to change. One focus group participant also struggled with tackling these problems, but emphasised the importance of little steps:

'Giving tools that actually can affect something … and if we all did something in a little way, wouldn't life be kinder, nicer and a bit more palatable?' 

As citizen psychologists, we can use our psychological insights to help each other take these steps forward.  

We need to think about what we want the future to look like, particularly at this pivotal point in our society's history. As one focus group participants articulated: 

'… at the moment it's very much like this is bad, this is happening, we have to stop it, and then the only alternative is … go back to how it was because it was slightly better back then, but that's not really a future, that's not really a vision. It's painting a picture of what do we see as being the society that we want to have… where does it already exist and how do we take all of those bits and re-paste them back together in the jigsaw world that we want?' 

Ultimately, we do not want to just undo the harm of the past 30 years; we want people to think about the kind of world in which they want to live and empower them to fight for that.  We see the MMCF group as a venue to continue to pursue challenging the austerity narrative and to bring people together to combat the divisions that austerity creates. With a new recession looming, this work is more important than ever.  

Authors:

Emma Bridger (BSc MSc PhD CPsychol FHEA)
Senior Research Fellow in Psychology
Birmingham City University

Angela Hewett, PhD CPsychol SFHEA
Senior Lecturer in Health Psychology
Birmingham City University

Martin Straker Welds 
Councillor, Birmingham City 

Dr Carl Harris
Clinical and Community Psychologist, Birmingham UK

Lawrence Moulin Consultant Clinical Psychologist 
Chair of West Midlands BPS Branch, Chair of DCP West Midlands Branch

Editor's note: This article originally appeared online in September 2020.

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