From poverty to flourishing: towards 2021

How might we use psychological knowledge to help people move from poverty to flourishing? This is the question raised by the British Psychological Society's policy priority area for this year, now extended into 2021. Ella Rhodes asked members of the Expert Reference Group about the ways that psychological theory, research, or practice either is, or should be, helping people make the change.

Bringing adversity into the light

Dr Denise Burford, Educational Psychologist, Luton Council

Marcus Rashford ruined this article. In April, I wrote that it was almost impossible to imagine that people living in poverty could be afforded the same level of empathy and celebrity attention that those with mental health concerns have received in recent years. 

There simply isn't much willingness, I argued, to think about what life is like for people living with week to week financial insecurity. The 2018 Joseph Rowntree Foundation report How to build lasting support to solve UK poverty identified three beliefs people have about poverty that stops them engaging with the issue: the UK is 'post-poverty', we are now a prosperous nation; 'self-makingness', an individual's situation is solely the result of their decisions and motivations; and 'the game is rigged', we're all at the mercy of elites so nothing can be done. No chance, I thought, of celebrities falling silent on prime time TV to encourage us to 'break the silence about poverty', as they did, last year, about mental health.

Then along comes Premier League footballer Marcus with his campaign to extend the vouchers for free school meals over the summer. The Government is forced into a U-turn as the campaign gains widespread support. Suddenly, we do seem to be a nation able to empathise with, and be galvanised on behalf of, those in poverty. Is it the impact of Covid; are people more able to imagine what it's like to be trapped in circumstances beyond their control? Or is the empathy limited to children, the narrative 'poor things let down by their feckless parents'?

Really engaging with the impact of those living in poverty requires us to think about how poverty increases stress, anxiety and low mood across the lifespan and how the impacts of poverty can be passed on from one generation to another, for example through stress and increased risk of post-natal depression (see the World Health Organization's 2014 report, Social Determinants of Mental Health). It requires us to see the impact of financial insecurity, working multiple shifts, or worrying about debt. It requires us to think about the impact of over-crowded accommodation, where the small shared living space must function as eating space, space to work, storage for clothes, and children of different ages share bedrooms and sometimes beds, making it difficult to play, work and sleep. We need to think about how increased stress pre- and postnatally affects our stress regulatory systems leading to, in the words of Stanford Psychologist Anthony Wagner, 'neurocognitive privilege'. 

Perhaps most of all, we need to think about how our services, institutions and societal responses may add to stress and shame for those living in poverty. Or more positively, what we can do to reduce the adverse effects on people living in poverty at different levels in the system.

One approach is to incorporate a wide lens about adversity when thinking about institutions, such as schools. Some have suggested broadening the concept of trauma-informed schools to adversity, including poverty and racism. Such ideas were prominent in this year's Early Intervention Foundation report Adverse childhood experiences, and in Lucy Johnstone's contribution to Lisa Cherry's 'trauma resonance resilience' podcast. This would include understanding of the psychological impacts of poverty, including stress, shame, and sleep difficulties. This empathy and understanding would need to extend to parents, moving us beyond the causation of the family, stigma and blame that families sometimes feel, which can be a barrier to their accessing services. School staff need to be well supported and given time and space to be curious about the experiences of students, and their families.

An adversity-informed approach could be taken in other institutions, for example the benefits and housing system. Local and central governments could introduce poverty impact assessments to new policy to avoid increasing stress, stigma and shame for people in poverty. We might then prioritise relationships and support which are responsive to people's needs rather than external timeframes. We might avoid policy initiatives using language such as 'troubled families' or using shame as a tool to target behaviour that impacts people in poverty disproportionately, such as the use of outdoor public spaces during lockdown.

At a societal level, a national conversation about poverty would need to include the limits of psychological solutions. If the government adopted a wellbeing measure, as advocated by some economists such as Richard Layard, psychologists need to highlight the social determinants of mental health and that a wellbeing measure will lead back to looking at socio-economic causes as contributing factors. No psychological measure will mitigate the need to eradicate poverty.

Psychologists can make an impact by bringing into the light the impact of poverty on children's ability to thrive, for example through population level measures or a 'thrive index', which would include the conditions of adults as well as children. At an individual level, practitioner psychologists can talk about socio-economic factors with our clients, those we work with and in our formulations. The British Psychological Society and course directors can consider whether they are effectively preparing psychologists to consider and talk about the social determinants of mental health in initial training courses and look for ways to ensure the profession includes those with lived experience of poverty.

We are collectively experiencing a national crisis, but we will be experiencing it differently. Those in poverty will be some of the hardest hit from Covid. As the country resets itself, there may be space to generate empathy for those living in poverty. Psychologists can help break the silence on the structural causes of mental distress. But some celebrity gold dust wouldn't go amiss… Marcus Rashford, you're not done yet!

Mental health is not a DIY project

Dr Jen Daffin (Clinical Psychologist) and colleagues Dr Sarah Brown (Clinical Psychologist) and Dr Kiran Guye (Clinical Psychologist). With thanks to Lynsey Skinner.

Mental health is fundamentally about social health. It's about our sense of belonging, feeling safe and connected, having meaning, trust, and good relationships within our families and communities as much as our access to good housing, education, and employment. It's about our sense of hope, how we understand ourselves and are understood in relation to others. Our access to these will determine how well we are able to thrive and have our basic physical and emotional needs met. But to date the predominant approach to dealing with trauma and distress has largely centred on screening and treatment akin to the medical model. 

Individual intervention to these social health issues can feel critical for many people. But it's often at best insufficient and at worst, maintains inequality by shifting responsibility for change on to the individual. It's crucial that attention goes beyond this focus both for cost-effectiveness and sustainability reasons, but also because we need to think preventatively and create the right conditions for people to thrive. 

Interventions that address trauma and distress at a community level are needed too. (It's worth checking out the Prevention Institute's 'framework for addressing and preventing community trauma'.) This means thinking about our basic physical needs (see the Health Foundation's infographic on what makes us healthy) alongside our psychological ones at a public health level. Only by creating the right conditions can we break the cycle of intergenerational disadvantage, trauma and distress many people are trapped in. 

In Wales, the Wellbeing of Future Generations Act gives a directive for public services to include the social determinants of health in their approaches to wellbeing. To work towards the prevention of trauma we need to understand and tackle the oppression of violence, neglect, social, cultural and economic disadvantage, and discrimination that create such trauma. Many of the children and young people growing up in these contexts will not be in a position to 'think their way out of their problems' through the use of psychological therapies. They are in survival mode, as are their families. Community focused, psychologically driven approaches are needed to complement the traditional clinic based mental health services.

In our Child and Family Psychology and Therapies service based in Aneurin Bevan University Health Board, Wales, we have been exploring these ideas. Using the metaphor of a tree we began to develop a socio-cultural ecological psychology framework to show how our life circumstances impact us psychologically and how distress is perpetuated. We co-produced this with people who were accessing support and it is guided by lived experience. Together a narrative about experiences and literature on social determinants of health, trauma and attachment theory and resilience were collated. This was occurring whilst the UN rapporteur on extreme poverty and human rights was visiting the UK, and so we decided in partnership with Psychologists for Social Change Cymru to send it as a letter to the Welsh Government. We intended to highlight that disadvantage and poverty are as much a consequence as a cause of poor mental health.  

Building on this work, alongside local authority and health board partners, we have been exploring the delivery of place-based community trauma approaches across some of the most deprived local areas. In this work, we are seeking to move towards collaborative socio-cultural ecological psychology approaches to addressing these issues. We work alongside a diverse range of partners, from the police to local residents, and our aim is to develop and deliver a new way of working that overcomes some of the inherent inequality of access, sustainability and financial issues embedded in medical and clinic-based approaches. Mental health is absolutely not a DIY project. It's a collective effort and it takes the village. 

Read more about our approach via tinyurl.com/commreswellbeing

Hearing the hard-to-reach

Dr Kathrine Gibson Smith (University of Aberdeen)

To promote a move from poverty to flourishing we need to promote equality in access to social, health, educational and economic domains for those experiencing poverty. This is particularly important in the face of the current pandemic, where inequality is being exacerbated due to reduced economic opportunity. But it will also be crucial in the period after, in enabling people to move towards a position where they are flourishing again. Rising unemployment, furloughing of staff and home schooling will mean that many more individuals and families will experience poverty, reduced opportunities and exclusion. 

We need a deep understanding of issues facing those who are experiencing poverty. Sadly, hidden, vulnerable and hard-to-reach groups are typically underrepresented in both research and social spheres. It is critical that we, as academics and practitioners, bring their voices to the forefront and ensure that they are heard. In addition we need to ask what works, and the mechanisms by which we can enable people move to a position where they are flourishing. 

The research that we do needs to permeate the public sphere, giving voice and hope to people who are experiencing poverty and disadvantage, shifting stigmatising beliefs and influencing policymakers. This cannot be achieved via publishing alone and silo working; we need to use contacts in the third sector, government agencies and the NHS to ensure that our research is targeted, relevant and sensitive to the populations we are trying to help. 

These organisations are also critical in negotiating access to populations who may otherwise be hard-to-reach, and in advising on appropriate recruitment strategies. Pursuing appropriate recruitment strategies during this pandemic is perhaps more important than ever, since there are physical restrictions on how we can access already hard-to-reach groups. We will need to be creative in how we access communities, for example using social media networks and remote technology platforms.  

Moreover, research concerning disadvantaged groups is often localised – particularly where it is addressing specific issues facing a specific community.  To enhance impact, academics need to demonstrate how research at a local level can be interpreted and applied to other contexts nationally. In qualitative research, generalisability is a contentious issue, but we must at least consider the transferability of findings and how we can lift what we know works in one context to another. Integration of theory into intervention design, analysis and evaluation – as endorsed by the Medical Research Council in their 2008 guidance on Developing and Evaluating Complex Interventions – may be one mechanism via which we can promote transferability of research findings. 

To illustrate, a study by a research group I previously worked with responded to a local NHS grant call to conduct research on the experiences of homeless persons relocating from a specialist homeless practice to a mainstream general practice. The research, published in the British Journal of General Practice in 2018, was tailored to address a specific need of the homeless practice: to help identify factors which promoted relocation to mainstream general practice and those which served as barriers. Relocation of those who were formerly homeless from the specialist practice to a mainstream general practice served two functions: to promote patients' recovery and to ensure that the specialist practice had the capacity to treat those who were currently experiencing homelessness. 

Integrating a behavioural change framework in this research, we highlighted the importance of beliefs about consequences, intentions, the environmental context, emotions, skills and identity in facilitating and hindering patient relocation from the specialist homeless practice. These findings were two-pronged – they gave important information on what enabled relocation within the local context and what could be done to further support patients, and also provided evidence on conceptual behaviour change factors which could be lifted into similar settings elsewhere.   

This transferability of research findings is critical in ensuring we are developing interventions and strategies which are evidence-based. But if we can collaborate and use existing research, this expedites the process whilst still retaining reliability and quality. Communities are being hard hit right now, and to promote flourishing, academic communities will need to be responsive and timely in identifying how we can best support them. The 'From Poverty to Flourishing' campaign was very much needed before… given economic forecasts, it will require an even bigger movement post-Covid to help individuals and families get back on their feet.  

Parenting, precarity and poverty

Professor Abigail Locke (Head of School of Psychology at Keele University)

As I write this, with the UK starting to come out of lockdown, the issues of parenting, precarity and poverty are more pertinent than ever. Many workers have been furloughed or lost their employment during this pandemic and families have become increasingly stretched, trying to balance a lack of childcare with caring, parental and working responsibilities. Austerity in families has been a prevalent feature in the UK for the past decade. For those who are already at the brink, the additional push that the pandemic has given may be too much to bear. 

As we know from the 2017 Joseph Rowntree Foundation report, 14 million people in the UK – one in five of the population – are living in poverty, with 4.5 million of them children. Given that the UK is one of the richest economies in the world, these are troubling statistics. As noted in the recent Marmot review on health equity in England, 'Ten years on', 'Child poverty is not an inevitability, but largely the result of political and policy choices in areas including social protection, taxation rates, housing and income and minimum wage policies'.

A key focus on this British Psychological Society Senate-voted priority is on children and families, to unpick the impact of poverty on their opportunities and relationships. For example, the precarity of employment status within the UK over the past decade, with the growth of zero hours contracts and the 'gig economy', adds a level of complexity to family relationships. Parents become stretched, with competing work and caring demands, perhaps working for a number of different employers and with no certainty of a reliable and consistent pay packet. The growing number of families who are reliant on foodbanks has been steadily increasing, with some suggestions that at least one third of those who access foodbanks are parents with children to support (see Edwina Prayogo and colleagues on foodbank access). This number will likely be increasing given current domestic and world events.

Whilst many of these aspects have been known but have been relatively unseen in many quarters, the impact of Covid-19 and the effects of that on employment and income across many in the UK have brought the importance of this to the fore. People with 'stable' incomes are suddenly feeling the pinch. The question then becomes, what insight can we offer as psychologists? 

We know from research that parental wellbeing has positive impacts on the wellbeing of their children. What also becomes apparent, when examining much of the popular literature about parenting, is that it is somewhat de-contextualised and without consideration of the myriad of intersectional characteristics that can impact on parenting experiences. There has been a focus on individualistic psychological traits such as 'building resilience' and developing 'parenting skills', both of which do have a place… within context. However, as psychologists we can sometimes fail to have a full consideration of the conditions which impact on familial health and wellbeing. 

Social class and precarity of working and relationships are some of these factors. It seems obvious that the experiences of parenting within difficult economic and social conditions will vary greatly from parenting with secure economic and social landscapes. As research from the past decade has shown us, this effect is both gendered and classed – it is mothers who typically bear the responsibility for child rearing as well as being more strongly impacted by the inequalities of the past decade within the UK (see the Marmot review). We also know from the literature around contemporary mothering cultures and 'intensive mothering' (see Sharon Hays' 1996 book The Cultural Contradictions of Motherhood), that mothers are working to inhabit a 'good mothering' identity and do their best for their children. However, as Val Gillies noted in her 2007 Marginalised Mothers, working class mothers are somewhat sidelined in these good mothering discourses. 

With even less to go around in austere times, the impact on families' wellbeing and parental identities of living and parenting in poverty needs to be more thoroughly considered. This Senate priority is working on a series of evidence-based strategies in order to tackle this. 

The power of decent work and living wages

Dr Ishbel McWha-Hermann (Occupational Psychologist, University of Edinburgh Business School) 

Often, as psychologists, when we think about poverty we think about the impact it has on people's lives. We try to document what it's like for those who are living in poverty and to address the physical or psychological consequences it brings. But as an occupational psychologist I want to emphasise the importance of employment, and specifically good quality employment, as a way of enabling people to shift 'from poverty to flourishing'.

Employment is crucial for lifting people out of poverty. Good quality employment, which the International Labour Organization (ILO) calls 'decent work', contributes to financial security and improved quality of life. Conversely, a lack of decent work traps people in poverty, unable to shift beyond their current status. Psychologists have studied decent work in a range of cultural and geographical contexts, finding good support for its connections with mental health as well as physical health (see Ryan Duffy's 'psychology of working theory'). 

The ILO, in their 2019 'World Employment Social Outlook', estimates that 'a majority of the 3.3 billion people employed globally in 2018 experienced a lack of material well-being, economic security, equal opportunities or scope for human development'. These workers may be engaged in precarious work, such as the gig economy, where a lack of job security can erode decent work, forcing people to work in sub-standard working conditions in order to make ends meet. Others may have more secure jobs, but are in jobs that don't provide sufficient wages in order to ever move out of poverty, to increase their own skills, to move on in their careers. These people are sometimes called the 'working poor', or said to be experiencing 'in-work poverty'. They're working and managing to get by but not earning enough to be above the poverty line. Indecent work like this perpetuates the cycle of poverty. 

Of course, low quality work is not representatively experienced by everyone. Those with marginalised identities tend to be overrepresented amongst the working poor, and face greater barriers to shifting out of poverty (see Mindi Thompson and Jason Dahling's 'Why work matters in understanding poverty'). As well as issues of gender, disability and ethnic minority status, other marginalised groups, such as refugees and solo parents, face substantial challenges to finding decent work. There's some important work to be done by occupational psychologists to extend our existing vast body of research on the experiences of members of marginalised groups at work, to understand how different groups are impacted by, or experience, poverty.

A key area of research which I have been involved in recently is around the living wage and the importance of having a wage that really enables people's lives to flourish and enables people to make choices about how to live their lives. Project GLOW (Global Living Organisational Wage, https://projectglow.net/) is a collaboration between predominantly psychologists in more than 25 countries. The project is underpinned by the idea that psychology has a lot to contribute to the discussion on living wages, both through understanding the tipping point at which a wage can enable a better quality of life, and through recognising the value of talking to people about living wages and learning from their experiences in order to provide evidence to organisations and decision makers. Psychologists can and should be playing a key role in understanding how living wages enable people to increase their own capabilities, to be able to achieve more, and to have a better quality of life. 

Here in Scotland, Rosalind Searle (University of Glasgow) and I have been working with EAWOP and Living Wage Scotland to develop a series of policy briefs on living wage topics (see www.eawop.org/reports), and we hosted an event with employers in November 2019 to showcase the experiences of living wage employers and discuss living wage issues. Influencing employers to understand the positive consequences of living wages for their employees is a key role we can play in helping shift people from poverty to flourishing. This work is particularly important now as we look ahead to a post Covid-19 world, where organisations have an unprecedented opportunity to reassess their policies in ways that really maximise the wellbeing of their people.

To sum up, psychology, and particularly occupational psychology, has a critical role to play in advocating for decent work, and work which pays a living wage. Through highlighting inadequate and low quality employment as a key cause of poverty, we can draw on interventions that focus on improving the quality of work people experience. We can provide evidence for when and how wages become decent, and ultimately enable a shift from poverty to flourishing.

The complexity of addiction

Professor Philip Murphy, Edge Hill University

When the pandemic eventually passes, the problems of poverty will remain in both British society and globally too. Although it is still early days for the 'From Poverty to Flourishing' campaign, my involvement in it has brought back to the forefront of my mind – as an academic psychologist whose education and ability to work owes so much to the public purse – the importance of participating in the search for solutions for society's problems. I've become more aware of how easily such a perspective is lost in the day-to-day demands of our jobs. 

With regard to my own work, I am a psychobiologist whose main research area for the past 34 years has been addiction and the harmful use of drugs outside the remit of prescription usage. There is undoubtedly a very large literature on the socioeconomic factors related to the harmful use of drugs (including alcohol) which highlight the role of poverty as leading to addictive behaviours, and conversely, the role of addictive behaviours as sustaining a situation of poverty. Having little access to socially legitimated means of improving one's situation is a feature of poverty associated with the related issues of criminal activity and harmful drug use (see, for example, Danya Fast and colleagues on the material, moral, and affective worlds of dealing and crime). 

As a psychobiologist I have always argued that any understanding of the behaviours associated with addictive and harmful drug use which exclusively focus on social processes will be as incomplete as an understanding based solely upon knowledge of neurobiological processes. The central nervous system does not exist in a vacuum, and the impact of a complex network of social influences involving peer pressure, enmeshment in crime, and broader socioeconomic factors upon engagement in harmful drug use also has empirical support.

Addressing the problems in peoples' lives due to addictive and harmful drug using behaviours is inextricably linked to fighting poverty in society. Psychology is the scientific discipline best placed to serve as a bridge between the different domains of knowledge which society needs in order to understand such behaviours and to make what will hopefully be the most appropriate and effective decisions in response to them. And there are other areas: I am aware, for example, of other psychobiologists whose work highlights the relationship of poor nutrition in children to impaired cognitive engagement in education (see the work of Katie Adolphus and others at Leeds). As poor childhood nutrition can be a result of growing up in poverty, and poor educational attainment limits the ability to escape situations of poverty and deprivation, this is another area of psychological research which will hopefully come to the fore as the From Poverty to Flourishing campaign proceeds throughout the year. I am sure that there must be many other such areas… we all have much to offer!

Sustainable livelihoods for refugee children and their families

Dr Mike Wells 

While child poverty remains a serious problem in the UK, children and young people of asylum-seekers (especially failed asylum-seekers) live in some of the very poorest households, where parents cannot work while their claims are being processed. These children and young people are excluded from several of the anti-poverty measures available to other children in the UK, as discussed in my PhD 'Resilience and Vulnerability: Supporting the Integration of Unaccompanied Asylum-seeking Minors in the UK'. Ensuring access to sustainable livelihoods is a fundamental bridge that will enable refugee and asylum-seeking children, young people and their families, to smoothly cross-over from poverty to flourishing.

The sustainable livelihoods framework uses the psychological concepts of self-efficacy and resilience to understand ways in which people can be empowered to tackle poverty. Sustainable livelihoods generally seek to enhance the capacity of poor individuals and households to gain access to and control over economic and social resources, and assets which open up opportunities and possibilities for the future (see Karen Jacobsen and Susan Fratzke's 2016 'Building livelihood opportunities for refugee populations'; and Heaven Crawley and colleagues' Centre for Migration Policy Research report on 'Survival and Livelihood strategies of refused asylum seekers living in the UK'). 

The goals of sustainable livelihoods are to encourage and promote the capacity of individuals and households to adopt a means of living which can maintain itself, while reducing the possibility for them to become impoverished or slip into poverty. Sustainable livelihoods also include advocacy to restore personal dignity and independence of individuals and households, fostering a thriving environment that promotes and protects their rights in accordance with the relevant bodies of international and domestic laws.

During the last two decades, a wide range of third sector organisations across the UK have directly or indirectly implemented various sustainable livelihoods initiatives to help refugee and asylum-seeking children and their families to become economically self-reliant in order to reduce being dependent on welfare or becoming impoverished and destitute. This includes programmes that aim to facilitate refugee employability or entrepreneurship, such as technical and vocational skills training, English language proficiency, programmes that increase access to information and communication technologies, and programmes that facilitate access to higher education institutions. Sustainable livelihoods programming can create work opportunities for refugee and asylum-seeking families, alleviate poverty, promote psychological wellbeing, build resilience, and foster integration into the host community of resettlement.

Despite the surging interest and investment in sustainable livelihoods programming, there are structural constraints. The policies of successive UK governments restrict asylum seekers' access to welfare support, education and work, resulting in social exclusion, increase in poverty and destitution. Moreover, even after legal barriers are removed, some refugees who may successfully complete training programmes may be unable to find work. Employers may be reluctant to hire them due to concerns about skills or security, discrimination on the part of employers, mental health and other psychosocial issues.

These structural challenges have long-term implications for the psychological wellbeing of the refugee population and the socio-economic development of the host communities in the UK. Recognising these challenges, the British Psychological Society's priority campaign could provide the platform for advocacy to encourage investment in sustainable livelihood programmes. We must create the space for refugee and asylum-seeking children and their families to thrive and flourish.

Find out more at www.bps.org.uk/poverty-flourishing

Our summer edition, 2021

With our combined July/August 2020 issue 'Towards a new normal, and beyond', we attempted to produce an issue which was a meaty and diverse print reading experience, a souvenir of a time, and a genuine collaborative and creative effort. The plan is to do the same in coming years, using the Society's member-voted theme as our guide. 

So for 2021, we would like to move 'From poverty to flourishing'.

We need to hear your ideas for topics and authors, coming at that theme with evidence-based perspectives from all corners of the discipline. Contributions can be a mix of the professional and personal, and we're also open to artistic input (illustration, photos, creative writing and more). 

Please get in touch with me on [email protected]

Dr Jon Sutton Managing Editor