It is an old theme this, the relationship between societal inequality and the mental well-being of those who live there.

A sample of some of these issues can be found on these links;

• The relationship between inequality and fear, for both rich and poor
• The relationship between inequality and health
• The relationship between inequality and educational attainment
• The myth of ‘trickle down’
• Inequality and myth of motivation

I was reminded of some of this over the past week in relation to two different issues. The first came to us in the form of the so-called Panama Papers, which have shown us something of how the super rich have organised the world to ensure that they remain super rich, and avoid paying taxes for services provided to those who are not.

Perhaps some real change may yet come from the Panama Papers- certainly the debate it is stimulating is refreshing in that for once, the targets for media indignation are not those whom we scapegoat at the bottom of the pile.

However, my fear is that it has already become one of those media-driven righteous crusades in which we let a little blood for public consumption, but change very little. The real sobering truth is that inequality is not just to do with Billionaires who stash their booty in tax havens; rather it is tall about US. OUR lifestyles, OUR consumer choices. It has more to do with the fear that stalks us that we might lose what we have, particularly the stuff that our peers are continuing to enjoy.

Meanwhile inequality in the UK is growing. Some of this is generational, in that those of us who bought the Thatcher idea of home ownership (and unwittingly also bought the slavery to the market forces that came with it) now are so fixated on the security and value of this property that our kids can not even begin to afford to buy their own version of the same.

Some of it is regional, in that the wealth of greater London is like a black hole that sucks people in and never quite spits them out.

Its greatest effects can be seen internationally however, in the way that our wealth is not just in contrast to that of poverty elsewhere, but entirely dependent on this.

But back to the point of this piece. The other thing that brought home to be the realities of inequality this week was some reading I was doing in relation to ‘Formulation’- a psychological term describing the process by which we come to an understanding of the nature, cause, story and meaning of mental distress. Part of this meant reading this guide, and in particular this section;

There is a careful balance to be struck between acknowledging the very real limitations and pressures that people face, while not diminishing their sense of hope or agency… The community/social inequalities/human rights perspective is often poorly integrated into practice. Recent research underlines the importance of this dimension.

Wilkinson and Pickett (2009) have presented compelling evidence that a society’s level of social inequality is causally related to its rates of mental illness: ‘If Britain became as equal as the four most equal societies (Japan, Norway, Sweden and Finland), mental illness might be more than halved’ (p.261). Particularly relevant to formulation is their suggestion that inequality has its most damaging impact at least partially through its personal meaning to the individual, in terms of feeling devalued, shamed, trapped and excluded. This underlines the importance of being aware of the wider contexts of formulations and clinical work. In the words of a World Health Organisation report on mental health: ‘…levels of mental distress among communities need to be understood less in terms of individual pathology and more as a response to relative deprivation and social injustice’ (WHO, 2009, p.111).

That sentence concerning how inequality results in people being ‘devalued, shamed, trapped and excluded’ should not be read as something just aimed at the super poor, but rather something that applies equally to us all.

Although perhaps some are more equal than others.