‘The psychological impact of the cost of living crises and how we can mitigate this in a psychologically informed environment (PIE)’.

24.06.2022: As I write this week’s PIE blog, as the lead for Psychologically Informed Environments (PIE), at the national youth homeless charity — Centrepoint, it is impossible not to reflect on the national events this week, specifically the rail workers strike. This has effected many of us in the organisation, as we have to work around the lack of public transport to get to work in supported accommodation services or have switched back to remote working in our support teams. I have personally had to drive, utilise buses and walk a bit further than usual this week to continue our PIE team frontline delivery or reschedule sessions for next week because our services have had staffing challenges. However, just like during the COVID-19 pandemic, I am proud to work for an organisation that has remained open for business as usual, and continues to ensure that we are supporting the homeless young people regardless of these new challenges this week. Of course, one of the reasons for this strike relates to the ongoing ‘cost of living crises’ facing the UK and therefore, for this blog I am going to reflect upon this further, in particular the impact that this crises is creating on our psychological well-being as well as upon youth homelessness.

One of the challenges of the current cost of living crises is the potential impact that this will have upon homelessness in general, not just young people. As noted in recent news reports (c.f. https://www.theguardian.com/society/2022/feb/22/homelessness-set-to-soar-in-england-amid-cost-of-living-crisis) it is predicted that the number of homeless people in England will increase by a third by 2024. This need is arguably created by a variety of factors, including freezes on welfare benefits, soaring energy and food costs with high inflation rates, and the end of the COVID-19 eviction bans. The charity Crises estimates that over 66,000 more people will be homeless by 2024, with around 8,000 more rough sleepers. Particular regions, including London where Centrepoint operates and living costs are highest, are naturally predicting the biggest increase.

At Centrepoint, we are of course particularly concerned about this impact on young people (c.f. https://centrepoint.org.uk/about-us/blog/helping-the-homeless-in-the-cost-of-living-crisis/). For example, we know that many young people are having to choose between ‘eating and heating’ as they struggle to balance costs of renting and other rising household or travel costs with stagnant often minimum wage income or zero hour contract jobs. As a result, it might take just one unexpected expense for them to get in real financial difficulty. Consequently, for young people in this situation it can mean a lot of time and energy is spent just struggling to ‘keep their heads above water’, rather than having space to seek opportunities to improve their circumstances and income. Young people are therefore being limited in their ability to fulfil their potential not by themselves, but by external factors outside of their control (c.f. DePaul, 2022). To experience for yourself what these challenges can be like, Centrepoint have devised an interactive decision making quiz, which asks you to step into the shoes of a homeless (or at risk of homelessness) young person — see here: https://centrepoint.org.uk/intheirshoes?utm_medium=organic&utm_source=twitter&utm_campaign=InTheirShoes

So what is the likely impact of this cost of living crises on psychological well-being, and how can being a psychologically informed environment or PIE, help us to support homeless young people (and help us cope ourselves)? There is significant research evidence of the impact of poverty on mental health (e.g. see previous PIE blog here: https://drhelenmiles.medium.com/reflecting-back-the-social-determinants-of-mental-health-and-the-importance-in-a-psychologically-c12009ce7d72). For example, the World Health Organisation (WHO) highlighted in their 2014 report (c.f. https://apps.who.int/iris/bitstream/handle/10665/112828/9789241506809_eng.pdf;jsessionid=8DC277E5856B0BF35BB3360D251D58C2?sequence=1) that ‘mental health and many common mental disorders are shaped to a great extent by the social, economic and physical environments in which people live’ and that ‘social inequalities are associated with increased risk of many common mental disorders’ (p.8).

Other systematic reviews (e.g. Frasquilho et al, 2015; Martin-Carrasco et al, 2016; Silva et al, 2018) have found that globally, periods of economic crises can be linked to increases in help seeking for common mental health problems, such as anxiety, depression and substance use, increased use of psychiatric medication and rates of hospital admissions, and ultimately increased suicidal behaviour. Economic crises may effect mental health either by increasing risk factors such as unemployment, debt, loss of socioeconomic status and/or decreasing protective factors such as job security and welfare protection programmes (Caldas de Almeida et al, 2017). Moreover, periods of economic crises also increase mental health issues because they can increase barriers to accessing mental health support due to cuts in resources and accessibility or access (Wahlbeck & McDaid, 2012; Maresso et al, 2015; Antunes et al, 2017). Sadly it is also most often those groups already at significant risk (e.g. homeless young people) wherein levels of poverty, psychological and physical well-being and exclusion worsen the most in economic downturns (World Health Organisation; WHO, 2010).

As well as these social influencers on mental health, an increase in the cost of living and resulting rates of poverty can also affect our general psychological well-being. Who, amongst us, hasn’t been worried recently when they have gone shopping or filled up their car with petrol as to how much it will cost, and what else we may need to sacrifice to pay for these ‘essentials’? The reduction in our finances means that often the first things we may cut back on are actually those things that bring us pleasure and happiness in life. Our hobbies, visits to friends or activities / events, or other items that we may purchase such as new clothes or the chance to go on holiday, are all areas where we may have to ‘cut back’ in order to afford the basics.

Moreover, poverty can result in changes in our emotional state (e.g. increased stress, anxiety, anger and sadness) as well as changes in our cognition and decision-making (Fell & Hewstone, 2015). It can also affect our sense of ‘agency’, the subjective sense that we have control over our lives and our belief that we can shape our future. This perceived lack of agency can then influence our mental well-being, something found in both adolescent and adult populations (e.g. Frenkel et al, 1995), and why empowering the homeless young people we support at Centrepoint is such a critical part of our PIE approach. Poverty is also humiliating and shaming, and can lead to feelings that you do not matter or you are valued and can add value to wider society (Prilleltensky, 2019). Many of the homeless young people we support at Centrepoint speak about their stigma of their homelessness and of not having access to things that their peers do or not being ‘seen’ as a young person who has a future role in society. This can also result in homeless young people being vulnerable to being groomed into alternative lifestyles, such as gangs, which can promise them status, respect and financial rewards for illegal activities.

Therefore, the UK Royal College of Psychiatrists (2022) has warned that the nation faces a mental health ‘threat of pandemic proportions’ due to the current cost of living crises (e.g. https://www.independent.co.uk/news/health/cost-of-living-crisis-mental-health-uk-b2104963.html). Moreover, Mental Health UK (2022) note that “the stress and worry of how to keep a roof over your head, put food on the table and cover rising energy bills is likely to have a significant impact on your mental health’ and ‘people living with mental illness are particularly at risk, as their symptoms might make it more difficult to manage their money’. It can be difficult to think about what we can do in these circumstances, particularly if we are already facing some of these challenges ourselves. Of course, we cannot personally change the global factors that are contributing to the current rise in inflation, and many of the wider systemic challenges in statutory services that support mental health. However, a PIE approach does give some suggestions of what we can at least do to support the homeless young people we are working with in Centrepoint (and look after ourselves) to manage the current cost of living crises.

Firstly, we can use our voice at Centrepoint through our amazing policy team (c.f. https://centrepoint.org.uk/what-we-do/policy-and-research/), who can continue their lobbying and pressure on those who can enact economic levers to mitigate against some of the most significant effects of rising inflation. These include the recent research and campaigning around Universal Credit rates for under 25’s, as well as the current food insecurity / poverty work (see here: https://twitter.com/centrepointuk/status/1538880655832100866). The voices, experiences and challenges of many of the homeless young people we support can get ‘lost’ in the current news around the cost of living crises, but we can ensure that we keep them in the public consciousness. Our organisation is also making steps to support staff in terms of the recent pay-rise, and the ongoing review of our benefits and rewards offer.

Secondly, within our supported accommodation services (and assessment / helpline teams), we need to be aware of the impact of the cost of living crises on the homeless young people we support. This may include the practical advice and support to help them manage their money more effectively with extra budgeting sessions, reviewing their income and outgoings, and/or a review of their current benefits to ensure that they are getting everything they are entitled to receive. This might also be something we can review for ourselves in our own household budgets. In our CP works teams, we can encourage and support young people into better employment or training opportunities than can increase their income (if not immediately, in the longer term). However, we also need to consider what other support can we access for young people via our partner charities, local foodbanks or our in-house ‘food points’? Can we support young people to cook food from scratch, rather than rely on ready-made, often more expensive food? Does the young person have enough funds to travel to education and employment, and if not, how can we access support for them to ensure they can?

Finally, within a psychologically informed approach, can we all hold an awareness of the psychological impact of the current cost of living crises on the homeless young people we support? Although those homeless young people we support who have mental health issues may be most impacted, even those without any diagnosed condition may be feeling more hopeless and anxious about the future than usual. If the homeless young people we support need access to specific mental health support, can we advocate for them or attend appointments with them to ensure that they are getting the help they need? Moreover, how we maintain their (and our own) hope in the face of the current ‘doom and gloom’ that pervades the news? If we need support as staff, can we reach out to our managers, to our employee assistance programme (Freephone 0800 243 458) or our staff support offer via the internal PIE team?

Most importantly, how can we show homeless young people that their generation is valued and can succeed despite the current cost of living challenges? This might be through offering them opportunities where they are available through our engagement offers, or creating activities and spaces for positive things within services (e.g. summer BBQ’s, creative projects, cooking meals together, having event nights) that don’t cost the young person anything but can be sociable and affirming to them. How can we utilise our PIE physical environment fund to ensure that our supported accommodation services are pleasant places to be (i.e. like a ‘home’) so that ‘staying in’ and having friends over in order to save money is something that they might want to do?

The cost of living crises is effecting all of us, and not just because of impact on travel because of the strikes this week. The homeless young people we support are arguably more not less effected than the general population. Therefore, we need to be mindful of this issue when working with them, although we also need to be aware of the impact of this on our colleagues and ourselves. What are their challenges? What do they need? How can we help? All of this, I would argue is the ‘bread and butter’ of psychologically informed working. During the current cost of living crises is it needed more than ever to ensure that all of us, but in particular the homeless young people we support at Centrepoint, can move on to a brighter and better future when this current challenge is hopefully over…