Well before the current COVID-19 pandemic hit our shores, it was already apparent that food insecurity was an emerging issue in the UK. In 2014, the Children’s Society presented evidence to an All-Party Parliamentary Group (APPG) to raise awareness of the issue. Four years later after a visit to the UK, Special UN Rapporteur Sir Phillip Alston highlighted the increase of people depending on foodbanks across the UK. Despite these high-profile reviews of the evidence, it has taken a pandemic and the persistent efforts of a professional footballer to thrust the circumstances of food insecurity in children firmly into the spotlight.
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| Marcus Rashford has led campaigns to end child food poverty over the course of the pandemic |
While the issues around food insecurity and the longer-term detrimental implications of this for children are now well documented, the implications of food insecurity in other vulnerable groups have been seldom considered. Research has documented the effects of food insecurity on mental health, but less is known about the impact of food insecurity specifically on those with existing severe mental illnesses (SMI) (ie. bipolar disorder and schizoaffective disorders). For example, research has shown that people with a mental health diagnosis face an income gap as high as £8,400 per year compared to the general population. Additionally, almost 25% of food banks have reported an increase in the number of people with mental health conditions accessing them. However, this does not distinguish between mental health conditions and severe mental illness which can be complex to manage often impacting every aspect of a person’s daily life.
Public health guidelines encourage a balanced diet, for a healthy lifestyle. But when faced with financial constraints, food purchases are often restricted to poorer quality foods which are more accessible on lower budgets. Research by Jones et al. (2014) found an average price disparity of £2.50 per 1000kcal of less healthy food products versus £7.49 for more healthy food products. The study classified food products in their data set (basket of food) according to the Eatwell Guide to include carbohydrates (bread, pasta), fruit and vegetables, dairy, protein (meat, beans) and high fat/sugary foods.
Cheaper foods may often be high in salt, saturated fat and/or sugar, the effects of which on long-term health are well documented. However, for people with SMI there are also additional health risks because they may already be at risk of weight gain due to psychiatric medication. Additionally, for those taking prescribed lithium for bipolar disorder, too much salt in a diet can be very dangerous.
UN Sustainable Development Goal 2.1 ‘Zero Hunger’ challenges us to ensure access to nutritious and sufficient food for everyone but in particular poorer people and those in vulnerable positions. This certainly will not happen until we take a “Marcus Rashford approach” and use the current impetus from the COVID crisis to highlight the issue of food insecurity in other vulnerable groups of people, such as those with SMI. The syndemic nature of having severe mental illness in conjunction with food insecurity means these two factors may interact to further marginalise and disempower people with SMI and yet this remains an under-researched area worldwide. This potentially leads to food insecurity in those with severe mental illness being under-managed and under-supported in mental health practice. In order to achieve parity of esteem between physical and mental health it is essential that we understand the issues relating to food insecurity in this population group.
To this end, we are currently working on research aiming to assess the prevalence of food insecurity in adults with a diagnosis of SMI and explore their experiences for better understanding and increased exposure to the issues they face. Preliminary findings of our review of the available research on this topic (a systematic review) show a lack of targeted measurement for this group of people who are sometimes included as part of wider studies. The issue of cause and effect (or causality) is also often referred to; what came first, food insecurity or SMI? We hope our overall findings later this year will provide an overall picture of food insecurity in people with severe mental illness and potentially a basis for affirmative action.
Supporting authors: Lauren Bussey, Emma Giles and Amelia Lake from the School of Health and Life Science, Teesside University.
Image: 'Rashford Mural' by Rathfelder via Wikipedia, copyright © 2020: https://en.wikipedia.org/wiki/File:Rashford_Mural.jpg (CC0 1.0)
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