Wild-eyed socialites locked in attics or ghostly widows walking into the ocean, never to be seen again – the way we perceive women and mental health has shifted unrecognisably from the wistful tragedy that was once spun for us. Today, we can be candid about our battles with anxiety and depression. We can shout into the ether that is the internet about our antidepressants and someone, somewhere will shout back in solidarity. From Girls to Fleabag, we’re almost emboldened by watching flawed female characters revel in their dysfunction.
The kicker, however, is that it’s often done so against a backdrop of comfortable upbringings, of secure housing and jobs, of self-care and therapists in neat, manicured rooms.
There is no doubt that the conversation around women’s mental health has evolved with such speed that the positive effects are overwhelming. But while riding the crest of progress that has been made, working class women and the all-engulfing pressure cooker that is financial strife have been left behind.
Living in the UK under austerity, stagnant wages and increasingly prohibitive living costs means that most of us have experienced some kind of anxiety around money or serious debt. However, what is critical is the gulf between social classes, and just how much financial instability can derail a person’s life. To fall into hardship is one thing, but to spend a lifetime trapped in it is another.
It becomes this all-consuming, grinding force that prevents women from being able to reach any sort of stability.
Jess Southgate, policy manager at Agenda
With one in three women in the UK living in poverty, compared to one in five men, gender introduces a complexity to how class and mental health intertwine, which both public services and our own discussions have struggled to contend with. And by the nature of economic disparity, it’s women from already marginalised communities who are overrepresented – women of colour, disabled women, trans women, single mothers...the list goes on.
We know there's a strong link between socioeconomic status and mental ill health, with working class people in the lowest 20% income bracket up to three times more likely to develop issues than society's most privileged, and women more than twice as likely as men to be affected. So, being a working class woman battling money problems – on top of a myriad other challenges associated with being a woman – often means living every day knowing that the tripwire setting off a catastrophic chain of events is frighteningly close.
"It becomes this all-consuming, grinding force that prevents women from being able to reach any sort of stability," Jess Southgate, policy manager of UK-based women’s charity Agenda, explains. An alliance of organisations that advocate for at-risk women and girls, Agenda has identified that being a woman in crisis at the fringes of society means not only facing structural inequalities, but also needing to juggle multiple issues.
"For one woman, it might be not having the means to move on from a violent or abusive relationship. For another, it’s starting or returning to selling sex because they have problems with their benefits being paid. It’s living in inadequate housing, it’s skipping meals, it’s not being able to send children to school in clean clothes… Many women then also turn to drugs and alcohol as coping mechanisms, which leads to offending. So it’s a daily battle which can become a lifetime of a woman getting stuck in a cycle of poverty and abuse."
The cumulative mental toll on working class women of having to live without a safety net in place doesn’t always have to reach such extremes to be life-changing. For Alicia*, one errant debt capsized her mental health in a matter of months. "Both my parents are immigrants, I grew up in council housing and went to a pretty normal school. But I did well at university and I had a stable job. I was doing everything you’re supposed to do," she recalls.
"I had colleagues who would say they were 'poor' or 'broke' but I think they took for granted that they all, realistically, had family or friends from similar backgrounds who could help them out if they got into a tight spot. I have never had that."
Working as a PA for a large consultancy firm, a £50 train ticket penalty and change of address meant by the time the fine caught up with Alicia, it had ballooned to £500, with a debt collection agency tracking her down to her workplace. She paid the fine with a credit card. One high-interest credit card turned into rent arrears, which turned into a payday loan to cover daily expenses. "It got to the point where I couldn’t afford the commute into work but I also couldn’t afford to leave or risk being put on statutory sick pay.
"My [inner monologue] was usually me telling myself I’m a failure, that I was going to have everything taken away from me. But it started to become really weird...more surreal...I thought I was talking to angels."
Here I was, a young professional, hallucinating and walking around barefoot.
Just before Christmas of the same year, Alicia was sectioned during what was identified as an acute psychotic episode. Five years on, she admits: "I [still] find it difficult to talk about because it is the kind of mental state you associate with the type of people you avoid in the street… It was humiliating. It still is."
Alicia’s experience illustrates that a woman does not need to be at the very edges of society for financial hardship to snowball into serious mental health issues. But it also speaks to our own failings around palatability and who 'gets' to be mentally unwell.
"Now that I work adjacent to mental health services, I make a point of speaking about my experience even though it can make me, and the people I’m talking to, visibly uncomfortable." Alicia adds: "Here I was, a young professional, hallucinating and walking around barefoot."
In response to telling her GP about her anxiety and, eventually, being signed off from work, Alicia was offered over-the-phone CBT and placed on a waiting list to see a counsellor. But without the option to pursue mental health support privately, the wait can be excruciating. For many like Alicia, it has the compounding effect where women have to reach a severe mental health crisis before receiving the help they need.
Southgate says a lack of understanding around how women’s issues interact, on top of dangerously stretched public health services, means women regularly receive erroneous diagnoses. "Women in crisis are often labelled as having a personality disorder, but when taking into account their background and their experiences of trauma, it would be more appropriate for them to have treatment for complex PTSD."
Southgate continues: "Exacerbating this, the public services women come into contact with aren't necessarily recognising how both gender and trauma add a different dimension to their situation. It can mean not factoring in the stress of childcare not being provided, or placing women in settings that have traditionally been designed for and been dominated by men – for example the criminal justice system, psychiatric care or addiction treatment and homelessness services."
So what can be done? Greater investment in services which understand the realities of being a woman in crisis could alleviate the already-vulnerable from being bounced around between services for weeks or months at a time before receiving help. But these investments also have to extend to prevention rather than fire-fighting alone.
For women paralysed by worsening mental health, having to navigate a not only labyrinthine but broken system of housing, debt, welfare and health services all too often becomes the breaking point.
"We’ve seen that wider community support services can be invaluable to women, because nobody should have to shoulder these burdens alone," Southgate adds. "So it’s a case of not only better investment, but giving those doing vital work in the community the tools so they can respond in a way that’s informed around gender and trauma, and cater to women."
For us, as friends, colleagues, family or partners, we also have a lot of work to do. It means widening our conversation and confronting the uncomfortable. We know that we all experience mental health differently, so now it’s just a case of making sure nobody – no woman – is left behind.
*Name has been changed