The personal cost of mental illness

I’ve found myself in a coffee shop as a barista – again. I’d tried teacher training for six months, and while I was an adequate classroom teacher and had been embracing the academic aspects of the PGCE, I’d realised I would never survive the rigours of the profession. So I slinked back to familiar territory: working a zero-hours contract for not a penny over minimum wage.

Before I started teacher training, I’d hoped that my summer job in a patisserie factory on the Devon-Cornwall border – with its piecemeal, changeable hours, precarious seasonal arrangement and comparatively low pay – would be the last of its kind. Half a year later, much to my disappointment, it wasn’t.

Don’t get me wrong. I’m grateful for the work. More importantly, to me at least, is that I’ve always managed to discover beauty in every position I’ve held: flies trapped in the amber resin of caramel for millionaire slices; icing sugar billowing out of the mixer and throughout the factory floor, like mist blowing around a headland; monumental traybakes of rocky road and gluten-free blondies the size and solemnity of gravestones.

Noticing these details has kept me going through the 10-, 12-, 14-hour mundanity. Except, predictably, it’s not enough. I wish there were other options available to me.

I struggle with sustaining what other people call “a career” because of my mental health. When I’m well, I’m a good employee. No one has wanted to let me go. But when I’m hit by an extreme mood, I find it hard to cope. As the world shatters into a thousand pieces, I can’t say I care about constructing a professional reply to a passive-aggressive email about tracking down Friday's missing delivery of apricot and almond tarts.

Former employers and colleagues haven’t known how to help either, other than suggesting I get signed off by a GP and recuperate at home – or leave: options that feel like solutions for them rather than for me. If anything, they actually leave me worse off, both emotionally and financially.

In 2022, the Mental Health Foundation, in partnership with the London School of Economics and Political Science (LSE), published a major report into the economics of mental health. It posited that mental health conditions cost the UK economy at least £117.9 billion a year, equivalent to around five per cent of the UK’s GDP. This was mostly due to “the lost productivity of people living with mental health conditions, as well as costs incurred by unpaid informal carers”.

The authors highlight that medications and counselling would improve people’s wellbeing first and reduce the strain on the public purse second. They also acknowledge that fairer pay and safer workplace environments would contribute to protecting employees’ mental health. With its headline trained on the tragedy of projected economic loss, however, I believe that it’s the fiscal health of the country, rather than the mental health of its labour force, that is the lasting takeaway message of this particular report.

Personally, I’m more interested in the inverse of this concern anyway, which maybe I’ll rewrite as a question. For those of us who are unwell, how much does our mental illness cost us?

Mind the mental health pay gap

I have become more aware than ever that my peers in their late 20s and early 30s are reaching milestones, such as going on several “once-in-a-lifetime” holidays and buying their first homes, things that I can only dream about, simply because I don’t get paid enough.

Of course, I’m not the only one facing the “mental health income gap”. According to the Money and Mental Health Policy Institute, people with common mental illnesses, such as anxiety or depression, receive average incomes of £8,400 less than their mentally well counterparts every year.

This is to say nothing about how living with “severe” mental illnesses, such as schizophrenia, personality disorders or bipolar disorder (which I have a diagnosis of), affects what someone has the potential to earn. Even a loss of £8,400 for anxiety and depression seems like an underestimate to me.

I’ve experienced countless factors that drive the mental health income gap first hand. I've regularly had to take jobs with low wages, I've lost skills due to time spent in crisis and recovery, and I've been stigmatised when I’ve been honest about the reasons for gaps in my CV. On paper, the Equality Act 2010 protects me against that last example. In practice, I’ve found it’s nigh on impossible to prove such discrimination.

I’ve often wondered how gender has shaped the impact mental illness has had on my finances too. Research compiled by the Equality and Human Rights Commission documents that men with depression or anxiety have an average hourly pay gap of around 30 per cent, while women with the same conditions have a pay gap of 10 per cent.

Having read Caroline Criado-Perez’s ‘Invisible Women’, I’ve decided not to accept those sex-disaggregated figures at face value. In her brilliant book, Criado-Perez warns that data alone cannot tell the whole story when it comes to accurately representing women’s realities, as much of the nuance gets syphoned out of the numbers.

Instead, it’s my belief that the mental health income gap between men and women is skewed because of the well-documented existence of the gender pay gap. Although it’s thankfully closing, women still don’t get paid as much as men.

Furthermore, the employment rate for disabled women is lower than men, meaning that there are women who cannot work who get excluded from the official statistics. And more women, which invariably means more women with mental illnesses, tend to be in part-time roles, which pay less per hour on average than full-time ones.

Unfortunately, but probably not unsurprisingly, there is also a deficit of available data on the financial hardship experienced by trans, non-binary, and gender-diverse people.

Invoking a revolution

According to reports like those penned by the Mental Health Foundation and LSE, people with mental illnesses are worth treating. Yet this conclusion is based on our aptitude for contributing to the never-ending project of growing the country’s wealth. Indeed, these sorts of studies are leapt on by politicians who turn mental health into the next front in the so-called “culture wars”.

In my more anarchical moments, I wonder why I should try to get better and back into work if the mental health income gap is the unfair reality I have to tolerate. Why should I make the effort if I can barely afford to move out of my parents’ house and find a place to rent, never mind go travelling or save for a deposit?

I’m not suggesting that these things are available to everyone working without the added complication of a mental illness. But when you earn at least £8,400 less per year than your sane counterparts, buying a house and having a holiday are patently fanciful goals.

I am aware of the argument that having a job is not all about money. Many mental health charities even suggest that labour has the potential to improve our wellbeing because it can give our lives a sense of purpose. It can make us feel better about ourselves.

The jobs I’ve done for years on end do not feel meaningful. Slicing big cakes into lots of smaller cakes, or making the umpteenth coffee for a grumpy customer tapping their nails impatiently on the bar doesn’t send joy flooding into my heart. Little me didn’t exactly dream of wearing an electric-blue hairnet when I grew up.

This is not what I’m supposed to say. I’m supposed to say that I’m grateful for the work. Which, really, I am. And I’m not being derisory about those types of roles either, but about the miserable and exploitative conditions that typically accompany them.

Most of the time, I think we should focus on narrowing the mental health income gap, especially for women and those of marginalised genders. To achieve this, we might turn to state-sponsored back-to-work schemes, proportionate remuneration for part-time hours, and a national rolling-out of a four-day working week. Some of the time, I worry that this misses the point and lets a crucial opportunity for change pass us by.

In their book ‘Health Communism’, Artie Vierkant and Beatrice Adler-Bolton assert that, under capitalism, health is an impossibility because, “to attain your health you must work, you must be productive and normative, and only then are you entitled to the health you can buy”.

The plan they subsequently construct for overthrowing capitalism, and therefore achieving health equality, is centred around the needs of disabled, neurodivergent, mad, and other people who cannot work – a group they collectively refer to as “the surplus”. Their aim is to transform the economy from a system that predates upon health to one that protects it.

I’m under no illusion. This would require a radical, existential shift in how we organise society, which won’t happen overnight. But just remember this: while I’m taking the money for your oat flat white, I’m secretly plotting the mental health revolution.