Creating a Wellbeing Society · income, and other socio-economic inequalities, are associated with a range of health inequalities and other societal problems. Marmot has identified

Creating a Wellbeing Society Scoping Housing Need, Homelessness and Mental Health in the West Midlands Conurbation – SUMMARY

Guy Daly, Kevin Gulliver and Jill Jesson

Foreword by Professor Kate Pickett, Department of Health Sciences, University of York,

Introduction by Amanda Tomlinson, Chief Executive of the Black Country Housing Group

.………………………………………………….Supported by………………………………………...................

THE CONTENTS OF THE REPORT, ITS CONCLUSIONS AND RECOMMENDATIONS ARE THE VIEWS OF THE

AUTHORS ONLY, AND DO NOT NECESSARILY REPRESENT THE VIEWS OF THE SUPPORTING

ORGANISATIONS OR THOSE OF THE BOARD OF TRUSTEES OF THE HUMAN CITY INSTITUTE.

Creating a Wellbeing Society – SUMMARY

Page | 1

CONTENTS

Acknowledgements 2

………………………………………………………………………………………………….

Foreword by Professor Kate Pickett,

Department of Health Sciences, University of York 3

………………………………………………………………………………………………….

Introduction by Amanda Tomlinson,

Chief Executive, Black Country Housing Group 4

………………………………………………………………………………………………….

1. About the Report 5

………………………………………………………………………………………………….

2. Inequality, Deprivation, Mental Health and Wellbeing 5

………………………………………………………………………………………………….

3. Housing Need, Homelessness, Mental Health and Wellbeing 7

………………………………………………………………………………………………….

4. Social Renting, Mental Health and Wellbeing 9

………………………………………………………………………………………………….

5. Case Study Summaries 10

………………………………………………………………………………………………….

6. Creating a Wellbeing Society 10

………………………………………………………………………………………………….

Select References 11

………………………………………………………………………………………………….

About the Authors and the Human City Institute 12

………………………………………………………………………………………………….


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Acknowledgements ………………………………………………………………………………………………….

The Board of the Human City Institute (HCI), the authors and sponsors would like to thank Professor

Kate Pickett for writing the foreword to this summary, and for the full report on which it is based.

This summary and the full report draw on the work and insights of Kate and her co-author for ‘The

Spirit Level’ and ‘The Inner Level’, Professor Richard Wilkinson, as well as the research of others

and of the Human City Institute.

Special thanks also to the Black Country Housing Group for being the main sponsor of the report

and HCI’s 9th annual lecture, and especially to Chief Executive Amanda Tomlinson, who

contributed an introduction to the report.

Many thanks to our other sponsors:

● Coventry University, Faculty of Health and Life Sciences

● Central Consultancy and Training

● Holiday Kitchen

● M-E-L Research Limited

● Nehemiah Housing

Rights All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in

any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior

permission of the author.

While all reasonable care and attention has been taken in preparing this report, the Human City Institute regrets

that it cannot assume responsibility for any errors or omissions. The views expressed are those of the authors and

not necessarily those of the supporting organisations or the Board of Trustees of the Human City Institute.

© The Authors 2019

ISBN 978-1-906149-38-3

First published in March 2019 by the Human City Institute

Cover design by Studio B9

Internal design and layout by Kevin Gulliver


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Foreword ………………………………………………………………………………………………….

Professor Kate Pickett

Department of Health Sciences,

University of York

‘The Spirit Level’, published in 2009, showed that people in

societies with large income gaps between rich and poor are

much more likely to suffer from a wide range of health and social

problems, including the psychological effects of social stress and

more prevalent mental health problems, than those living in

more equal societies. In ‘The Inner Level’, published in 2018,

Richard Wilkinson and I explore what these psychological effects and social stresses are: how

inequality gets into our minds, how it increases anxiety levels and what are the consequences for

levels of mental illness and emotional disorders. In sum, how living in a more unequal society

changes how we think and feel, and how we relate to each other.

Levels of status anxiety are more pronounced in societies with the largest differences in income

between rich and poor: markers of class and status tend to increase or decrease depending on

the scale of inequality of income and wealth in society. Britain is one of the most unequal societies

in the industrialised world, with income inequality now back at levels last seen a century ago, and

wealth inequality worsened considerably in the last decade as austerity policies have played

out. Although the severest effects of inequality are on those nearer the bottom of the social

ladder, the majority of the population is also affected to a lesser extent. The outcomes are major

inequalities in physical and mental health.

This new report from the Human City Institute shows how such inequalities and deprivation have

a geographical dimension across the West Midlands conurbation. Health inequalities, including

those related to mental health, are noticeable between the most deprived and the most affluent

neighbourhoods. The report also underscores how housing need and homelessness impact on

mental health and wellbeing. HCI puts forward some proposals for reducing socio-economic

inequality at the macro level together with housing-specific initiatives that could improve mental

health and promote wellbeing.

I am, pleased, therefore, to write this foreword to the ‘Creating a Wellbeing Society’ report since

it adds to the weight of evidence that a fairer and more equitable approach are urgent,

including investment in homes and communities, if inequalities are to be reduced and a society

based on a wellbeing model is to be realised.


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Introduction ………………………………………………………………………………………………….

Amanda Tomlinson,

Chief Executive,

Black Country Housing Group

This new report by the Human City Institute, supported by the

Black Country Housing Group (BCHG), Coventry University,

Family Kitchen, M-E-L Research, and Nehemiah Housing, seeks

to provide an overview of how housing need, homelessness,

urban deprivation, mental health problems and wellbeing

linked. The report explores linkages within the context of the

West Midlands Combined Authority (WMCA) core area covering Birmingham, Coventry, Dudley,

Sandwell, Solihull, Walsall and Wolverhampton. It utilises mapping of key data in the conurbation

against a national backdrop.

The report, ‘Creating a Wellbeing Society – Scoping Housing Need, Homelessness and Mental

Health in the West Midlands Conurbation’, sets out to illustrate the linkages between deprived

neighbourhoods, with concentrations of overcrowded and poor housing, to unequal distributions

of mental health problems and low levels of wellbeing. These are particular concerns for BCHG;

both in terms of housing and services delivered, and our focus on improving mental health and

wellbeing at work. BCHG, as a major employer in the conurbation, is committed to ensuring we

have a healthy and resilient workforce. We have recently committed to the initiative ‘Time to

Change’, which seeks to improve attitudes and behaviour towards mental health.

HCI’s report reveals how housing need, homelessness, relative deprivation and economic

inequality are key factors behind the incidence of mental health problems and troubling levels

of general wellbeing. HCI also reveals how social tenants are especially vulnerable to status

anxiety because of negative stereotyping and that they are concentrated in low income

brackets. For these reasons, BCHG is a major supporter of the Homeless Taskforce established by

the WMCA’s Metro Mayor, and of the WMCA’s mental health strategy. And we believe, as

outlined in HCI’s report, that these problems should be tackled in concert because of significant

correlations and two way cause-and-effect.

The following report also makes an important contribution to how these problems can be

confronted. Reducing inequalities of various kinds is essential. But so is investment in housing and

mental health services; both in the NHS and within communities. BCHG is proud to support HCI’s

research and publication of key findings in this summary.


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1. About the Report ………………………………………………………………………………………………….

Report Aims ~ This summary of a new report by the Human City Institute (HCI) considers how

housing need, homelessness, neighbourhood deprivation and mental health intersect. The

summary seeks to provide an overview of how health inequalities in relation to mental health play

out within the West Midlands Combined Authority (WMCA) area, which is HCI’s home region,

between the seven local authorities in the WMCA, and across the 1,681 designated

neighbourhoods in the conurbation. There is also a focus on social housing and its ongoing

marginalisation and the negative stereotyping of social tenants. It then moves on to reflect on a

series of mini-case studies of initiatives to tackle housing and mental health problems and

promote wellbeing, arising from local government, social housing and community sectors. Finally,

some brief consideration is given to actions that might help create a ‘wellbeing society’.

Research Approach ~ The summary is largely based upon:

● A cursory review of key literature focusing on the links between inequality, housing,

deprivation, mental health and wellbeing.

● Mapping of data from the Index of Multiple Deprivation (IMD) 2015, plus housing data.

● Deployment of relevant findings from HCI surveys and focus groups with social tenants.

● Case studies of mental health and wellbeing promotion by key local government, social

housing and community organisations.

2. Inequality, Deprivation, Mental Health and Wellbeing ………………………………………………………………………………………………….

As reported in a range research, including ‘The Spirit Level’ (2009), inequality in wealth and

income, and other socio-economic inequalities, are associated with a range of health

inequalities and other societal problems. Marmot has identified the ‘social gradient’ whereby life

expectancy falls and illness rates rise the lower down the gradient a person is placed in terms of

their income and social status. Over all, more unequal countries, such as Britain, tend to have

greater health inequalities, including those associated with mental health and wellbeing. ‘The

Inner Level’ (2018) reveals that levels of status anxiety, which affect mental health and wellbeing,

are more pronounced in societies with the greatest income inequalities, like Britain.

Britain’s income inequality has remained high but flat in recent years. Looking at the longer term,

though, as Dorling has identified, income inequality declined from the end of WWI until 1979,

when it began to rise again. It is now back to levels not seen since the Edwardian era. And as the

Equality Trust (2018) points out, Britain has a yawning and growing wealth gap. The wealthiest

1,000 individuals have amassed total wealth which is significantly greater than that of the poorest

40% of households, or 24 million people. The top 10%, according to the government’s Wealth and

Asset Surveys (WAS) have seen their wealth expand considerably in the last ten years, while those

in the bottom tenth have seen the value of their meagre assets decline.


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There are major disparities (as Map (1) on the previous page illustrates) in how deprivation and

income inequality are distributed geographically in the WMCA. Some 454 neighbourhoods in the

WMCA – ONS (2015) – are placed in the top tenth most deprived or around 33,000 nationally.

Alongside, 464 of the WMCA’s neighbourhoods – 1 in 4 – are ranked in the most deprived 10% for

income deprivation across Britain.

What is also clear from the last WAS in 2016 is how tenure embeds inequality and has become a

major factor in perpetuating wealth inequalities between home owners and renters, as table (1)

illustrates.

Outright home owners have 36 times the wealth (at £475,000) of social tenants (at about £13,000),

and mortgagees (at £219,000) have 17 times. The table also shows that net property wealth

represents approximately half of the total wealth of outright home owners and mortgagees.

3. Housing Need, Homelessness, Mental Health and Wellbeing ………………………………………………………………………………………………….

People with mental health problems are more likely to be in housing need – finding themselves in

rented accommodation, social housing, and in overcrowded or poor housing; partly linked to

their lower socio-economic life chances brought about by wider inequalities. The WMCA has

particular problems – around 1 in 5 neighbourhoods in the WMCA area (see map (2) on the

previous page) have high levels of overcrowded and poor housing.

Research by the NHF/Mental Health Network (2011) shows that ‘home’ should be the basis for a

secure and safe life in all neighbourhoods. But precarious tenancies, frequent moves, the threat

of eviction, poor quality of life, and the location of much rented housing, in the most deprived

locations, all exacerbate mental health problems and affect wellbeing. Homelessness is both a

cause of, and a symptom of poor mental health and low wellbeing.

Surveys have revealed that approaching half of homeless people had been diagnosed with a

mental health problem, compared to 25% of the general population. A further third have

reported suicidal thoughts and two thirds have panic attacks. Over two thirds have felt

depressed, 1 in 10 had been diagnosed with bipolar disorder or schizophrenia. Two fifths have

had drug or alcohol problems.

Own Outright

Buying

Mortgage

Shared

Ownership

Private Rented

Sector

Housing

Association Council All

Net Property Wealth £220,000 £100,000 £32,000 £0 £0 £0 £94,000

Net Financial Wealth £50,000 £10,000 £1,000 £1,800 £500 £400 £34,000

Physical Wealth £40,000 £35,000 £15,000 £17,100 £12,500 £11,500 £23,000

Private Pension Wealth £165,000 £74,000 £14,000 £1,800 £600 £700 £109,000

ALL £475,000 £219,000 £62,000 £20,700 £13,600 £12,600 £260,000

Table (1) - Wealth and Assets by Tenure

Source - WAS (2016) with calculations/estimates by HCI - NB figures are rounded


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-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Ho

use

ho

lds

Chart (1) - Homeless Acceptances in the West Midlands ConurbationSource: Human City Institute Analysis from MHCLG Lives Tables (2019)

- 200 400 600 800

1,000 1,200 1,400 1,600 1,800 2,000 2,200 2,400 2,600

Ho

use

ho

lds

Chart (2) - Use of Temporary Accommodation in the WM ConurbationSource: Human City Institute Analysis from MHCLG Lives Tables (2019)

182207

230 223

186

249

289 295

420

0

50

100

150

200

250

300

350

400

Nu

mb

er

Chart (3) - Number of Rough Sleepers in the West Midlands RegionSource: Human City Institute Analysis from MHCLG Lives Tables (2019)


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Homelessness and housing need are growing issues in the West Midlands:

● Emerging models pioneered by national homelessness charities Shelter and Crisis calculate

both core and wider forms of homelessness are much higher than official figures show.

● This is especially so in Birmingham, which has the largest number of homeless people of any

local authority in England (more than 15,500). This equates to 1 in 73 of the population, which

is the highest ratio outside of London and the south-east.

● Statutory homelessness in the WMCA is higher than ten years ago and has averaged over

5,800 households over the last decade (see chart (1) on the previous page).

● Chart (2) on page 8 shows that use of temporary accommodation in the WMCA area has

risen by 250% over the last decade, costing more than £40m last year.

● Rough sleeping has doubled in the West Midlands and risen by 333% in the WMCA area,

although from a low base.

● Rough sleeping counts are likely underestimates, since they do not include people sleeping

in cars, sheds, tents, on public transport, or squatting.

● Homelessness also adversely affects both physical and mental health, reduces levels of

wellbeing and lowers life chances.

● Homelessness stems largely from national policies – especially those associated with austerity

that have cut local authority and housing budgets. Eviction from shorthold tenancies,

exclusion by family and friends, welfare reforms, and a lack of social housing are also drivers.

4. Social Renting, Mental Health and Wellbeing ………………………………………………………………………………………………….

Status anxiety, linked to inequalities in social class and income between social tenants and others,

is stoked by negative portrayals in the media and stereotyping of social tenants as ‘skivers’ rather

than ‘strivers’, in the era of austerity. Social stigma remains a problem for many social tenants,

and compounds their often difficult financial circumstances (including debt which is strongly

associated with poor mental health).

Although efforts by tenant groups and social landlords to redress status anxiety have had some

impact, social tenants do now form a large segment of a growing ‘precariat’ class, created by

a range of national fiscal and welfare benefit policies, austerity and the growth of low paid,

insecure and low status employment.

These trends have clearly affected the wellbeing of social tenants. Asked how their general

health and wellbeing had changed in recent years, 57% of social tenants in HCI’s surveys said

that their health and wellbeing had worsened, while only 8% registered improvements, and 35%

said they had stayed the same.

Here are representative comments from HCI’s focus groups on this topic, linked to growing

difficulties in making ends meet:


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5. Case Study Summaries ………………………………………………………………………………………………….

Black County Housing Group ~ High levels of community investment activity to improve the health

and wellbeing of residents, and commitment to improved mental health for both residents and

employees.

Holiday Kitchen ~ Offers family wellbeing support, and supports healthy communal cooking for

children during school holidays.

M-E-L Research ~ M-E-L has undertaken a series of major research projects to evaluate initiatives

related to mental health, improved wellbeing, housing and disadvantage.

Nehemiah Housing ~ Nehemiah, a BME housing association, offers residents support to improve

general wellbeing, reduce loneliness and improve life chances.

6. Creating a Wellbeing Society ………………………………………………………………………………………………….

There are specific macro-changes that the UK could make to its tax and benefit system, to

ameliorate current levels of income and wealth inequality, including:

“People on low incomes and on benefits are

penalised every which way – people are just

depressed because they can’t make ends meet,

it is too difficult.”

“Only work zero hours but the income isn’t enough to

pay bills so sometimes have to go to money lenders who

charge the earth. I can’t seem to get ahead anymore and am feeling down all of the

time.”

“Not coping any more. Just have to buy the cheapest food or go

without. There are days where you just don’t

eat. Bills always rising. Feel like packing it in.”

“These flats are really poor. Rats and other vermin, plus

damp is a problem. Can’t afford to heat my flat

properly, no money, so in winter go to bed early to cut

down heating bills.”

“Was homeless before moving into this flat so

got no furniture or cooking stuff. Struggling

with depression and have to sleep on the floor, and going back to begging.”


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● A more progressive income tax system and introduction of wealth taxes (including a review

of council tax bands last upgraded 25 years ago).

● A more generous benefits system, introduction of a Real Living Wage, greater rights for zero

hours contract workers, investment in economic regeneration and localised public services.

● Possible introduction of a Universal Basic Income and initiatives to extend ownership and

control of assets by low income groups beyond becoming home owners.

● Development of more localised and co-operative forms of enterprise and business.

Some housing and health specific approaches, including:

● Increased investment in social and affordable housing, together with furthering opportunities

for tenants to control their housing and communities (via extending mutualism for example).

● Strengthened approaches to improve existing housing, bring empty homes back into use, and

combat homelessness.

● Investment in the most deprived neighbourhoods to support families and children, and

vulnerable individuals.

● More emphasis on tackling mental health problems and promoting wellbeing at the

community and individual level, through the NHS and via public health strategies at devolved

and local government levels, plus higher funding for care and support.

Select References ………………………………………………………………………………………………….

Dorling D. (2014) Inequality and the 1%, Verso. London.

Gulliver K. (2017) Affordable Lives? Housing Affordability, Tenure and Inequality in England, Bulletin No. 14,

Human City Institute. Birmingham.

Gulliver K. & Daly G. (2019 forthcoming) A New Deal for Tenants: Tackling Marginalisation, Residualisation

and Precarity in Social Housing, Human City Institute. Birmingham.

Human City Institute (2017) Human City Manifesto – Realising the Potential of Citizens and Communities in

the Shared Society, HCI. Birmingham.

Marmot M. (2007) The Status Syndrome: How Social Standing Affects Our Health and Longevity, Times Books.

London.

Marmot M. (2010) The Marmot Review report – 'Fair Society, Healthy Lives, UK Government. London.

NHF/MHN (2011) Housing and Mental Health, Briefing 233.

ONS (2006-2016) Wealth and Assets Surveys (WAS).

Pickett K. & Wilkinson R. (2009) The Spirit Level: Why Equality is Better for Everyone, Penguin. London.

Pickett K. & Wilkinson R. (2018) The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and

Improve Everyone’s Well-Being, Penguin. London.


Page | 12

About the Authors and the Human City Institute ………………………………………………………………………………………………….

Professor Guy Daly is Chair of HCI and Pro-Vice-Chancellor (Health and Life

Sciences) at Coventry University. He is a member of various UK health groups

- Council of Deans of Health Executive UK, West Midlands Clinical Senate and

the West Midlands Combined Authority Wellbeing Board, the Coventry and

Warwickshire Sustainability Transformation Partnership. He is a social policy

academic with research interests in social care, housing policy, local

government, and the governance of public services. He is an active member of the Social

Services Research Group and is currently Joint Editor of its journal, Research, Policy and Planning.

Kevin Gulliver is Operational Director of the Human City Institute, former Chair

of the Centre for Community Research, and a freelance housing and

regeneration research consultant. Before this Kevin worked in senior positions

in housing associations, community health services and the probation

service. He is author of six books about the history of social housing and social

housing organisations, and more than 100 reports on housing, mutualism,

poverty, deprivation, welfare reform, austerity, debt and financial exclusion, equality and

diversity. Kevin writes regularly for Inside Housing, 24Housing, the Guardian, New Start, LSE Politics

and Policy blog.

Dr Jill Jesson is a retired public health academic, having worked in the School

of Pharmacy and the Business School, at the University of Aston, Birmingham.

She has also been an associate of M-E-L Research Ltd, a commercial research

consultancy based in Birmingham, for over twenty years. Jill has published

widely on topics such as literature reviews, qualitative research, community

pharmacy and consumers, public health, housing and communities. She is

currently a Director of the Centre for Community Research (CfCR), which is a non-profit research

organisation based in Aston, Birmingham. Jill is HCI’s longest-serving Trustee.

About the Human City Institute

HCI is an independent, charitable ‘think tank’ based in Birmingham undertaking research into

‘human city’ issues, investigating exclusion, and promoting solutions to the problems of the most

disadvantaged groups in today’s complex and diverse cities, towns and communities. HCI works

around research themes that incorporate new visions for housing, mutualism and social value,

health, wealth and life chances, no community left behind, and studies of age cohorts such as

the young and older people.

HCI’s work in recent years has centred upon scoping the ingredients for ‘human’ cities; exploring

the role of mutualism, community and resident-led action; equality & diversity; the widening

inequality gap in health and wealth, the impact of austerity and welfare reform; and the role of

innovative social and community investment approaches to alleviating poverty and

disadvantage while boosting life chances.

The HUMAN CITY Institute E: [email protected]

Tw: @humancityinst W: www.humancityinstitute.com

Supported by

ISBN 978-1-906149-38-3

Creating a Wellbeing Society Scoping Housing Need, Homelessness and Mental Health in the West Midlands Conurbation – SUMMARY

Guy Daly, Kevin Gulliver and Jill Jesson

Foreword by Professor Kate Pickett, Department of Health Sciences, University of York,

Introduction by Amanda Tomlinson, Chief Executive of the Black Country Housing Group

Creating a Wellbeing Society · income, and other socio-economic inequalities, are associated with a range of health inequalities and other societal problems. Marmot has identified

Documents