Mental health services urged to address poverty and isolation as part of recovery

Mental health services are failing to adequately address the social and economic problems affecting people with mental illness, despite evidence that poverty, insecure housing and isolation are major drivers of poor mental health outcomes, according to a major new research programme led by King’s College London.

The two-year ENRICHED programme, funded by the Maudsley Charity and the ESRC Centre for Society and Mental Health at King’s College London, reviewed national and international evidence on interventions designed to support people with mental health conditions, particularly those from marginalised communities.

Researchers said the findings highlighted the need for a major shift in mental health care, with housing, employment and social connection treated as central to recovery rather than secondary concerns.

Professor Craig Morgan, co-director of the ESRC Centre for Society and Mental Health, professor of social epidemiology at King’s College London and principal investigator of the research, said: “When a service user is discharged into inadequate or unsafe housing and mounting rent arrears, they can quickly become trapped in a cycle of social and economic exclusion, deteriorating mental health, and readmission. Our findings show that mental health services need to more systematically and routinely address the real-world social and economic challenges service users face.”

The programme, published across five studies, found that social and economic disadvantage both contributes to mental ill-health and can be intensified by it, trapping many people in cycles of poverty, unemployment, debt and worsening mental distress.

One strand of the research examined how social and economic needs are currently addressed within services at South London and Maudsley NHS Foundation Trust. Researchers found staff widely recognised the importance of factors such as housing, debt, trauma, employment and relationships in supporting recovery, but reported that services lacked the resources and capacity to provide consistent support.

The researchers noted that the only social intervention currently mandated nationally for people with severe mental illness is Individual Placement and Support, which focuses on helping people into employment. While valuable, the programme does not address other key needs such as housing stability, financial security or social isolation.

Despite these pressures, the research identified examples of services already adopting more holistic approaches, including peer support services, community welfare teams and culturally tailored advocacy programmes.

Further research highlighted the work of Lambeth Vocational Services at South London and Maudsley NHS Foundation Trust, which offers user-led employment and vocational programmes for people with mental health difficulties.

Dr Anna Greenburgh, research associate in the Centre for Society and Mental Health at King’s College London, said: “The work taking place in Lambeth Vocational Services has been transformative for service users, helping people not only find employment but also rebuilding confidence, purpose, and connection. This concept of prioritising social inclusion through holistic, person-centred approaches, and offering a wider range of support across a continuum of need, can be applied by any service across the country.”

Researchers also conducted two systematic reviews examining interventions designed to improve social and economic outcomes for people with mental health difficulties. One review analysed 78 interventions across 16 countries, including Housing First programmes, culturally adapted mental health services, financial advice schemes and specialist support for mothers and people experiencing domestic abuse.

The review found all interventions demonstrated either feasibility or positive outcomes in areas such as housing stability, employment, reduced isolation or improved access to support.

A second review covering 266 studies across 34 countries found major gaps in the reporting of participant characteristics including ethnicity, gender and socioeconomic status, making it difficult to determine who benefits most from interventions.

Dr Helen Baldwin, postdoctoral research associate in the Centre for Society and Mental Health at King’s College London, said: “Because most studies fail to report participants’ background characteristics, we still know far too little about who actually benefits from social and economic interventions for people with mental health difficulties. Future research must do better in representing marginalised groups if we are to understand what works, and for whom.”

The final publication from the programme proposes a framework for embedding social and economic support into mainstream mental health care. Recommendations include routine assessment of financial and social needs, stronger links between NHS and community organisations, long-term funding for social interventions and greater recognition of cultural inequalities in care planning.

Professor Jayati Das-Munshi, professor of social and psychiatric epidemiology at King’s College London and co-investigator of the research, said: “This is about rethinking what recovery really means. It’s not just about reducing symptoms, it’s about helping people live full, connected and meaningful lives.”

Researchers said the findings demonstrated the need for more joined-up approaches integrating mental health care with housing, welfare support, employment services and community connection, arguing that greater investment in social interventions could improve long-term outcomes and reduce inequalities for people living with mental illness.