Food insecurity and mental health

In this new era of galloping inflation and $12 iceberg lettuces, many of us are looking carefully at our grocery bills. For my clients, who experience the most severe and ongoing mental health disorders, the consequences of recent price hikes may leave them hungry or push them further towards low quality packaged and fast foods.

Our team is investigating the prevalence and impact of food insecurity in this population, because we suspect it may be higher than recognised and have an important effect on people’s ability to manage their symptoms and their lives.

In one cross-sectional study of more than 200 people in Sydney taking long-acting antipsychotic medication, we found 45% were food insecure. A separate cross-sectional study identified food insecurity in 31% of participants, using the Household Food Insecurity Access Scale.

This is an 8 to 11-fold increased food insecurity prevalence for people with severe mental illness compared to the general Australian population.  These findings were supported by meta-analysis of data from around the world, identifying a food insecurity prevalence estimate of 40% in people with severe mental illness.

Based on this research, it is clear to see that urgent action is needed to ensure these highly vulnerable people can eat healthily, as most of us take for granted. It stands to reason that people cannot live well with a mental illness when such a basic human need is unmet.

Nutrition interacts with mental health in several ways; poor diet can be a consequence of mental illness and it can exacerbate psychological as well as physical health problems.

People who live with serious mental illness may have reduced access to food generally because their income is low; Australia’s workforce participation rate for people with a psychosocial disability linked to mental illness is considerably lower than for people with other forms of disability and for the broader population, and long-term reliance on the Disability Support Pension or other income support payments puts people below the poverty line, where many nutritious options are out of reach.

People with severe mental illness often live in supported public housing, with limited food storage and cooking facilities. Then there are barriers to shopping: the experience of going to a supermarket which may be overwhelming for people with mental health conditions.

Lack of access to a balanced, nutritious diet frequently results in poorer physical and metabolic health, which we know contributes strongly to a 15-year lifespan reduction among people with serious mental illness, and can also be a source of significant psychological stress.

At the same time, mental health medication side-effects typically include weight gain, making good nutrition even more important for this vulnerable group. And as if that were not enough, it has also been shown that food insecurity is strongly linked to suicidality.

But despite these devastating consequences, nutrition and food security are not routinely on the radar of our mental health system, which often prioritises the treatment of mental health symptoms over attending to the person’s overall wellbeing.

As our team confirms the prevalence, impact and other characteristics of food insecurity in this population group, we hope to develop screening and assessment guidelines, as well as tools and checklists clinicians can use to evaluate clients’ access to food – just as they already do for housing.

If mental health clinicians are alert to the issue, and ask clients where their next meal is coming from, they create a valuable opportunity to identify need and connect people with services. For our south Eastern Sydney region we have created a resource about low-cost and free food sources, so clinicians can give clients practical advice. This simple directory could easily be replicated in other areas.

We also want to trial interventions, which could include nutrition education, teaching budgeting and cooking skills, or developing links with food rescue organisations, and we will include more people with lived experience of mental illness in this research program, so their priorities are embedded deeply across all our studies.

This work is progressing through the Keeping the Body In Mind(gardens) translational research hub, focused on protecting the physical health of people living with severe mental illness and funded by the Mindgardens Neuroscience Network.

It is important to point this out because the Mindgardens model, which brings together the strengths of Members including UNSW and the South Eastern Sydney Local Health District, ensures a useful balance between mental health consumers’ perspectives, research imperatives, clinical application of findings, and learnings for the mental health system; too often in mental health, studies have proceeded without this grounding in clients’ daily experiences.

We believe nutrition has been neglected factor in mental health support and recovery. Our research aims to address gaps in understanding, and show how nutritional screening that includes food security can be introduced as a routine aspect of clinical and psychosocial support.

We hope food security will come to be seen as an essential issue in the care and support of people with serious mental illness.