Distress and dissent within and beyond healthcare

I am a final year medical student, due to start work as a junior doctor in August. For me, the strikes by nurses, ambulance workers, and now junior doctors have been a source of active hope, mobilised people around me, and created possibilities for rethinking how we understand health itself. Instead of the colonial capitalist idea that health is your individual responsibility, determined by your behaviour or genetics, strikes at the intersection with health (which all strikes are) help us to understand how the extractive economy and the exploitation it relies on becomes embodied as ill-health.

Throughout my training I have seen the mental health impacts of long hours, unmanageable workloads, low pay and staff shortages on healthcare workers. According to NHS practitioner health, almost one quarter of sick leave for nurses is due to anxiety, stress, depression, or other psychiatric illness. Suicidality amongst nurses, in particular female nurses, is estimated to be around 23% higher than the national average. Even before the pandemic, doctors were citing workplace stress, low pay, lack of support and staff shortages as causes of mental health issues. Three in four NHS Trusts say more nurses are visiting mental health services because of stress, debt, and poverty.

The work-related mental distress of healthcare workers is caused and compounded by the underfunding and marketisation of the NHS, itself part of austerity and the privatisation of all public services across the UK. Not only are healthcare workers suffering the mental health consequences of austerity, we are also seeing it destroy the health of patients. Over 330,000 excess deaths were linked to austerity between 2012 and 2019. In clinics and mutual aid organising, I have seen people devastated physically and mentally by financial stress, unable to afford heating and food, and frequently further traumatised by loan sharks. Recent work by Medact highlights how across the entire economy, including the health and care sector, outsourcing, the gig economy, precarious work, differences in pay and unpaid work, and inadequate sick pay compound to create mental and physical health inequalities. Everything we need to be healthy – housing, food, a liveable income, rest, clean air, community, a stable climate – is governed in the interests of capital rather than health. 

The mental health catastrophe created by this rising inequality, corporate greed, and the decimation of public services is being fought not just by the health unions but by everyone else on strike. 

The UK’s latest intensification of inequality and economic precarity is also compounding existing mental health inequalities. The environmental injustice of pollution has been shown to create mental distress amongst poor and racialised communities, who are then the most affected by other health crises such as austerity and COVID-19. Systematic discrimination against disabled people in the workplace means they are more likely to already be in precarious work. Poverty, debt and predatory loans disproportionately impact racialised communities in the UK, one of the many reasons why the rise in suicide driven by the cost of living crisis is hitting racialised communities the hardest. And, as living conditions worsen, so does violent scapegoating of marginalised communities. We are witnessing the horrific mental health impact of rising hate-crime and discrimination towards trans people, and the intensification of the hostile environment, deportation and detention

The uneven mental health impact of the cost of living crisis is no surprise. The extractive economy relies on devaluing the lives of poor people, racialised people, disabled people, women, LGBTQIA+ people, migrants and anyone else whose health is deliberately harmed for the sake of capital, in order to justify and hide the premature death it creates. Françoise Vergès in A Decolonial Feminism describes how “wear and tear on the body…is inseparable from an economy which divides bodies between those who have a right to good health and to relax, and those whose health does not matter and who do not have a right to rest”. Despite this, individualistic health narrative tells us that our biology or behaviour is the cause of mental distress, not the systems of sickness which create or exacerbate it. 

As healthcare workers, we are asked to accept (and in many cases, actively enforce) this economy, or simply attempt to patch up the consequences. This inability to deal with the root causes of mental distress and other health issues was a large contributor to my own mental health struggles as a medical student. Dr Sanah Ahsan asks – “Services may (just about) be keeping people alive, but how ethical is that when we’re doing nothing to change unlivable conditions?”. It often feels like, at best, we are sending people back out into the fire with a few bandages on their burns. 

At worst, and in particular for those who are migrants, disabled, and racialised, healthcare workers can cause a lot more mental distress. Under the mental health system, patients, in particular those from poor and racialised backgrounds, face punitive coercion, detention and criminalisation in the name of ‘care’. The ‘do no harm’ narrative disguises how medicine has, throughout history and today, been used as a tool of violence, and has always been deeply intertwined with police, prisons and borders. Health workers’ engagement with the politics of mental distress must also mean engaging with abolitionist medicine. Patient-led abolitionist campaigns against carceral mental health systems are leading the way, and some health workers, such as the Docs not Cops movement, are incorporating abolition into their organising.

As well as this, organising at the intersection of health and labour must challenge not only the mental health impacts of exploitative work, but the very idea that work and health are synonymous. When health is seen only as the capacity to work and be productive to capital, medicine is focussed on returning people to work (even when work makes you sick), and people who cannot work are treated as a ‘burden’. Both Labour and the Tories are currently emphasising ‘returning people to work’ whilst disabled people already face horrific physical and mental distress by being forced to work, constantly disbelieved and denied disability payments. 

Strikes by healthcare workers can open up the space to question an economy which creates sickness, deprives people of the care they need to heal, and punishes those it deems ‘unhealthy’. They present an opportunity to fight collectively across unions, highlighting how workplace exploitation, low pay and precarity create mental distress. Through shared political analysis of the causes of mental distress, and dismantling hierarchies, solidarity across movements can reclaim health as a theoretical and practical organising tool for social justice. By linking the strikes of healthcare workers to all strikes, and to the health of all people, we can work to abolish conditions designed to create sickness.

Rhiannon (she/her) is a Welsh-Armenian student doctor, researcher and organiser. Her work focuses on health and climate justice, in particular extractivism, re-imagining health and access to medicines. She loves doing mutual aid work, learning to practise abolition, and trying to work out how to be a healer amidst the violence of colonial capitalism. You can find out more about her work and the collectives she organises with here