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ENERGY POVERTY HANDBOOK

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CASE STUDY OF NIGEL 2.

CASE STUDY OF NIGEL 2. Psychological health and mental wellbeing The relationship between a cold home and mental health operates two ways. Having a mental illness, like other vulnerable groups, can make people more vulnerable to cold related harm for the reasons outlined earlier. However, energy poverty and being cold at home can also increase your risk of having a diagnosable clinical mental health condition such as anxiety and depression, and can also lead to impaired mental wellbeing through increased stress and worry about debt and balancing household finances (Liddell and Guiney, 2015; PHE, 2015b). On-going pan-European analysis of the 2012 European Quality of Life Survey by Thomson et al. (2016) confirms that the prevalence of poor well-being and likely depression (based on the WHO-5 Well-being index) is statistically higher within EU28 households that state they cannot afford to heat their homes adequately, compared to those that say they can. In addition, both of the case studies in this chapter illustrate the psychological impacts of living in a cold home, to different extents and for different reasons. For example case study 1 in the previous section illustrates how over time Katie’s resilience and ability to cope was diminished due to fatigue, poor nutrition, and accumulated stress about her husband’s health and the deterioration of their home. Whilst in case study 2 below, stress and loneliness is evident for Nigel. ADAPTED FROM ON-GOING WORK BY GILBERTSON ET AL. (2013) Nigel is a middle aged man who lived alone in a semi-detached ex Council house. He is a private man and didn’t want anyone to know he was struggling. “I become a little bit of a recluse because you get used to being able to turn the hot water on to have a shower, but if you’ve got to heat water in a kettle on top of a fire (…) then wash out of a bowl, you don’t sort of feel fresh and clean.” He is on a low income and has no money for repairs. He expects the repair to be expensive and was trying to save for the work when, by luck, he came across a Warm Homes Scheme run by a Home Improvement Agency (HIA) charity. Nigel thought it was complete chance he found out about the WHS and was concerned “there are many people who are struggling who don’t know it’s there” especially as many vulnerable people aren’t on the Internet. Nigel had been embarrassed about asking for help but he feels less isolated now. He thought there were many more like him who were vulnerable but embarrassed to ask for help. “There’s loads of people like me, we won’t speak up and ask for help.” The cumulative impact of energy poverty on mental wellbeing has been clearly articulated in the work of Liddell (2014), Liddell and Guiney (2015), and in the Warm Well families study (Tod et al., 2016), which developed a ‘trade-off model’ to illustrate the various pressures and influences on households with young families, focusing on children with asthma. The model illustrates the trade-offs and choices people are forced to make regarding the allocation of household income, and the psychological impact of that burden. The cumulative nature of energy poverty impacts on health and wellbeing is illustrated diagrammatically in the ‘Circle of risk’ model below in Figure 1. Nigel has an oil fired boiler that doesn’t work and needs repairing. He has no functioning water heating system. He hadn’t got any hot water and was trying to use a wood burning stove to heat water to wash. He wasn’t seeing people because he was embarrassed about struggling to keep clean. He was also ashamed that he didn’t have the money fix the heating and he worried about making his money cover household costs. He says he stopped inviting people round to his home so the fact he was struggling was invisible to others. 48 HEALTH IMPACTS OF COLD HOUSING AND ENERGY POVERTY HEALTH IMPACTS OF COLD HOUSING AND ENERGY POVERTY 49

Figure 1 - The ‘Circle of Risk’ Model (PHE, 2015b: 24; Liddell and Guiney, 2015) Health-risk behaviours smoking/ overeating Increased stress Less disposable income Poor physical health status 3. Social health and isolation Energy poverty Impaired immune, cardiovascular and hormonal function Stress Mood distortion what was considered negotiable in terms of energy use, for example “adult household members would regularly adjust their own consumption and daily practices in order to secure that of their dependents” (Middlemiss and Gillard, 2015: 151). The Warm Well Families study (Tod et al., 2016) also illustrated how different households in the same family or network would help one another out in terms of advice, loaning or borrowing money for fuel, or inviting people into their home for part of the day to avoid heating two households. It is possible to see the negative synergy between mental illhealth, stress and social isolation; the combined effect of these interactions leading to cold related harm. In the Keeping Warm in Later Life project (Tod et al., 2012), this cumulative picture is depicted in some of the pen portraits generated from the findings. In addition, for children, there is some suggestion that provision of adequate, affordable warmth may reduce absences from school or work (Thomson et al., 2013), and may contribute to bullying at school, thus increasing social isolation at a young age. From the information and evidence presented so far, it is easy to understand how important social relations and networks are to ameliorating the negative health impacts of a cold home. Someone who is well integrated in society, but energy vulnerable, is more likely to be supported practically, financially and in terms of advice, information and signposting to help. Again the case studies illustrate how someone can incrementally become lost to society because of the burden of living in a cold home, or because of shame and embarrassment of the consequences. Nigel was ashamed of both his own hygiene but also the condition of his home, and so gradually cut himself off from social contact. For people who are ill, mentally and/or physically, the effort of surviving day-to-day means they lose the ability to socialise. The consequent loneliness further compromises health. It also means others will not notice if someone slips from struggling to crisis. In the recent work of Middlemiss and Gillard (2015) characterising energy vulnerability, the quality of social relations emerge as one of six challenges linked to energy vulnerability of a household. They indicate that social relations within the household and outside, alongside ill health play a mediating role in households’ ability to cope with rising costs and low incomes. The presence of social networks may have an impact on present and future challenges There are a number of on-going and future challenges that undermine our ability to reduce the impact of energy poverty and cold homes on human health. Among the key issues are: • The tendency for government departments to look at energy policy and health in silos, from an inter-department perspective. There is a need for but lack of cross policy analysis to understand the nature of the combined impacts of policy on energy poverty and health, either positive or negative. However, the source of the negative health impact of cold homes is linked to additional policy areas including welfare, environment and neighbourhoods. As such it is a complex milieu, which demands cross policy analysis and responses, especially if the vulnerabilities and needs of those most at risk are to be addressed, and policy intervention-generated inequalities avoided. Without more sophisticated inter-department working there is a risk that policy interventions may not reach those most vulnerable and intervention generated health inequalities will ensure. 50 HEALTH IMPACTS OF COLD HOUSING AND ENERGY POVERTY HEALTH IMPACTS OF COLD HOUSING AND ENERGY POVERTY 51

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