MAC-UK’s Response to The Marmot Review- 10 Years On Reading the Marmot Review on Health Equity in England: Ten Years On, the impact of inequality and austerity on health is laid bare. The report shows the importance of social determinants on life expectancy and physical health, but also indicates what the cost of inequality is on our mental health. At MAC-UK, we advocate for understanding mental health in the context in which it exists, influenced as it is by housing, education, poverty, access to services and community resources. We also believe that it is essential to look at the wider context, such as the way in which the legacy of social formation influences how society is shaped now, and the impact that structural hierarchies of power have on the mental health and behaviour of marginalised communities. Our work uses this contextualisation as some of the foundational principles of how we work with young people and with the systems and services around them. What we can see from previous findings, and as underlined by the Marmot report Ten Years On, is that if we instigate policies that impoverish large sections of our population, while enabling the enrichment of a small proportion of others, this will have an adverse effect on people’s health. The realities of austerity mean that sections of the population that have been historically under-resourced and exploited, those working-class communities, migrant communities and communities of colour that have been disempowered, are more likely to feel the effects than those communities that have historically had access to power and to the decision making processes. The report indicates that there is a correlation between the impact of social determinants on both our physical and mental health. As we can see by the Marmot Review’s findings, poverty and inequality (including “unemployment, job insecurity, unmanageable debt and lack of support services, all of which are more likely to occur in the most deprived deciles”) plays a part in, not only avoidable physical health complaints, but on such things as suicide (p.33). The strain of living in poverty can be overwhelming, and sadly, when we enact policies that result in people living precariously, it becomes more difficult to cope and there will be an increase in poor mental health. However, it is not only poverty that impacts adversely on people, it is also the realities of inequality that impact those who are experiencing deprivation more severely (p.39). It is not surprising that one of the possible conclusions drawn from these findings is that the children from poorer backgrounds in wealthier areas may do worse due to a feeling of self-esteem or exclusion. This is the psychological consequence of inequality. At MAC-UK we have developed the INTEGRATE Model, which at its core focuses on the value of building relationships, meeting young people where they are at, equipping them with decision-making powers, and valuing them for who they are not what they have. Our projects are led by the young people that access them, and because of this we are also compelled to invest in creating systems change. If we design services through the eyes of young people, in the way that those who access them actually want, then this inevitably means changing the way those services are set up in the first place. As a charity we would encourage all services that work with young people who have experienced high levels of adversity, and therefore developmentally more prone to emotional dysregulation and ‘acting out’, to understand how the mechanisms of behaviour work and to respond in a way that is psychologically informed. This means taking their experiences of adversity, inequality or marginalisation into account. To do this we have to work with staff in both the statutory and voluntary sector to help them understand the context in which they work, one that has often been stripped of resources and set up in a way that might not meet the needs of the young people they are working with. Thinking about mental health in its wider context means recognising there are power dynamics in society that institutionally disadvantage certain sectors of society. These are inherently racialised, gendered, and work in the interest of class division. These power dynamics perpetuate the division that exacerbates poor mental health, and austerity overwhelmingly solidifies these positions. At MAC-UK we have successfully co-produced projects, working with young people to design the kind of services they need. We are now taking our learning and applying it to the wider social context in which it lives, which means advocating for an actual public health approach to poor mental health and serious youth violence, one that takes into account all three tiers of what this means. If we can tackle poverty and inequality then we might have a better chance of addressing the challenges in our society. By equipping young people with the power we are enabling them to develop the tools to better deal with their mental health, there cannot be one without the other. If we want to help young people with their mental health, then it is essential to restructure the systems that oppress them in the first place. As Marmot says, “austerity will cast a long shadow over the lives of the children born and growing up under its effects.”p.5 Austerity has cost people their lives, and will continue to make people suffer, not only with the impacts of it on people’s physical health, but also by not addressing the underlying social determinants that impact on people’s mental well-being.