Patterns of severe and multiple disadvantage in women

Many people will face a major adversity at some point in their life. A period of overwhelming depression or anxiety. Time in a violent or abusive relationship. Perhaps a spell with no home, or dependent on drugs or alcohol.

Some people will experience more than one of these. In fact, we know that people who experience one type of adversity are more likely to also experience another. There are many reasons why. Someone surviving an abusive relationship may experience severe anxiety as a result. Someone in a precarious housing situation may turn to substances as a way of coping. It may also be that some other characteristic – such as belonging to a group that is discriminated against or being disabled in some way – makes several other adversities more likely.

The existence of multiple disadvantage – that is, that some people experience many types of adversity in their lives – is not surprising. It is also well known that facing multiple stressors tends to lead to worse outcomes than facing one. It has even been shown to reduce life expectancy.

However, the nature of multiple disadvantage is less well understood, and so what it means for policy and services is less clear. Each person experiencing multiple disadvantages has their own distinct and complex story. But across these individuals, there are some broad patterns that group people together. This project aimed to find some of those broad, shared patterns of multiple disadvantage. So rather than saying to services that there are people who have one issue and there are people who have many: we can make a first step in showing that some people face this combination of problems in their lives, and other people face that combination.

There are numerous ways of defining disadvantage and the picture of multiple disadvantage we see depends on which issues are included or excluded. In previous research, which focused on rough sleeping, use of drug and alcohol services, and offending – an estimated 75,000 people were described as facing severe and multiple deprivation in a year, with men more likely to be affected than women https://lankellychase.org.uk/resources/publications/hard-edges/

This current piece of work was preceded by a scoping study involving a series of consultations with groups of seriously disadvantaged women (including refugees, travellers, ex-prisoners and sex workers) and the definition operationalised was informed by their input https://lankellychase.org.uk/wp-content/uploads/2016/10/WomenandGirlsFacingSevereandMultipleDisadvantage_FullReport_Oct2016.pdf.

In this recent study Gender Matters, – which focused on mental health, violence and abuse, homelessness, and substance dependence – an estimated 336,000 people in England were described as facing severe and multiple disadvantage in a year, with women and men equally likely to be affected.

The study uses data from many sources, including a representative survey of the general population in which people were asked about four types of disadvantage: mental illness, experience of violence and abuse, substance dependence, and homelessness. These were the types of disadvantage that the severely disadvantaged women in our prior scoping study had said mattered most in their lives.

A form of cluster analysis grouped individuals according to what disadvantages they had faced and women’s experiences of multiple disadvantage tended to fit one of five distinct profiles:

• Nearly half (46%*) of all women never experienced any of the particular primary disadvantages we explored in our analysis, although they may have faced other difficulties at some point, such as ill health or poverty.
• About a quarter (28%) had experienced severe problems with mental health or suffered violence and abuse at some time in their lives, but not the other primary disadvantages we examined.

The remaining quarter of women – or one in four women – reported experiences which fit one of three different patterns of multiple disadvantage:

Pattern A: one woman in twenty (6%) had experienced a combination of poor mental health and socioeconomic deprivation. Three-quarters (74%) were unemployed or economically inactive, half (50%) lived in the lowest income households, and a quarter (26%) were seriously behind with debt repayments. Half (52%) of the women in this group had a disability and third (33%) were living with a chronic condition. Black and minority ethnic women were over-represented in this group, as were women born abroad.

Pattern B: more than one woman in ten (13%) had experienced some combination of violence and abuse, poor mental health, substance dependence, and/or homelessness. These women had all experienced at least two of these, nearly all of them had faced both poor mental health (96%) and violence and abuse (95%). This group differed from the last in tending to be economically secure at the time they were interviewed.

Pattern C: more than one woman in twenty (7%) had faced two, three, or even all four types of primary disadvantage alongside multiple other economic, social and health-related disadvantages. Women in this group were the most likely to be in serious debt (46%), material deprivation (30%) and living in homes with mould on the walls (44%). Half (46%) were socially isolated, and a fifth were carers (21%) and/or lone parents (19%). This group were also much more likely than the women in other groups to have face multiple adversities in childhood. One in six (16%) had been an offender.

Similar disadvantage clusters were found amongst men, but while experience of violence and abuse was prominent among women, substance dependence emerged more strongly in the multiple disadvantage profiles of men. And while for men the range of disadvantages were all strongly associated with economic disadvantage this was much less the case for women. Multiple disadvantage was evident among women in both higher and lower income households which suggests that household income does not protect women from multiple disadvantage to the extent that it may protect men.

People who face multiple, severe disadvantages in their lives are a diverse population. While they all have complex, individual stories, many do share distinct similarities in their experiences. Understanding these patterns is important if services are to meet people’s needs in ways that are both efficient and nuanced. The modelling presented in this report is an initial step in that process. It shows how pervasive experience of violence and abuse is in the lives of women facing multiple disadvantages, how closely this is linked with mental health, and how services need to recognise the relevance of this if they are to support women effectively.

* note figures represent probabilities generated by the statistical programme and are not directly measured proportions, see this report for details: https://lankellychase.org.uk/resources/publications/gender-matters/