With shorter days, colder temperatures and more inconveniences associated with everyday living, the onset of winter gives most people a bit of a jolt. For those living in fuel poverty, the season can quickly prompt high levels of worry, stress, anxiety and depression. In fact, the negative impacts on mental health may precede any measurable physical impacts, which tend to emerge over longer exposure to cold, damp living conditions.
Increasingly, health experts consider the concept of 'mental health and well-being’ as an important element of physical health. It relates to a sense of contentment and positive outlook that is central to individual self-fulfillment, and is often associated with the ability to work productively and creatively, and to participate in a community. Mental health if often considered as somewhat distinct from clinical diagnosis of mental illness, but the two can be very much linked. Without intervention, a person who is mentally 'unwell' could continue to slide across the spectrum towards mental illness.
In a fuel poor home, the experience of chronic thermal discomfort, coupled withthe challenges of coping with condensation, damp and mould, can trigger a range of low-grade mental and emotional disorders for the occupants. In many cases, simple worry is the first stage, as people become anxious about whether their living conditions will negatively affect the family’s health or cause damage to their possessions.
As other stressors are added to the mix – finding the monthly budget is never enough to cover expenses, falling into arrears with the utility company, etc. – people begin to describe feelings of helplessness and lacking any sense of control over their circumstances. Many come to fear that their home situation will leave them isolated from the community. Studies done in Ireland confirm that multiple stressors can have an exponential effect on mental health, leading to what is known as ‘cumulative stress disorders’.
Consistently, people report that the financial pressure of managing high energy bills and the experience, or fear, of falling into debt is the most significant stress factor. While parents bear the brunt of these stresses, they are not the only ones affected: studies indicate that 25% of adolescents living in cold homes are at risk of developing a range of mental health problems, compared with only 5% of adolescents who live in warm housings.
Measuring mental health and well-being impacts
Assessing the mental health and well-being impacts of fuel poverty often starts with an interaction between someone from a social agency and the person identified as fuel poor. It may also stem from discussions between a person and his or her family physician.
Generally, the 'self-reporting' of personal experience is considered the most reliable method of gathering information about home comfort and broader well-being. In fact, health professionals have developed a standardised survey to assess the severity of fuel poverty impacts on mental health and well-being.
As with physical health, those doing an assessment seek to identify certain ‘exposure factors’ that can be objectively measured to understand who is at risk of mental health impacts of fuel poverty. Many of these are related to energy bill affordability, including calculations of the following:
- the ratio of energy costs to overall income
- the balance of spending on various other household expenses
- the likelihood that a person will self-disconnect or ration energy use
- the financial penalty that will be incurred if disconnected, or
- the level of arrears in energy bills experienced in the household.
Other trackable factors might be the amount of space used for living versus total space available in the home, and the person (or family's) willingness to invite other people into the home or to go out and participate in the community. It must not be overlooked that poor mental health arising from fuel poverty can have a significant flow-on effects for people’s physical health.
Taking steps to improve mental health and well-being
In light of the above indicators, efforts to make the energy bills of fuel poor households more affordable – and thus rebuild a sense of being able to manage their circumstances – is a high priority. Financial assistance, either through government subsidy programs or monthly payment schemes offered by utility companies, is often the first measure as it is easy to introduce and provides some degree of immediate relief. However, such schemes do not address the underlying challenge of a mismatch between income and energy needs.
Thus, a more effective long-term strategy is to enable individuals to apply energy efficiency measures. A remarkable number of dwellings in Europe lack basic tools to control heat (and thus energy use), so installing thermostats and heating controls on all heating devices is a vital first step. This empowers householders to monitor both temperatures and heating levels, and to adjust them according to the household energy budget, timetable and priorities.
To further reinforce this sense of self-management, many assistance schemes place strong emphasis on helping households learn more about how energy works in the home and equipping them with strategies and skills to reduce household energy consumption. Once armed with a toolkit to ensure energy is being used as efficiently as possible, and an address book of who to contact for help or advice, occupants report the stress of living in fuel poverty starts to lift.
Building this sense of resilience and capacity to cope with the daily realities of fuel poverty is hugely important. Robust studies show that some people measure improved mental health as contributing as much as 50% of the benefits felt after a home retrofit project.
 Liddell, C. and Guiney C. (2014) ‘Living in a cold and damp home: frameworks for understanding impacts on mental well-being’, Public Health, 11 November 2014, University of Ulster, Coleraine.
 Marmot Review, (2011) The Health Impacts of Cold Homes and Fuel Poverty.
 Common scales include Warwick-Edinburgh Mental Wellbeing Scale(which uses 14 statements relating to aspects of mental well-being) or the Hospital Anxiety and Depression Scale. Other, broader measures of quality of life might also provide insights into mental well-being, such as the Australian Well-being Index (http://www.australianunity.com.au/about-us/wellbeing/auwbi), which draws on a range of external conditions deemed central to self-fulfilment.
 Liddell, Morris and Langdon (2011) Kirklees Warm Zone: The Project and its impacts on Well-being, report commissioned by the Department for Social Development Northern Ireland, University of Ulster, Colraine.