Where people live, whether they are struggling financially, and access to educational and other opportunities have also been linked to voice-hearing in cases where people have a diagnosis of psychosis. For example, recent research in LondontJames Kirkbride et al (2014). Social Deprivation, Inequality, and the Neighbourhood-Level Incidence of Psychotic Syndromes in East London. Schizophrenia Bulletin. found that povertytPoverty is when your resources are well below your minimum needs. and deprivationtThe lack or denial of something considered to be a necessity. can increase a person’s risk of developing psychosis, as can living in a city as opposed to a rural area. Inequality is also a contributing factor. Poor people living in neighbourhoods where richer people also live tend to have a greater risk of developing psychotic experiences than those living in neighbourhoods where most people have a similar income.

People from minority ethnic groups living in the UK are much more likely than white British people to be diagnosed with schizophrenia or other psychotic disorders. This is true regardless of whether they have been born in the UK or have migrated here from other countries. Exactly why this happens is unclear, but social exclusiontExclusion from the prevailing social system and its rights and privileges, typically as a result of poverty or the fact of belonging to a minority social group., deprivation, discriminationtThe unjust or prejudicial treatment of different categories of people, especially on the grounds of race, age, or sex., every-day and institutional racismtA form of racial discrimination that has become normal within the practices of an organisation or institution. are known to contribute to the problem.

Refugees are at a particularly high risk. A study of 1.3 million people in Sweden tAnna-Clara Hollander et al (2016). Refugee migration and risk of scizophrenia and other non-affective psychoses: cohort study of 1.3 million people in Sweden. The BMJ. found that the incidence of psychosis amongst refugees was 3 times higher than in the Swedish population. Crucially, in this study, people who were refugees were 66% more likely to be diagnosed with psychotic disorders than non-refugee migrants from the same region.  This suggests is that the specific experiences of refugees, including war, famine, persecution and genocide, as well as the trauma associated with the journey may be contributing factors.

But while there seems to be a clear link between having a difficult life, social exclusion, racism and being diagnosed with schizophrenia or psychosis, less work has been done specifically on the relation between these factors and hearing voices. It does seem to be the case, though, that the more difficulties and dangers an individual is exposed to, the higher their likelihood of developing unusual experiences and beliefs, including hearing voices. Some studies in the US tCherise Rosen et al. (2017). Exploring the Intersections of Trauma, Structural Adversity, and Psychosis among a Primarily African-American Sample: A Mixed-Methods Analysis. Frontiers in Psychiatry 8(8). have suggested that, in certain African American communities at least, high rates of abuse, poverty, gang violence, drug use and repeated experience of racism are reflected in the nature of the voices people experience – what they are like, what they say, and the meanings people attribute to them.