There is a vicious, self-reinforcing cycle of poverty associated with mental illness. You become poor. Sometimes through circumstances well beyond your control, such as losing your job, or perhaps because of a pre-existing mental illness or health concerns.
So you seek out government assistance to help you through the tough times.
But living in poverty for any significant length of time increases all sorts of risk factors for health and mental health problems. You are more stressed, worrying about money constantly, and how you’re going to pay the bills or have enough money to eat. You eat worse because bad, processed food is so often cheaper than nutritional food. If you can still afford to live on your own, you will likely do so in a neighborhood more prone to violence, exposing you to more trauma and risk for personal violence.
It’s a vicious circle where both poverty seems linked to greater rates of mental illness, and in some cases, certain kinds of mental illness seem linked to a greater likelihood of living in poverty.
The relationship between mental illness and poverty is a complex one. For instance, in a 2005 study, researcher Chris Hudson looked at the health records of 34,000 patients who have been hospitalized at least twice for mental illness over a period of 7 years.
“He looked at whether or not these patients had “drifted down” to less affluent ZIP codes following their first hospitalization,” according to the news account of the study.
He found that poverty — acting through economic stressors such as unemployment and lack of affordable housing — is more likely to precede mental illness, except in patients with schizophrenia.
Hudson says his data suggests that “poverty impacts mental illness both directly and indirectly.”
And it’s not just a U.S. problem. Poverty and mental illness share a close, complex relationship throughout the world.
Esther Entin, writing in The Atlantic, discussed the results of a recent Lancet study (2011) that looked at the relationship between mental illness and poverty in various regions through the world, including Africa, India, Mexico, Thailand, and China.
Throwing money at people doesn’t seem to help much:
Programs that primarily aimed at alleviating poverty had varied outcomes but generally were not markedly successful in decreasing the mental health problems of the target populations: “Unconditional cash transfer programs had no significant mental health effect and micro credit intervention had negative consequences increasing stress levels among recipients.”
But actual mental health intervention programs seem to help:
The researchers saw more improvement when they looked at the impact of intervention programs aimed at improving the mental health of people living in poverty. The interventions they reviewed varied from administration of psychiatric drugs, to community-based rehabilitation programs, to individual or group psychotherapy, to residential drug treatment, to family education. They also looked at the impact of mental health help on the rate and duration of employment and on family finances.
Here they found financial situations improved as their mental health improved.
There are no easy answers here, especially in times of economic decline or recession. Government money is less free-flowing, especially to such intervention programs, while individual welfare programs continue to be well-funded. Such funding priorities appear to directly contradict the latest research, where we should be emphasizing more treatment and recovery programs, rather than individual handouts.
Once a person gets on SSI or SSDI in the U.S., getting off of it can be just as hard. Social workers and others often encourage a person to remain “disabled” or in poverty to continue receiving their full benefits. Perversely, the programs often discourage work or even looking for work, and punish them financially as soon as they do, with little transition time or a “weaning off” period.
As more research is conducted in this area, perhaps the solutions will become more clear. And our policy makers can take the actual data and help craft funding that aligns with the data, rather than competes with it.
Because being poor is not a life-long condition one has to be resigned to for the rest of their lives. Recovery from poverty and mental illness is not only possible, but should be everyone’s goal.
Read the full Atlantic article: Poverty and Mental Health: Can the Two-Way Connection Be Broken?
References
Hudson, C.G. (2005). Socioeconomic Status and Mental Illness: Tests of the Social Causation and Selection Hypotheses. American Journal of Orthopsychiatry, 75, 3-18.
Lancet. (2011). Mental health care — the economic imperative. The Lancet, 378, 1440.
doi:10.1016/S0140-6736(11)61633-4
17 comments
fun fun fun. i had been doing remarkably well for four years or so. i had been working in a professional capacity for two years in the job i had at the time. i was married, and my husband and i purchased our home. my depression returned, worse than ever before. i was out of work for four months on fmla, back to work for a year, and now, off permanently. now, we are living on one income, his, and it is insufficient to meet our monthly obligations. we’re going to have to rent the house out soon to move into a cheap apartment. we’re scared to do that because we got one of those housing grants, and if you haven’t lived in your house for three years, they have to be paid back. i can’t afford psychiatric medications. i’m struggling to afford my counseling… it’s a miserable, snowballing situation. and, the lack of money has a hugely negative impact on my anxiety and my feelings of worthlessness; i’m not working, so i’m not lifting my family up out of this horrible situation.
I know that my mental illness has caused downward mobility. Whether or not the downward mobility will prove to be permanent remains to be seen, but it is directly related to the mental illness.
I read this post as, at least a bit, inferring that people who are impoverished would be likely to benefit from being on medications. Let’s be honest here, saying that people should be in mental health care by in large, at least what I have seen firsthand in my travels the past 5 or more years, are pressed to have psychiatric evaluations and get medicated. So, are you indirectly advocating for medicating the results of becoming impoverished?
I hope not. Medicating Axis 4 consequences are a waste of time.
I do think that mental illness can occur as a result of poverty. I do get worried about how you should be considered “disabled” to get benefits….
I actually wrote about a comic in Japan that focuses on those who are poor and forced to take on a large amount of debt because they think they can survive with it.
You can read it at: http://www.mangatherapy.com/post/12219533617/yamikin-ushijimakun-manga
Last I checked, SSI has a two-year “weaning off” program (“Ticket to Work”). The bigger obstacle to leaving disability or other benefits programs is the lack of jobs. There is an easy answer. Tax the uber wealthy and create the jobs they refuse to create with the hoarded wealth they made off the rest of us. The jobs created would include many more jobs in mental health counseling and rehabilitation. A full employment economy is possible, so is a healthy society. They money is available, the will to access it so far has not been but we should break out of our societal personality disorder of worshiping the wealthy and stop allowing them to rule over us in the oppressive manners that they do so that causes poverty and promotes all this mental illness your article addresses.
Social Security and SSI do offer the ticket to work program, but it is optional, you are not required to use it. I think the point I take from the article is that while no one chooses to have mental issues, staying on disability should not be an option for the long term. I work for Social Security and I see it everyday. We put people on disability but don’t require them to seek help for the illness that prevents them from working. The system is broken. Allowing people to just waste away on disability isn’t the answer. They should be required to seek help while they are on benefits in the hope that one day they will return to work.
The strange thing about disability is that you think you’ll be okay when your medicare kicks in but when it comes to mental health (at least in this area) nobody takes medicare. Nobody tells you, you have to apply for medicade. You don’t get enough money on disability to pay for your meds and doctors while you’re waiting.
When it’s mental health, it’s a medical expense on top of regular doctor visits. Some mental health medications can be real expensive. If you finally do get back to work, you almost have to make extra just for extra medical expenses, additional co-pays, deductibles and stuff employer insurance doesn’t completely cover. So not just any old job will be good enough. It’s an extra pressure to go after higher paying jobs, when you may feel you’re just not up to the stress. Stress doesn’t mix well with any mental illness.
Well, I have been depressed most of my life. I went at the age of 16 on my own to get help. I have taken some sort of meds ever since then. Have been in therapy many, many years, I worked, lived on my own paid all of my bills, my life was good. Then in the late 70’s I was horribly harassed at my place of work, and at the same time my boyfriend and I realized I was pregnant. And he just walked out on me, so therefore I had to go on welfare, because I had my baby, then I was laid off from my job, at that time the place I worked went down, so I had no choice. So with a new baby, and still sick from the pregnancy and depression, I started college, and within that first year of nursing, I had a teacher, a nurse that harassed me unbearably once she found out I suffered from a mental illness. So eventually I dropped out from depression, and simply being worn out. I was off a year, a miserable, year trying to get support form my son’s father, which I did. Then I went back to college, and finished my bachelor’s degree and started on my masters degree in clinical psychology, never finished that, was taking care of my dying father, and my young son, and depressed because of money problems, I don’t know how we made it that far. And we had started moving into cheaper apartments, which all were dumps, with slumlords, all we could afford, no one told me about section 8 vouchers. So after being terrified by slumlords, and crazy neighbors, we, moved,and moved, and moved. Finally I could no longer go to school, too sick. So my Dr.’s told me to file for SSDI. I was in my early 40’s by this time, I couldn’t get a job, lived in a slum apt, my son was going in depression from fear, from living in fear from the landlords, over and over again. So I received my SSDI, still lived in slums, still moved, my son was able to get in to college, graduated, and I am still living in slums. He is doing ok, finished college, and making his way. He lives in tiny little, decent apts, I still get slum ones, I am on a section 8 voucher, so no one will rent to you except slum lords or the housing authority, and those are not places you want to go. Right now am being horrible harassed by other people in my senior building for whatever reasons they seem to come up with, cannot get anyone to help me get out of here, need a security deposit, and a tiny small apt, but, no one will rent to me because no one wants to take the section 8 voucher. My rent is always paid, I am a quiet, clean tenant, but, it doesn’t matter. And I am slowly dying day, by day, living in my apt afraid to leave my apt mostly now, because of the stalking, verbal abuse, all I want to do is to move, but ,no one will help me to get a decent little apt, and help me to get in it. All I need is a little apt, and help with the security depostit, and none of the agencies will help me, they all mostly pass the buck or make it too hard to get the help that I need, I will pay them back, monthly until it is done, but, they don’t care. They just tell me things, and then I never hear from them again. I am so sick now, I don’t care about much anymore, actually afraid to be alive anymore, I have been so traumatized and harassed, and all I want to do is move, and no one will help me. So this is where you get when you are mentally ill, and take care of yourself, you lose all of your rights to peace, credibility, and because of that you are looked at as a less than desirable person. Shame on this country, and shame on the people. I am not that kind of person, never was, never will be. Shame on all of you.
I think if someone has a mental illness, it’s harder to
work, and that equals poverty. And on the other hand if
someone is dealing with a low paying job, or a stint of
unemployment for any amount of time this can absolutely
cause mental illness. It’s like a double-edged sword or
a catch-22 however you’d want to put it…
Interesting article. I particularly liked the findings that mental health services helped more than financial assistance. It’s like that old saying about fish & fishing.
I think most people would prefer to be able function independently than be stuck always waiting for a hand-out from somewhere. I just wish we lived in a society that prioritized everyone’s need to better themselves & their situation.
Greetings.Having experienced that “drift” as you call it. It seemed more like being pushed down than drifting down. People want power over other people and there is no better way to do it than to achieve economic control. I have tried to convince people that if you want to get rid of someone you give them wings and watch them fly and celebrate it. It has been my experience particularly with narcissistic peopleor perhaps I have come in contact with psycopathsthat they will do anything psychologically to destroy someone if they want something and you have foolishly gotten in the way. I have several degrees and am now in poverty. I would say though that it is partly due to the old way of thinking that you are working to take care of your family and your husband and you save nothing for yourself and nothing is what ex-husbands intend for you to end up and they are proud of themselves for accomplishing that. I would advise young women and I truly believe this is a female issue to have your own savings your own paycheck your own retirement. To have goals and find someone who has goals as well that will mesh with yours. I wish you all good luck.
l am a 62 yr. Old woman who has lived with mental illness over 40 yr.I have been through hundreds of jobs and still live on welfare for support. Although I am well educated and intelligent I can’t maintain stable work.I have anxiety disorder and agoraphobia.I live in an advanced seniors place 85+, but hate every minute of my existence.I have been looking for work to two years now but,never get called back.How do I get help and understanding in a cruel,prejudical and discriminatory world?
Pick me!
There’s a flaw in logic here in determining causality. I don’t think poverty causes mental illness per se. More likely, mental illness runs in families, so a head of household who’s ill and unable to work consistently would be poor. He or she would then raise children in that environment. A child who inherits a condition, even if he or she tried to claw his or her way up, might not be able to due to the limitations of the illness.
About cause and effect, for example, I’ve seen studies where everyone except the patient is utterly perplexed by how a someone in a week-long stay at a psych ward can report improvement; stabilizing on meds within the week. How, “experts” wonder, when most psych meds take weeks in order to begin working? There’s a gap in knowledge. If they’d asked any of those patients, they would have known that most people locked up in psych wards are mainly interested in getting out. Of course, patients would report that they feel better in order to achieve this end.
One does not necessarily cause the other. The so-called experts are trying to connect the dots, but miss too many of the dots along the way.
Interesting to me that know one has considered how we as a society could attempt to address the sources of stress for under resourced people aside from employment. If one has difficulty maintaining full employment are they then doomed to live is substandard housing and threatening environments? We know from research that this kind of “toxic” stress alters brain function and acts as a trigger for individuals with biological vulnerability. Yes therapy is incredibly valuable. Learning to “manage” stress in incredibly valuable but why do people in poverty have to be the best at managing threat and stress? It is not just about money folks! Those of us not living in those conditions could make a difference that is not about money.
It’s astonishing to see that mental illness has a greater presence due to poverty and potentially class. I don’t think I necessarily believe that class has anything to do with mental illness, especially when the education orcastrated is invalid and unreliable. Besides that, your article was informative.
One problem is that the system in the US is too all or nothing. Mental illness and other disabilities are not all or nothing. People who are affected by poverty and/or mental illness need access to treatment and a hand up, but not to be labeled and treated like they are not capable of being contributing members of society. One reason that people who get disability benefits tend to be stuck and not return to regular work is that they are penalized for working and earning their own money. There needs to be support for the transition so that people can recover and not lose supports that they still need. Many people are partially disabled and can work, but maybe not 40 hours/week. Maybe they are not able to fully support themselves, but they want to do what they can. But the US system doesn’t allow it. If you start to work, you lose your benefits, and are thrown back into poverty, and the cycle repeat again.
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