An interesting paradox exists in our country: there is often a shortage of psychiatric providers in the poorest and most remote areas, where there is the greatest need for treatment. There is no shortage of patients in a typical inner city clinic or psychiatric ward. On any given day inner city mental health clinics have an influx of people who are struggling with various mental health disorders, whether it’s a mood disorder, psychosis, substance abuse, or a personality disorder. In rural areas, even finding mental health practitioners can be challenging, with 55% of counties having no practicing psychiatrists, psychologists, or social workers. While the shortage of psychiatric providers in the inner city and rural areas poses a significant problem, it is also beneficial to examine the relationship between poverty and mental health.
It’s pretty clear that many people who experience extreme poverty also struggle with various mental health issues. Although every person who experiences poverty is not mentally ill and every mentally ill person is not poverty stricken, a strong correlation does seem to exist between mental illness and financial instability. In fact, the mental health community continues to engage in the age old debate; what comes first, mental illness or poverty. Various studies have shown that employment status has a significant impact on mental health symptoms. In fact, The World Health Organization cites a study that indicates that unemployment increases the prevalence of psychiatric disturbances, particularly neurotic disorders, psychoses and substance abuse disorders. It’s been found that unemployment almost quadruples the odds of drug abuse, more than doubles the odds of depressive, anxiety and obsessive–compulsive disorders, and increases the odds of mixed anxiety and depressive disorder by more than two-thirds.
Additionally, in 2005 researcher Chris Hudson studied the health records of over 34,000 people. The results indicated that with the exception of Schizophrenia, economic pressures such as unemployment and lack of affordable housing often precedes mental illness. These results suggest that poverty does in fact increase a person’s risk for experiencing mental disability and psychiatric hospitalization.
Given this data, one would intuitively think that the solution to the problem is to create programs that will provide financial assistance to individuals who live in poverty. However, additional research shows that this may not be the best solution. In fact, when researchers evaluated the effectiveness of intervention programs in low and middle-income regions, they found that “unconditional cash programs” did not result in any significant improvement in mental health. This conclusion may be reflective of the difficulties that mentally ill individuals have with effectively managing their resources. Although it is true that limited economic resources contributes to mental illness, individuals who struggle with active symptoms also tend to struggle with their finances. For example, an individual who struggles with Bipolar Disorder may go on a shopping spree, purchasing unessential items and creating more debt during a manic phase. Similarly, a person who is struggling with depression may find it difficult to concentrate or communicate and may begin to avoid paying their bills and communicating with creditors. This may worsen their financial situation and inadvertently their mental status as they struggle to get their basic needs met.
Poverty and unemployment do not just increase the odds of experiencing mental illness and drug abuse for adults, they also increase the chance for children. According to the National Center for Children in Poverty, more than 16 million children live in families below the poverty level. Children in poverty are at risk for social, behavioral, and mental health problems. Foster care youth are also at high risk. Casey Family Programs reports that between ½ and ¾ of children entering foster care exhibit behavioral or social competency problems that warrant mental health services. Youth who have “aged out” of foster care also show high rates of psychiatric disability. Former foster youth experience more than 7 times the rate of drug dependence and nearly 2 times the rate of alcohol dependence experienced in the general population, continuing the cycle of poverty and mental illness.
So what does this mean for people who are dealing with mental health issues that are exacerbated by poverty? There are no easy answers as the relationship between poverty and mental health is very complicated. And what about the specific needs of youth in poverty? The National Association of Children in Poverty, states that solutions are on the horizon. Effective approaches to combating the disproportionate rate of mental illness in children living in poverty include school programs, where the children spend most of their time, and integrating approaches across different child serving sectors. Strategies that engage families are effective, also, but what about those who do not have access to parental resources, such as children in foster care? According to a study conducted by the Stuart Foundation, foster care alumni experienced PTSD at a rate nearly 5 times that of the general population. The same study found that 45% of foster youth completed high school, compared with 79% of the general population, which would increase their chances of remaining below the poverty level.
The study in 2005 that was conducted by Chris Hudson found that the financial status of participants improved as their mental health improved, suggesting that intervention programs should focus on treating the symptoms of the mental illness rather than the financial lack. This makes logical sense if it is assumed that as symptomology decreases that individuals will sustain jobs and earn more income. However, this same study also showed that clinical symptoms continued to improve as the economic status of the individuals improved. In other words, mental health recovery does seems to help people improve their finances, however, as their finances continue to increase, there seems to be a continued improvement in their mental health, as well. This reflects the dual nature of the connection between income and mental health.
Research shows that both mental health treatment and financial stability seem to be interacting factors that help individuals create healthy and emotionally stable lives. Therefore, it seems that intervention programs that provide a combination of effective mental health treatment modalities combined with financial assistance to ensure that the individual’s basic needs are met may be very useful. Also, early intervention programs designed to teach financial skills to children who live in poverty stricken areas may be very helpful in giving young people the tools that they need to secure and maintain employment. This could help to avoid this vicious cycle early on. These types of programs may best the best approach to meeting the needs of this population.