“The mental health effects of poverty are wide ranging and reach across the lifespan.” Psychiatric Times, 2018.
It has been difficult for me to think clearly this week, let alone write something of importance, that is not about the torrent of gun violence and death we’ve witnessed these last few weeks. (To clarify: we have not just “witnessed it”, many of us have given it the green light either by voting for those who refuse to pass substantial gun restrictions, or not forcing our elected officials to do so through boycotting, protesting and voting them the hell out of office). I’ll include myself in the group not boycotting and protesting…yet.
There’s been a lot of talk, particularly from those who are adamantly opposed to gun control, about providing additional mental health services in an effort to help avoid these tragedies. Here’s what Texas Governor (R) Greg Abbott said about mental health care access in the wake of the elementary school massacre in his state, as reported by NBC News:
Gov. Greg Abbott said Wednesday that the Uvalde school shooter had a "mental health challenge" and the state needed to "do a better job with mental health"…
NBC News also reported that “in April [of this year], he slashed $211 million from the department that oversees mental health programs.”
Since mental health is in the news again, I think a discussion of how poverty, or even a temporary lack of money, impacts both our individual and collective mental health. I’ve described in previous posts the overarching anxiety and even despair, that hover over your days when you know you don’t have enough money to cover your bills, when the debt keeps piling up and you’re pretty sure that short of a lottery win, you can’t envision a path to paying it off.
According to a 2018 article published in Psychiatric Times, there is a direct relationship between poverty and adverse mental health outcomes:
The evidence is strong for a causal relationship between poverty and mental health. 3 However, findings suggest that poverty leads to mental health and developmental problems that in turn prevent individuals and families from leaving poverty, creating a vicious, intergenerational cycle of poverty and poor health. 4
Clearly, this adverse relationship tends to keep people in poverty. When you’re anxious, worried, unable to sleep or eat properly, your physical health suffers too. And let’s not forget that no healthcare is available to those living below the poverty line in many states, because those states, ironically, states with the highest levels of poor people, have refused to accept the Affordable Care Act’s Medicaid expansion provisions. Additionally, when you are physically and mentally below par, you’re hardly ready to shine in a job interview.
To sum up: when you don’t have money, you tend to have poor physical and mental health and have much less access to proper health care than those in a higher economic status. And when you don’t feel well mentally, you’re much less likely to get a job, thus perpetuating the cycle of poverty.
Excess stress, especially stress that lingers over long periods of time, is a key factor that negatively impacts our mental health and could tip us over the edge. A 2016 article in The Guardian discusses the “strength-vulnerability model” of mental health which posits there is a tipping point, and it is different for everyone:
…our brains can only handle a certain amount of stress before a crucial threshold is crossed and we end up mentally ill. Some people can handle a lot of stress before a breakdown occurs, others not so much.
But what seems to be most damaging is living in poverty as a child. At a young age, it is more than stress, it can be trauma, both physical and financial, which stays with you well into adulthood. A Health Magazine article from just a year ago analyzes the various forms of trauma caused when children live in an environment where their basic needs are not being met. Children’s brains are still physically malleable into their mid- twenty’s and thus susceptible to neurological changes:
When basic needs aren't met consistently due to financial instability or poverty (the latter of which is often systemic, multi-generational, and difficult to overcome), it can have a neurological impact.…poverty affects the prefrontal cortex, which is what enables us to perform advanced cognitive tasks.
Our mental and physical health are inextricably linked, and when you add the effects of low-income and poverty to the inequities of health care, it is a potent, sometimes deadly combination. According to a study published in the Journal of the American Medical Association (JAMA), the difference between the average life expectancy of the poor and higher income people in the United States as of 2014, is 10-15 years.
There are federal and community programs for low-income areas to ease poverty and improve access to health care, but these gestures apparently are not enough.
"Without government programs, instead of one out of five children living in poverty, it would be one in three children living in poverty," Dreyer says. "So they really do help keep children out of poverty. The problem is, we need to expand and enhance them rather than fight just to keep them alive." The good news, he says, is programs such as the Supplemental Nutrition Assistance Program (or food stamps), WIC and school-lunch programs and certain tax credits that are permanently in place. (Dreyer is the president of the American Academy of Pediatrics)
What more can we do to improve our nation’s physical and mental health and close the gap in health outcomes between the rich and the poor?
Please leave your thoughts below. All comments are welcome!
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