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The Invisible Many: How the Impoverished Confront Mental Health Barriers in the US

Before we start this I’d like you to do the poll below.

How closely have you been affected by mental illness?
I have struggled/am struggling with mental illness
I have had friends who struggle with mental illness
No close friends of mine, but friends of friends or acquaintances have struggled with mental illness
I feel very distant from mental illness

(if the embed isn’t working, please go to this link https://linkto.run/p/BTBORJ5H)

With rising teen suicide rates and teen mental health disorders, it seems that everyone has some story to tell about mental illness. I know that I have friends who struggle with seasonal depression and anxiety disorders, and while I thank my lucky stars that no one close to me has committed suicide, I know that some of my peers can’t do the same. So, I’d just like to start off this presentation by taking a moment to reflect on the seriousness of mental illness and how deeply it’s seeped into our culture today.

Ready?

Alright, let’s start this talk off with

Incidence

People with less disposable income are at higher risk of developing mental illness. You remember that growing teen suicide rate I was talking about? Well it turns out that that may be linked to growing economic inequality. But more than that, low amounts of disposable income can adversely affect mental health in many ways at many stages of life.

Adults, too, are at high risk for development of anxiety and depression due high levels of toxic stress. As Dr. David Ansell writes in his book The Death Gap: How Inequality Kills, “Frequent cycles of stress like those in impoverished neighborhoods challenge the body’s ability to remain in homeostasis or steady state. The impact of repeated cycles of stress and hormone activation is called the ‘allostatic load,’ and stress-induced shifts in allostatic load can permanently raise blood pressure, induce plaque formation in arteries, and cause organ failure…Stress-induced high cortisol levels stimulate appetite through a number of mechanisms including the release of ghrelin, a peptide that stimulates hunger. However, ghrelin released during chronic stress also makes the brain more susceptible to posttraumatic stress disorder (PTSD).” So, biologically, poverty alters brain chemistry and promotes development of PTSD. But more than that, poverty places a psychological weight for mental illness—unable to pay your medical bill, causing you to develop a long term illness? Unable to pay for the medical bill of a family member, so they pass away? Unable to maintain a job? All traumatic events that are linked to a development of depression. Perhaps the worst part, though, is the vicious cycle this can put someone through. After developing PTSD, they may find it hard to keep their job. So then they become depressed, causing them to self-medicate, further scrambling their neurotransmitters and hormones. Repeat ad infinitum. 

Teens, adults, and now children. Children are, arguably, the most affected by poverty due to their plastic nature. Traumatic events during childhood are not temporary, and can impact a child’s mental health forever. Dr. Kerry Gibson makes a good case for the relevance of childhood poverty in the video below:

Dr. Gibson being interviewed by the New Zealand Herald

Gibson touches on the childhood equivalent of the biological priming that poverty has on adults and also on another important topic: absentee or abusive parenting. Parental substance abuse, verbal, physical, or sexual abuse of their child, and parental incarceration are all what are known as adverse childhood experiences, ACEs for short. ACEs can have an extreme physical as well as mental affect on the health of a child, and those repercussions reverberate throughout the child’s life. And all of those ACEs I listed? Positively correlated with lower income, likely for the reasons I’ve already listed. On every front, and at every age, poverty can and does cause serious mental illness to many within its clutches.

Treatment

It’s no secret that many mentally ill people receive no treatment for their illness: nearly 50%, by some estimates. However, most people misattribute the cause—while stigma and the popularity of self-management definitely play a role, the true killer is cost. In a survey carried out by SAMHSA, a branch of the US Department of Health and Human Services, people who did not receive treatment, when asked why, listed a fear of others’ judgement fifth, and self-management second. The primary cause? Cost. 

Already at higher risk of developing mental illness from toxic stress, ACEs and economic anxiety, people without disposable income find themselves doubly disadvantaged when it comes to treatment. With treatment costs rising and unreliable health insurance payouts, to say nothing of the rising number of Americans with no health insurance at all, many Americans simply cannot afford treatment. Money that could’ve been spent getting treatment instead has to go to food, rent, and physical health, while mental health care, seen as inessential, is one of the first expenses cut by low-income individuals and families. But even people who seek treatment, either who are lucky enough to have healthcare providers that recognize mental health as a necessity, or who empty their own pockets, still face unequal medical treatment. The reason? Location. To quote Dr. David Ansell again, “I found that premature illness and death are spawned in communities of immense poverty and further exacerbated by the inability of health care institutions to provide complete care as they are inundated by the uninsured…the same embedded forces that created high-mortality neighborhoods also degraded the capabilities of the health care facilities that served them.” Even from within hospitals, mental health institutions and emergency departments, inequality rears its head, making services provided less potent and attributing to the increased stress, depression, and suicide rates among the impoverished. So, if the mentally ill rarely go to therapy, or find their treatment ineffective, where do they end up?

 

Prison

An estimated 25% of inmates suffers from some sort of mental illness. Yep. Worse still, prisons may actually cause mental illness—the prison system’s use of solitary confinement, isolating prisoners for as long as 15 days straight, can have serious repercussions and exacerbates existing mental conditions, sometimes even causing paranoia, hallucinations and, in extreme cases, suicide. And yet, each day thousands of poor mentally ill people are being funneled into the prison system because they can’t afford to manage their illness, or because their illness causes them to act out. It’s not all dark though, at least the mentally ill get treatment in prison, right? Right? Well, half of them do. But even if you’re not swayed by the flagrant human rights violations at play, then have some statistics. Housing an inmate with mental illness costs $31,000 annually for room and board, while providing mental care over the same time frame would cost only $10,000. Not to mention, in that time, that person could also be working, consuming, paying tax. So then, why don’t they make the switch? Everything seems to be in favor, why not? “The problem is a lack of infrastructure,” says Sheriff Tom Dart, a local Cook County overseer and reformer who’s looking to change the system from the inside. I asked him that question in an email correspondance. “It’d require an investment up front [to establish mental health services]…while the prisons are already built.” Unwilling to bite the bullet, the US government is willing to suffer this inefficiency just because it’s easier in the short term. But everything isn’t so dreary everywhere. On a citywide level, many places are working hard to enact change. San Antonio and Miami have, in recent years, instated vetting protocols to divert the mentally ill away from jail and to the resources they need, cutting prison numbers nearly in half and saving millions of dollars a year. To quote from NAMI, an organization dedicated to the fight against this prison pipeline, “reform is possible. We need to build on success. Step by step, we can both save money and save lives…Together, we can do it, but it is going to require everyone doing their part.”

The Next Step

Awareness is always the first step towards change, that’s why I made this presentation. This problem, in all its multitudes, is severely underrepresented even in circles where conversation about mental health flows freely, and a great deal of this stems from ignorance. This is where you can help. Now that you know about this, don’t be afraid to share it—taking an active role in disseminating information and eliminating false information is one of the most valuable jobs there is. If you’re feeling even more impassioned, then volunteer. Look into local advocacy groups—I’m sure there are some you don’t know about. But advocacy is not, in itself, change. True change comes from something larger than the individual—the only way to have true health inequality over income is to have massive systemic change that reshapes the way that we see mental health in the US. But even here, the individual is valued—Sheriff Dart worked himself into a position of power within the system and used that power to change the Illinois prison system for the better. Better yet, foundations and lobbyists are always pushing for positive change, and now, slowly but surely, they’re starting to focus on income inequality: NAMI, the APF, and the National Association of Counties and Council of State Governments, among others, are turning towards this massive problem, and—bit by bit—are starting to eat away at it. So go on! Add your voice to the fray! Sign a petition, send a letter to your local congressperson; if you’ve been affected by mental health, either personally or by relation, share your story! With a problem this big, no action is too small.

Bibliography: https://docs.google.com/document/d/1BlkFzNNyF6inwO3HIrLOER2-NrmtC8ifloOjhzCN_qo/edit?usp=sharing

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COMMENTS: 8
  1. April 24, 2020 by Megan

    Hi Theo! I really liked your project, and I can tell you put a lot of work and research into it. As someone who also took the Ab Psych class, it was rewarding to see our learning put into good research and explanations! ACEs are super important for people to learn, and especially how it relates to the health-wealth gap. I love all the media you put into explaining your project, like videos, graphs, and linking sources. Among the similarities between our projects, I found the “Next Step” really important for mental health. Raising awareness, ending stigma, and building empathy are all things that should change in this society. Great job, Theo.

    • April 27, 2020 by Theo

      Thank you so much! After hearing about the ACEs in our course, I knew that I needed to incorporate them somehow after hearing about their importance. Luckily they aligned with what I’d already chosen for my research project! I’m sure your project went just as well, and I hope that you found my suggested actions helpful and inspiring.

  2. April 24, 2020 by Adam

    I really enjoyed reading this project! I didn’t realize the severity of the barriers that impoverished people face when it comes to mental health, especially in prisons. It seems problematic for the the government to ignore the issue of mental health.

    • April 27, 2020 by Theo

      Absolutely. I’m glad that my presentation was able to convince you of the systemic inequalities linking mental illness to lowered income, that now you feel more empathy towards those living in lower income households, and that you’re inspired to take action, spreading the word or even more, if you have the time.

  3. April 26, 2020 by Sierra Martin

    Hey Theo! Great work. Your project was clearly through and well-researched. I found your writing style in particular to be very clear and concise, which was great because you were dealing with complicated topics; I was still able to understand the nuances of your topic without feeling overwhelmed or overburdened with information. Well done!

    • April 27, 2020 by Theo

      Thank you! My writing style comes from reading a lot when I was younger (because of a certain lack of friends) and a great deal of late night writing–I find that when sleep is on the line, I’m able to cut out a lot of the rambling tangents that I’m usually prone to. I’m glad that you were able to parse all of the information, and I can only hope that that means that you’ll be able to remember this pressing concern in the future!

  4. April 27, 2020 by Isabell

    Hello Theo, I really liked your presentation and the care you put into it. it is very well written and the information you use helps back up your argument in a clear manner. There is a lot of information but it is all very clear and easy to understand. I think you also did a really good job of addressing the stigma against this topic and providing accurate information and different ways to help.

  5. April 27, 2020 by Theo

    Thank you Isabell! I did struggle a lot with what to include and what to cut–there’s just so much more out there about poverty and mental illness, and I’ve only begun to scratch the surface. I hope that the information I’ve given stays with you, that you’re able to spread awareness on the topic, and that maybe, just maybe, I’ve inspired you to look more deeply into the problem at hand. Thank you again for your nice words!

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