Vicious cycle: Mental illness and poverty go hand in hand

Sue Abderholden, MHP, is the executive director of the National Alliance on Mental Illness (NAMI) of Minnesota. She has received numerous awards for her advocacy, including the Distinguished Service Award from the Minnesota Council of Child Caring Agencies, National Association of Social Workers Citizen of the Year, Excellence Award from the NAMI National Executive Directors group, the Paul Wellstone Advocacy Award from the Minnesota Psychiatric Society, the Advocacy Award from the Pacer Center, and others.

Mental illnesses and poverty go hand in hand. Having a serious mental illness can lead to poverty; living in poverty increases the risk of developing a mental illness.

Having a mental illness can lead to poverty: According to the World Health Organization, mental illness is the leading cause of disability around the world. Once your mental illness is disabling, meaning it severely limits your ability to finish your high school or college education, and it severely limits your ability to work, you will be living in poverty. The 2009 federal poverty threshold for a single person is $930 per month. If you have little work history, you end up on General Assistance for $203 per month, or Supplemental Security Income, which is around $700 per month. Even if you have enough work history to qualify for Social Security Disability, the average monthly income is $1400.

While you can work a limited number of hours without losing Social Security income and medical benefits, people with a serious mental illness have the highest unemployment rate. The stigma surrounding mental illnesses is so great that few people will disclose a mental illness to potential employers. Without disclosure it is impossible to provide employment modifications or access the protections afforded under the Americans with Disabilities Act, and thus many people are not hired or are not able to keep their job.

Poverty can lead to a mental illness: There is research pointing to causal links between poverty and mental illness, particularly depression. Knowing the impact that stress and trauma can have on a person's mental health, it is not hard to recognize that people living in poverty have higher stress and may be more prone to developing depression.

If you live in poverty, you have less control over your life, where one emergency can lead to homelessness. You may have poor social supports and no one to help with children or financial emergencies. You are more likely to be exposed to violence in your home or neighborhood. On top of that, people living in poverty may not have health insurance, access to transportation, and may have a difficult time finding a culturally competent mental health provider. Untreated depression can cause additional stress, such as losing one's job, or housing, or feeling rejected by one's community. And so a vicious cycle is created.

We can break this vicious cycle: If we are to tackle this issue, we need to work on both fronts – the mental health system, and the poverty reduction programs. This includes making sure that:

There are culturally competent mental health providers in low-income communities.
Poverty and mental health programs are paired together.
There is access to supported employment programs.
An adequate supply of affordable housing exists.
Early identification and resiliency programs for children are available.
Programs work to lift people out of poverty.
We continue to work to reduce stigma.

We must use integrated approaches to tackle this issue, such as supportive housing programs, where housing is affordable and services are on-site, or school-based mental health services. These issues are huge, and can at times seem unsolvable. But we do know what works; we just have to do it.

Vicious cycle: Mental illness and poverty go hand in hand

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