Only a limited set of topics bring mental illness into the news. Obamacare's mental health coverage requirements briefly brought mental health into the spotlight. And every time there's a mass shooting in the US (disturbingly regularly, as it turns out), it also sparks a conversation about mental illness. But another American crisis, the persistently weak economy, is also a mental health issue. And it's a mental health issue that often goes unspoken.
Mental illness is tightly bound up with economic well-being. Being out of work hurts mental health, and severe mental illness keeps lots of people out of work. And even more upsetting, growing up poor can make a person more susceptible to some forms of mental illness, creating a sort of vicious cycle. Here are three ways mental and economic well-being play into each other.
1. Unemployment makes for mental health problems
A recent Gallup poll showed that unemployed Americans generally have higher depression rates the longer they are without a job. Roughly one in five people who have been unemployed for a year or longer report that they currently have or are being treated for depression.
That depression can snowball into bigger problems, says one expert.
"It is deeply, deeply traumatic for people to lose jobs, like it is for them to lose their homes," says Schroeder Stribling, executive director at N Street Village, a service provider to homeless and low-income women in Washington, DC. "It gets to the core of the sense of who you are and your worth and dignity and can take a serious bite out of it. And if it's prolonged, it has kind of a cumulative effect."
Losing your job often means losing your health insurance, meaning some people can't receive treatment for the anxiety or depression that unemployment causes, Stribling adds. And if the condition worsens, it can also get in the way of a job search.
2. Poverty and mental illness can create a vicious cycle
This economic-psychiatric cycle can be even more insidious, spanning generations. Being poor — particularly as a child — can make mental health problems even more likely down the road.
According to one 2013 paper from researchers at Cornell University, children raised in poverty were more likely to act out aggressively or exhibit "learned helplessness" — a condition in which people believe and act as if there is no escape from their illness. Another 2013 study found that poor housing is connected with later emotional and behavioral problems.
And one 2011 study examining records from 34,000 patients found that poverty preceded mental illness in patients, except for cases of schizophrenia. This may also be evidence that poverty indirectly plays into mental illness.
Importantly, say both Stribling and Peterson, the sorts of mental health problems that result from childhood poverty tend not to be the severe disorders like bipolar or schizophrenia.
But put all of these interactions together, and it shows one pathway through which the prevalence of mental illness and poverty can both feed into each other and hurt upward mobility.
"It's one mechanism by which the cycle of poverty perpetuates itself," says Stribling. Though the poverty cycle occurs through many channels — housing, education levels, family structure — she believes mental illness plays into it as well.
Poverty doesn't always make for mental problems. Many people born in poor or economically stressful settings will end up perfectly healthy mentally, she adds, but the stress of growing up in poverty can cause mental illness to present itself.
Stribling says the common phrase to describe this phenomenon is that "genetics loads the gun, but environment pulls the trigger."
What all these factors mean is that the need for mental health in the US is not simply a function of physical and mental well-being; it's a matter of economic strength. If mental illness both causes and results from economic problems, it means that making sure people have adequate access is an economic issue.
Still, it appears adequate access is a long way off. According to data compiled by the Kaiser Family Foundation, only around 51 percent of America's mental health need is met. The nation needs around 2,700 new mental health professionals in "health professional shortage areas" in order to meet all of these people's needs.
3. Severe mental illness makes for very, very high unemployment
Patients with serious mental illness — major disorders like schizophrenia or bipolar disorder — show one major connection between economics and mental health. According to the National Alliance on Mental Illness, around 1 in 17 Americans lives with a serious mental illness. That comes out to around 18 million people.
Though there's no official count of the jobless rate among mentally ill Americans, experts in the field agree that it's quite high.
"People with severe mental illness have an unemployment rate of 85, 90 percent," estimates Brent Peterson, vice president of development and marketing at Thresholds, a mental health service provider in Chicago. And though illness makes work difficult for some of these people, he says many capable workers are excluded from work by the stigma of mental illness — too often, employers think mental illness means cognitive deficiencies.
Thresholds partners with Banana Republic to find jobs for patients in Chicago. The store has reported that the workers are often the most loyal employees. Peterson says that this is because the workers so often want work so badly.
"It is a population that is in many cases able to work with the appropriate supports," he says.
Working can, in fact, be part of a structure that can make an illness more livable.
"Work is a very, very important part of recovery for people," says Ron Homberg, director of policy and legal affairs at the National Alliance on Mental Illness. "When you ask someone with a serious mental illness what would be important for them, work is right at the top of the list."
Correction. This article originally in one instance referred to NAMI as the National Association for Mental Illness.