Mental Illness Is A Much Bigger Problem For The Poor, New Study Shows
Huffington Post; Jonathan Cohn, 5/28/2015
On Thursday, the U.S.听听released a new 听that demonstrates, in vivid terms, something that public health experts have known for a while: Mental health problems are far more common among the poor than the rich.
The basis for the study is five years of responses to the听, an in-person poll that the federal government has operated continuously since the late 1950s. Today鈥檚 version includes questions designed to measure the prevalence of 鈥渟erious psychological distress,鈥 a standard that public health experts use as a proxy for certain kinds of mental illness.
Infographic by Cameron Love
According to the new CDC paper, 8.7 percent of people with incomes below the听, or $20,090 for a family of three, reported serious psychological distress from 2009 to 2013. For people with annual incomes at or above four times the poverty line — that鈥檚 $80,360 for a family of three — the figure was just 1.2 percent.
Researchers also discovered that about 30.4 percent of working-age adults with serious distress had no health insurance, compared with just 20.5 percent of working-age adults without serious distress.
The study, whose lead author is CDC epidemiologist Judith Weissman, does not address the issue of causality — in other words, whether mental health problems lead to more economic hardship or whether economic hardship leads to more mental health problems. But most researchers believe the process听听in both听.听
Studies have shown, for example, that infants and toddlers growing up in low-income communities are more likely to experience the kind of 鈥溾 (neglect, abuse, seeing violence in the home) that can hinder brain development and lead to mental illness in adulthood. Additional听听have suggested, though not conclusively, that adults who become unemployed are more likely to develop depression.
At the same time, somebody who had mental health problems might have a听听holding onto a job — or, at least, a good job. And without employment, historically, it鈥檚 been tough to get health insurance or to have enough money to pay for timely听听of psychiatric problems.
For the people and families that deal with mental illness, the result can be a vicious, downward spiral that — in the worst cases — ends with some combination of medical and financial catastrophe.
A major goal of the Affordable Care Act, or Obamacare, was to address these problems — partly by helping听听of additional people to get health insurance and partly by requiring insurance plans to provide more comprehensive听听of mental health care. These regulations were an extension of bipartisan efforts, dating back to the 1980s and 1990s, to establish听听between mental and physical health care coverage.
The data in this latest CDC study isn’t recent enough to capture most of the Affordable Care Act鈥檚 effects. But听听focusing on a provision of the law that became effective back in 2010, found that young adults who obtained insurance were more likely to get mental health treatment. Studies of past government initiatives with similar characteristics, such as an expansion of Medicaid eligibility in听, have provided yet more evidence that access to health insurance leads to better mental health.
Still, many people who obtained insurance under the Affordable Care Act听 mightily to get mental health care — either because they have trouble finding providers who accept insurance or because they face daunting听听for every treatment session and prescription. That鈥檚 why organizations like the听听have called upon officials to find ways of further improving mental health coverage — whether by providing people with more protection from high deductibles or strengthening the regulation of networks of mental health care providers.
Not everybody would favor such an approach. The Affordable Care Act鈥檚听听frequently call for scaling back the existing requirements on mental health insurance, because, they say, such mandates tend to drive up insurance premiums. They are probably right about that, although untreated mental illness can lead to future health problems, both mental and physical, that can be expensive to treat.
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