A mental health revolution: Addressing childhood poverty

Let's rethink what can have the most impact on our mental health

When was the last time you visited a mental health clinician? A mental health center? What did you do when you or a loved one needed help? Who did you call? Where did you go?

These questions, as hard as they may be to answer, help provide a clear picture as to some of the problems we face as a society when tackling mental health. The truth of it is that most of us haven’t sought care or known where to go when we or someone close to us needs help. We sometimes wait until it is too late because that’s easier than confronting the challenges of navigating an overly complex and intimidating system.

In a world that has taught us to overly tend to our physical health, we find ourselves standing, perhaps unsurprisingly, on the edge of a global epidemic, our mental health. This cornerstone of our well-being, remains trapped in a labyrinth of archaic design. As we marvel at the advancements of modern medicine, we must also confront an uncomfortable truth: our mental health care system, an antiquated relic of a bygone era, is ill-equipped to handle the complex challenges of our time. It’s design is incapable of meeting us where we are today.

But when we back away from the flaws in the structures, the designs and how they fail us, we see novel ways by which we might be able to better impact on mental health. Ways to impact it outside the traditional system.

In a meeting this past week, a friend and colleague, Dr. Gary Belkin, had a slide that reminded me of the importance of something we rarely talk about in the context of mental health - poverty. He was referencing the child tax credit and how important it was for communities.

If you are not familiar with the child tax credit, it’s a crucial federal program that offers financial assistance to families with qualifying children, providing up to $2,000 per child under 17 as of 2021, with income-based phase-outs. However, for tax year 2021, the American Rescue Plan Act temporarily boosted the credit to $3,000-$3,600 per child, making it fully refundable, and introduced advance monthly payments, offering immediate relief. Talk about a major life saver! Eligibility for the tax credit is based on factors like the child's age, citizenship status, and income.

But sadly, like many good programs, this one too ended.

The good and bad thing about time is that it allows us to get a better sense of the impact of our decisions. It’s been over a year since the child tax credit expired, and it’s had an impact on families everywhere. One survey found that sixty percent of families who had received these monthly payments described an increased difficulty meeting their expenses once the payments stopped. These families also reported increased financial stress and difficulty affording other goods for their children and household.

Poverty has a pernicious effect on our mental health. Studies consistently reveal a strong correlation between income disparities and the mental health and well-being of communities. The data paints a clear picture: as income inequality rises, so do rates of mental health, including depression and even psychosis. This connection persists even after considering various other factors. Additionally, suicide rates, especially among young men, tend to increase in societies marked by income inequality. Children from lower-income backgrounds often bear the brunt of these disparities, experiencing higher rates of mental disorders.

So yeah, our financial security matters a lot.

Dr. Tom Insel said about his time running the National Institute of Mental Health (NIMH) that he “Spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.”

What Dr. Insel is pointing at are some of these crucial factors that we often give much less weight to in our health policy discussions on mental health. I don’t think we need another reminder of the critical need to transcend our way away from an overly reductionist view of the human mind—one that erroneously confines it to a mere neural network. To really underscore the point, while we saw profound advances in the science of our brain in during the “decade of the brain,” we also saw some of the most significant jumps in mortality for people with mental illness. When you only focus on one piece of the problem you never truly get a solution that works as well as you want.

And he’s right - we’ve put a lot of money into better understanding mental health but it simply hasn’t been enough to meet us in this moment. A moment, I don’t need to remind any of you, we are still in. Looking at how much we spend in this country on health care, and mental health, one might be lulled into thinking that more money is going to solve our problem. Hint: we spend more on mental health than any other country and we aren’t any better on outcomes. But then you consider the data on the impact on families from the expiration of this child tax credit and all of the sudden new priorities emerge.

According to NPR, “…A year ago, child poverty hit a historic low of 5.2%. The latest figures [a year after the child tax credits expired] put it at 12.4%, the same as the overall poverty rate. The surge happened as record inflation was rising and a lot of pandemic relief was running out, but Census officials and other experts say a key was the child tax credit.” Think on this, my friends. Of the 74 million children living in the US, 11 million live in poverty.

The deeply entrenched maladaptive psychological patterns, from the suffocating grip of depression and anxiety to the insidious allure of addictive behaviors, the labyrinthine struggles with concentration and performance, the complex dance of identity and relationships, and the haunting echoes of trauma are not, and have never been, the result of a simple brain malfunction or elusive chemical imbalance. No, these facets of human existence are not to be 'cured' with a prescription pad. Our solutions have to go deeper. While the brain may play a role in mediating our psychological behaviors, it is a grave mistake to reduce the profound complexities of the human experience to mere neuronal firings. It's high time we redirected our gaze; for far too long, we've been searching for answers in all the wrong places.

Poverty seems like an ideal place to start.

When you begin to move away our traditional structures like clinics and more money for these clinics, you liberate yourself to new options. And in fact, there may be no better way to improve the mental health of our communities than to tackle things like poverty. Eradicating poverty isn't just a matter of charity; it's a radical act of self-interest for society's mental health. Poverty doesn't just strain wallets; it’s a relentless corrosion our psyche. The constant stress, anxiety, and despair that accompany financial instability aren't merely emotional burdens; they're a ticking time bomb for bigger mental health problems. If you can’t afford your home, there’s a high likelihood you can’t afford care either.

Limited access to mental health services, often compounds the problem, leaving too many people looking for help, often in the wrong places. The cycle of poverty isn't just a trap; it's a crucible for mental anguish, forcing people into environments where hopelessness often grows. By boldly confronting poverty, we're not just extending a helping hand; we're investing in a society where minds can flourish, unburdened by the relentless weight of need. It's a call to action that doesn't just help our mental health; it revitalizes the very soul of our communities, which can be healing for all. That would be revolutionary, wouldn’t it?