Poverty & Mental Illness

By: Brin Bailey, Elise Quam, Matt Roesler

Wherever You Live, Wherever You Work: The Social Determinants of Mental Health

Poverty is bad for your mental health

Those living below the poverty line are three times more likely to have serious psychological distress as compared to those living above the poverty level.
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39% of those who are homeless report some form of mental health issue

66% report either substance abuse and/or mental health problems

Money is the #1 reason given as to why adults in America do not receive proper mental health services

The Barriers to Accessing Care

  • Individuals who are diagnosed with an SPMI may face marginalization, lack of education and social exclusion
  • Unemployment rate for individuals with SPMI= 73-93%
  • Unemployment=reduced access to health care
  • Limited access to health care=Medicaid, uninsured, or public aid
  • Medicaid/Public Aid=limitations on providers, medications and available appointments
  • Public aid often limits accessibility to mental health care
  • Social Stressors=reduced quality of health
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Impacts to Quality

  • Barriers to access impact the quality of care
  • Chronic stress impacts ability to achieve quality care
  • "Transient" population- difficult to have consistent care

Living Situations

  • "The homeless population appears to have diminished networks of social relations, poor health, and high levels of contact with the criminal justice system, relative to the general population”
  • ”New Freedom Commission on Mental Health develops initiatives to collaborate treatment models for homeless individuals, and promotion of evidence based guidelines in clinical practice for medication management, community treatment, illness management, family psychoeducation, employment support, and dual diagnosis treatment.”
  • Rates of poor people with a mental illness was much lower than those who were homeless.


  • Co-occurring disorders
  • Severe and persistent mental illness
  • Many not appropriately diagnosed


  • Harm Reduction - "Housing First" and "Consumer Choice"
  • Must address co-occurring disorders
  • Hard to achieve treatment objects when experiencing chronic stress
  • Providers should focus on promoting safety and security

Legal System

Why are poor people disproportionately involved in the legal system?

  • Commit crimes to survive.
  • Unable to afford legal help.
  • Unable to afford medications.
  • Often live in high crime areas.
  • Find safety in jail.

Mental Health Concerns in Jails/Prisons

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State prisoners who had a mental health disorder, were twice as likely as those without, to have been homeless prior to their arrest (James & Glaze, 2006).

Corrections Budgets

Corrections budgets devote very little attention to mental health concerns of inmates.

California Corrections & Rehabilitations Department devotes 3% of its budget to mental health (California Department of Corrections, 2015). This includes training costs of its correction officers.

Cops Dealing with Mental Health

  • Most patrol officers are expected to train in many topics but many receive little to no training in dealing with people suffering from mental health disorders.
  • Until they learn otherwise, cops assume every person they encounter wants to harm them.

Poverty/Mental Health/Hosptials

Troubling Cycle

  • People suffering from mental illness enter hospitals voluntarily.
  • They often are given diagnosis that allows continued medical treatment.
  • They turn from voluntary to involuntary.
  • Often receive troubling prognosis and fall victim to secondary deviance (Rooney, 2009)

"When people are mentally ill, they are at increased risk of becoming and/or staying poor. They have higher health costs, difficulty getting and/or retaining jobs, are less productive at work, and suffer the social stigma and isolation of mental health" (Hudson, 2005).

Connection between sociology, poverty and health.

The best predictor of overall health and longevity is often the zip code (Ward, 2015).

  • Some poor can't afford physical needs
  • Poverty influences choices - More poor people are sedentary, obese, smoke and have high blood pressure.
  • Typically live in bad neighborhoods
  • Stress causes dangerous hormones.


California Department of Corrections. (2015). CDCR’s Budget for Fiscal Year 2014-2015. Retrieved April 29, 2015, from California Department of Corrections and Rehabilitation : http://www.cdcr.ca.gov/Budget/Budget_Overview.html

El-Mallakh, P. (n.d.). Doing My Best: Poverty and Self-Care Among Individuals With Schizophrenia and Diabetes Mellitus. Archives of Psychiatric Nursing, 49-60.

Fischer, P., & Breakey, W. (n.d.). The Epidemiology Of Alcohol, Drug, And Mental Disorders Among Homeless Persons. American Psychologist, 1115-1128.

Gulcur, L., Nakae, M., & Tsemberis, S. (2004). Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health, 94, 4, 651-656.

Hudson, C. G. (2005). Socioeconomic status and mental illness: tests of the social causation and selection hypotheses. The American Journal of Orthopsychiatry, 75(1), 3–18. doi:10.1037/0002-9432.75.1.3

Huntley, S. (2014). A comparison of substance abuse severity among homeless and non-homeless adults. Journal of Human Behavior in the Social Environment, 25, 3, 312-321.

James, D. J., & Glaze, L. E. (2006). Mental Health Problems of Prison and Jail Inmates. Bureau of Justice Statistics Special Report. Retrieved from http://www.bjs.gov/content/pub/pdf/mhppji.pdf

Rooney, R. (Ed.). (2009). Strategies for Work with Involuntary Clients (2nd ed.). Columbia University Press.

Ward MD, Ed. (2015). Health is Socially Determined. University of Minnesota - SW 8804 Class Presentation on February 18, 2015