ICBioethics Blog 

Mental Illness, Poverty and Children

Written by: Barbara Postol

We hear bits and pieces on the evening news about how mental health care needs to be given more attention, clearly it does. General health in itself is not an even distribution across socioeconomic statuses. People who are poor and have lower education or job status experience poorer health and die before their more well-suited counterparts.

The association between poverty and mental illness has long been established. Since the 1930s epidemiological studies have reported the highest rates of mental illnesses as occurring in lower income populations. In itself, poverty and its associated variables is an extensive topic. The World Health Organization reports that no group of people is immune to mental illness, but the risk is higher for the poor, homeless, unemployed and those who have low education.

The effects of poverty and mental health seem to be most observable among children. This may be especially important as problems that begin in childhood can have lasting impairments into adulthood, which could lead to a higher cost for society. For example, it is estimated that the prevention of a case of conduct disorder (which is marked by externalizing behaviors such as vandalism, lying, and stealing) is estimated to save 1.7 million dollars in lifetime associated costs. Children living in poverty are three times more likely to experience mental health problems than children who do not live in poverty.

Childhood poverty is also associated with long-term poverty into adulthood. Parental education levels and families who receive social assistance are also factors that contribute to a prevalence of mental illness.  There are many other factors which positively or negatively affect the prevalence of mental health problems including parental nurturance, discipline; maternal psychological status, and coping strategies; however, poverty diminishes buffers against many of these factors. Children are more likely to be funneled through other systems (juvenile justice, school, or family counseling) than receive treatments from an HMO.

Children are twice as likely to be hospitalized for mental illness; however hospitalization requires that children have to become a threat to themselves or others. Moderate cases of mental illness are unfortunately often not treated until they become serious. In this capacity, managed care lets too many poor children fall through the cracks. Many children in the welfare system depend on Medicaid to provide for their extensive mental health needs. Children began to be enrolled into Medicaid starting in the 1980s and into Medicaid managed care plans since then. Medicaid offers a focus on prevention, coordination of care, and reduction of emergency department use — all of which are beneficial. Yet, many children in the Medicaid system require a great deal of services. Many plans operate on a capitation service and are not reimbursed for expensive health needs. Therefore, a strong incentive to control health service use exists.

There is much finger pointing and blame when it comes to topics like poverty in US politics, but children are innocent and they are falling through the cracks. Mental health care to one of the most vulnerable populations, poor children, is being grossly underserved in one of the greatest nations in the world, which is an undeniable fact.

Mitch GennusoComment