 Poverty
and Children's Mental Health
The poverty rate in the United States is among the highest in developing
countries, and it is especially high for families with young children.
Indeed, of all age groups, children aged 0 to 5 years are at highest
risk of living in poverty. It is increasingly likely that poor children
will live in families with working parents. Census Bureau figures
indicate that only 22% of poor families with children reported receiving
cash public assistance in 2001*.
In fact, as poor families work more and increase their earnings,
it appears that their net economic resources actually decrease as
their costs increase and they lose eligibility for various forms
of support, such as food stamps, public health insurance, and the
earned income tax credit.**
The nature of poverty in the United States is an important issue
in the context of children's mental health, as it has been well
documented that children from poor families are more likely than
their better-off counterparts to suffer from emotional and behavioral
disorders. However, researchers and advocates have long debated
what causes this association between poverty and mental health difficulties
in children. On one hand, it has been argued that the stress and
adversity associated with poverty are a primary cause of children's
difficulties. On the other hand, it is possible that other factors,
particularly family and community characteristics, cause both poverty
and mental health difficulties. The associations between poverty
and children's mental health are very complex, with children living
in poverty less likely to attend good quality schools, less likely
to have access to adequate health and mental health care, and more
likely to live in violent neighborhoods. Parents working at low-wage
jobs, especially single parents, must work long hours to earn enough
to support the family, leaving children without adult supervision.
A recent
study published in the Journal of the American Medical Association
(JAMA) provides some new information relevant to this debate.
The study describes a natural experiment in poverty reduction that
occurred when a casino opened on an American Indian reservation.
American Indians on the reservation began receiving an income supplement
derived from the casino's operations, with the result that some
families that had been poor moved out of poverty. Among children
who moved out of poverty, psychiatric symptoms of conduct and oppositional
defiant disorders (but not symptoms of anxiety and depression) decreased
to the levels found among peers who were never poor, while there
was no reduction of symptoms among children who remained poor. The
study thus provides support for the ideas that the conditions of
poverty can cause certain mental health disorders and that alleviating
poverty can have positive effects on children's mental health.
What are your opinions or observations about possible links between
poverty and mental health? We look forward to a lively discussion
that might include your thoughts regarding:
- the implications of the
JAMA article,
- the effects of poverty on communities and families,
- other studies or data that provide insight into this issue,
and/or
- personal experience that bears on this issue.
We look forward to hearing from you.
Janet S. Walker,
Web editor
Your thoughts…
Comments:
 My best friends book is a must and Poverty and Children's Mental Health is very important! Posted Tuesday, January 22, 2008 by truehopeglen at 04:24 PM
We understand that health insurance can be very confusing; the terms can be difficult to understand and the forms intimidating. WBR LeoP Posted Saturday, January 20, 2007 at 02:44 PM
The problem of reception Medical and health insurance for unemployeds interests WBR LeoP Posted Saturday, January 20, 2007 at 01:35 PM
I would like to respond to the comments above by the school nurse. AMEN! to calling the mental health system what it is: CORRUPT! I am a licensed therapist and I have been appalled at the greed and corruption in the mental health system, so much so that I am ashamed to be associated with such disgrace. And even worse, the governing powers - state officials or state watchdogs tend to turn a blind eye. It is so rampant that it is horrifying. Posted Wednesday, January 10, 2007 at 01:16 PM
13. What's happening to foster kids today? You get put into foster care and you basically get a diagnosis of mental illness. In one study, 80 percent of the kids in foster care were being medicated with antidepressants, Ritalin and antipsychotics. In this country, we're almost getting to where being poor, or coming from a broken family where you have to be placed in foster care, means
you're therefore mentally ill. From ROBERT WHITAKER, Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill,_ 2002)*******************
Can I ask what you meant by this John, being poor and coming from a broken family should not even begin to mean a child should be put in foster care. We pay millions of people to take care of these kids and psychiatrize them even foster parents get paid, and yet we can't make sure a family has enough of the basics to survive on decently there is some thing wrong with that in my eyes! Give families half the money that we pay these others and for all the treatments and drugs and I bet that many of these families could and actually would become self sufficient some place along the way! Janie************************
I was sharing this quote from Whitaker because it makes a strong point that we pathologize chidlren who are having a hard time, rather than facing issues of community and social justice. John*****************************
It is just so rediculous to me how many people will put the money in their own pockets by way of grants and pay checks and supplements and then when a poor person ask for help act like the person is taking it right out of their
pocket. Our systems are wrong and they hurt people, and to many of them. We give big business tax breaks for hiring people they make into slaves, some times without medical benefits, taking children who are loved out of the homes of
their parents, and then co-opting people into doing this stuff to others by calling it jobs and benefits. Then we wonder why we still have some people that are not doing any better in life and why life isn't getting better for so many and why so many are being done the way they are by psychiatry, adults and children alike. No one understands that poor people are being oppressed and not poor by choice or because they are lazy. It is not a choice to have to live like most poor people have to live, it is what they have to do to survive! Janie***************
If we really care to stop suicide we will start to change things that cause it in the first place like: stop all the high stress we put on kids and familes, remember that kids can't be in some sort of doctors; counselors; principals;
mental health; office and in a classroom at the same time and parents can't be with a kid and working at a job at the same time most of the time, the false and anonymous abuse system is out of control and used a lot of times for the wrong reasons and so that is a big reason a lot of our children are; abuse is never acceptable but that means real and actual abuse not perceptions of what is abusive based on common sense instead of the prison population, bullying is never acceptable and never the fault of the one being bullied and must be stopped, stop ripping kids away from their families in the first place, meet
real educational; physical; and social needs, teach better communications and coping skills as a general habit, get to know children and their families as people and not those people that are a part of that system, don't make them afraid to get to know the system or afraid to ask for what they need, let them know that they can get the help they really need and ask for and only that exact help, give kids the benefit of the doubt rather then seeing them as trouble makers or liars, see real needs and only real needs and address them, give each and every one of our kids
something to feel proud of themselves about, do not segregate by systemitizing some of our children, appreciate all childrens gifts and talents not just the
so called gifted and talented even the ones who have areas of concerns, keep kids from failing by asking them what they really want and need to succeed, help kids learn to accept others and make real friends, give the schools back to the children and the families that must use them, never expect any more from any one then we do ourselves if some
thing is unrealistic for us or we had problems with it then chances are that others will too, we need to think about how we would want to be treated if it was us or what we needed to help us through difficult things, stop making every thing so called "normal" and appreciate differences in all people. Thank you! Janie Lee
http://home.earthlink.net/~people-of-courage/
Posted Sunday, December 11, 2005 at 07:25 PM
"As a school nurse I deal with students on a daily basis who have many different mental health issues." Do you realize that this so called mental health treatment is for sale and being marketed to these kids and their families by your good school system and community in this very way? Believe me the poor are not the ones getting rich off of this it is the corrupt mental health business at the expense of these children. It is peoples way of living at the expense of these kids telling you and others that they are doing them a favor. This is in fact a billion dollar business. "For the most part these students come from poor families." Is that a reason to take advantage of them? We have a system which keeps people remaining at the poverty level so that they can never get ahead let them try and see how fast what they do to get ahead is snatched away from them...it is true there is no incentive for these people to rise above...but it is not because they are going for the free ride...free medical care, free medicine, food, free childcare, the welfare checks, free housing, the list goes on and on. Yes these things are given, but the problem is that once a family starts to get a little more then they should have and still not enough to get out of these traps some benefit will be cut or taken away from them so that they can not get out. This means that they can not usually get ahead enough to actually ever become self sufficient and start giving back that is not fair. It is pervasive in our society, that people like you and others believe that people are asking for to much and oppressing the ones that want to get out so that they can't. I do not believe children are taught how to work the system, but rather get stuck in it by the fact that they are not the wealthy children whose families have influential friends. They grow up believing that they can not get ahead as their parents incomes are taken to pay the ones working against them saying they are there to help them are living off the sweat of their parents hard earned incomes a lot of times. Businesses that should provide health care do not. A lot of it rest in perceptions of what work is and what getting paid is and who actually is paying them. The wealthy believe they are "entitiled" to make a living off the sweat of the poor and the psychiatric system takes advantage of it to do business. The mental health issues in the children I see are many and varied. You are a psychiatric dealer! Your business is to psychiatrize children and families to stay in business. I often feel as though I am fighting a losing battle trying to deal with people like you. The children have learned to expect the help we provide, what help is that? To judge them and oppress them and keep them down? It is true there is no free school, no free lunch, no free government programs the poor people pay for it with their souls. They have people in the systems that would say just exactly what you are saying here, "whether it be feeding them because they come to school hungry, or buying clothes for them because they have worn the same ones for two weeks , or paying for special field trips, providing food for holidays and gifts under the tree, the list is endless" With an attitude like this about these people what gives you a right to even work with them? Get another job that you would be more decently suited to. "I will continue to help the young people that come to my office for help with their problems" I sure am with that other girl and wish you wouldn't, but then you would not get paid for what you so called do to help these children do you? It is said that we have people employeed in the systems, being paid for by poor peoples taxes and who have the ideas you do. You actually make me sick, but it is not a mental illness it is oppression and traps set by psychiatry and the psycho-social-court systems that keep so many people trapped! Thanks!
Posted Sunday, December 11, 2005 at 02:27 PM
I think that families with more economic resources are more likely to get treatment for their children at an earlier age and thus the children are not as likely to present with issues as they grow older.
Children who live in poverty have much more things to deal with emotionally, they also have the added stress of finding food, clothing, and shelter. They are also less likely to received appropriate medical care and mental health care early when it counts most.
I am a single mother and am considered to be living in poverty. When my son started having behavioral problems at the age of 18 months doctors told me it was because he was a boy and because we were poor (more stress on me and my children). It ends up that he is autistic. It took 5 years to get him properly evaluated. My friend who is well off and carries private insurance got her son evaluated at 18 months when he showed the signs and symptoms. He as a result got early intervention and is doing much better now at a later age.
Money gets you results. Posted Saturday, August 27, 2005 by ASD at 03:36 PM
I wonder whether the people conducting this research focused on other aspects of these youths lives in addition to poverty. I do believe that poverty and mental illness have a relationship, but how extensive is that relationship? Do other factors determine the effect that poverty has on mental illness? It seems as though there is a HUGE amount of bias here and there is no control group. There was no mention in there of the families' situations or African-Americans, Hispanic-Americans, Asian-Americans and their sturuggle with mental illness and poverty. This study really can not be used as an all-inclusive study to support the relationship between mental illness and poverty. It seems as though these people focused on what would work well for the outcome they would like to receive. As for the nurse who believes that people receiving assistance enjoy receiving free things and have no motivation to do otherwise, you need to do your research. Get out and actually speak with people on assistance in all different areas, races, and cultures. Then, let us know what you find. While I myself have not received assistance, I know many people including my mother who had to receive it due to an unfortunate situation and managed to rise above the system. My mother did rise above those challenges, graduate from college and become a senior level manager. Had she never had that assistance, she may not have been able to make it, considering the fact that she had twins at the age of 23 and had to leave her husband because he was abusive. I know another person who grew up on welfare her entire life and she did not want to be like her mother, on welfare, raising 3 children. She wanted something better for herself. She did go to college, but unfortunately, she got into an abusive relationship and did end up in the same situation as her mother. However, she decided that she would not stay there and is now working for a hospital, making good money, and raising her three sons. If we are going to look at people on welfare in this manner, we can compare the people on assistance for extended amounts of time to the doctors that don't really love to help people, but they love the money that they are making in their profession. What is the difference? They are not on the "system", but the ethical assumption is still the same. They are just trying to get by. Or what about CORPORATE WELFARE where people get things just becase of their name or who they know. Is this any better than these people who need assistance for whatever length of time, so they can raise their families? I am EXTREMELY glad that you were not my school nurse because anyone who is that ignorant should not be filling youth with such ignorance. You know what? I believe that IGNORANCE may have an effect on poverty and mental illness. What do you think about that? Posted Tuesday, December 7, 2004 by MAC at 11:45 AM
I come from a lower middle-class, "Leave It To Beaver" type of family. Not a lot of money, but it was never an issue, at least as far as we kids were concerned. I spent time as an adult where I had to sell my blood to get money for food, but that did not last too long. I have my share of "issues", but nothing psychological.
Howeever, I have a friend from Guatemala who grew up in abject poverty. She suffers from many problems that I can see as related to her childhood, including fear/resentment of authority, irrational jealousy and a "martyr" type attitude towards money (or the lack of it).
It never occured to me before, but mi amiga has made me realize that this is a serious problem and yet another reason to be concerned about childhood poverty. Posted Monday, November 22, 2004 at 02:35 PM
In response to the last posting: I am from an upper middle class home, and as an adolescent and young adult, I experienced fairly serious mental health difficulties. And yes, my family's affluence did help me get past all that to the point where I have a pretty normal adult life, family, job, etc. I never received help from public services (so probably was never "counted" officially in statistics), but did have psychotherapy paid for by my parents and, to a lesser extent, their insurance. Had I been less well off, I don't think the worst consequences would have been directly from the symptoms of my illness, but more because I only functioned about half way for about 10 years. With money, functioning half way can actually look OK and you can at least tread water until you are ready to resume life. If you have no resources, functioning half way puts you on a downward slide and I can see how things can easily get worse and worse, and you get into a hole that you may never get out of. I think a lot about how easy my life is--despite my struggles with mental illness--compared to people who have fewer resources, for whom there is not the potential out there to pick up a middle class lifestyle whenever they are able. Surviving on the edge of economic uncertainty is precarious and difficult even for people who don't have mental health issues. Posted Wednesday, September 22, 2004 by pretty well recovered and grat at 08:02 AM
I certainly agree with most of the above well thought out statements. Thinking about this subject leads me to wonder if many children in affleuent families are not identified as having emotional, behavioral and mental health needs because their family circumstances make it possible to hide and deny the pain and challenge these children experience. Are we sometimes more lenient about behavior because we don't expect disorders and rather call them "problems" when a child who is acting out comes from a economically priveledged family? The growing deparity between the rich and the poor would only exasperate these ways society protects the wealty from the stigma of mental illness. I think it is important that when we identify a relationship between mental illness and poverty, we guard against judging the poor as weaker, more pathological, and ultimately "less human". We are not so far from widespead belief in "eugenics". There are wealthy people in our world today who seek justification for thier priveledge. Posted Tuesday, May 4, 2004 at 07:58 PM
The more I hear about the poverty issue and children's mental health, the more I feel it is a key issue. Posted Friday, April 30, 2004 at 01:06 PM
Depression and anxiety are often referred to as internalizing problems, while ODD, ADHD, CD are referred to as externalizing. In my 30 yrs. clinical experience, there are often multiple biopsychosocial(spiritual) determinents of serious, persisting, recurrent, behavioral health d/o's. No doubt that poverty, that often is transgenerational, is a serious & persisting psychosocial stressor.
When distressed, we know that F's tend to internalize; while M's tend to externalize by acting out.
In a country that is seen as having an abundance of resources, the high rate of poverty here is unacceptable. The remedies are many and the problem is deeply embedded systemically. As the JAMA investigation shows, intervention results in some positive impact. Posted Friday, April 23, 2004 by R Kensinger, LSW, ACSW at 08:24 AM
Well I don't see how you can say that there is too much focus on poverty as a cause of mental illness. Mostly I think people think it's caused by bad parenting and maybe biology. I don't think people at all consider how hard it is and how stressful to have little money, and how that can really trigger mental health issues for kids and adults. Posted Friday, April 2, 2004 at 10:10 AM
While I think there is good evidence that poverty exacerbates certain symptoms of mental illness, it also seems clear that a child's mental illness can cause or contribute substantially to family impovrishment. One route is that mentioned in the previous post-- the mother had to leave employment to care for her child, and lost out financially. Another reason for this appears to be the breakup of marriages/partnerships that are disproportionate among families of kids with disabilities generally, and may be even more so among families with kids with emotional/behavioral difficulties. Kids usually end up with their mothers who, now single, have fewer resources to use to meet the challenges they face. Posted Friday, April 2, 2004 at 10:07 AM
There seems to be an unproportional degree of focus on the concept of poverty as the cause for mental ailments. In my case, I am a single parent of two children, one diagnosed on the Autistic Spectrum. This diagnosis was arrived at only after years of incorrect diagnoses of ODD, ADHD and Bipolar Disorder. During those years my child would probably have qualified for the study. Due to my son's neurological condition and the resulting behaviors, I have been unable to find anyone who can appropriately care for him in my absence. Even the so called "professionals" have failed miserably in this respect. I have been forced to resort to homeschooling for this reason. If there was someone who could appropriately care for my ASD child in my absence, I would not be stuck in poverty as I am today (due to the inability to attain adequate care). You can speculate and you can derive but until you have lived in this type of situation you could never understand. You need to consider all of the possibilities before attributing this correlation to a single relationship where poverty is the direct cause and mental illness the result. I am certain that it goes both ways. I would even be willing to bet that if you dig a bit deeper you will find that mental or neurological illnesses/disorders are most often the cause of poverty rather than poverty being the cause of the ailment. Certainly having adequate income to obtain the needed supports is helpful to the mental health of both the child and his or her family. However, among the more serious ailments, the ailment as the cause of poverty will likely be observed with an even greater frequency than poverty as the cause of the ailment. I propose that an experiment be designed to test this theory. The results may not only prove to be interesting, but perhaps useful as well. Posted Saturday, March 27, 2004 at 07:33 PM
I have two grown, formerly bipolar children who are well using only the new vitamin-mineral supplement, EMPower Plus, developed here in my home province of Alberta, Canada (See www.truehope.com). This nutrient mixture has now been researched at Harvard, among other places, with great results.
These exciting research results led me to also give this nutrient to my two younger children still at home, at a lower dose. Hurrah - it curbs their temper tantrums and makes the little guy, 9 years old, much less "hyperactive". But here's the kicker - I have to pay for it myself.No insurance or health care plan will pay for it (yet).
Perhaps poverty is also associated with malnutrition, and thus nutrient deficiency -- leading to mental illness. I realize this thought is a major paradigm shift, but so was finding out that the world was round.
Posted Saturday, March 27, 2004 by Jackie, award-winning health e at 02:07 PM
I noticed in the summary of the JAMA article that symptoms of conduct disorder and ODD improved, thought symptoms of anxiety and depression did not. I have been wondering more generally about the responsiveness of different types of disorders to "treatment" (including, in this case, a poverty reduction "treatment"). In particular, I am wondering if conduct problems have a larger component of environmental impact as a cause (i.e. family, community, peer group stress and/or dysfuncion) versus other sorts of disorders that might have a stronger biological basis and be (even) more difficult to treat. Does anyone know about this? Posted Saturday, March 20, 2004 at 07:54 AM
I recommend that people take a look at the link to the national center for children in poverty (I got this by clicking on the two asterisks at the end of the first paragraph at the top of the page). This provides an example of how hard it is for a family to meet their costs when they try to make it by working, but then lose access to health insurance, food stamps, and various tax credits. They need to earn $38,000 to be as well off as they are with no income. I understand the resentment of people who see the poor getting benefits (at the same time when benefits like health insurance and pensions are being cut for those of us in the middle class), but is the answer to cut poor people off? At minimum wage or probably even double minimum wage, you can't afford health insurance. What does the nurse suggest? Should we just let people suffer? And not provide food stamps so they'll be starving? I agree with the other post that a humane society would offer a reasonable standard of living to anyone who is willing to work. Posted Friday, March 19, 2004 at 09:44 AM
I disagree with your proposition that people want to remain poor because it is a free ride. THis is less true than in the past, and may never have been true of many people in the first place. A growing number of poor people work, and many poor children live in families with two working parents. The disincentive isn't that poverty/dependency looks so good, it's that working looks so bad. You can work full time and the minimum wage and not make enought to even begin to make ends meet, much less have resources needed when the inevitable crisis occurs (car breaks down, illness in the family, etc.) I see the sickness in our society arising from the fact that the rich have 'way too much and that many of the poor can't even aspire to a decent standard of life, even when they try hard. Of course, even with supports and incentives, there will be some people who won't be very motivated to work, or who will for some reason be unable to. But this is not confined to poor people-- if you look at any middle class family you'll usually find at least one person who is not making it on his or her own, but is being carried by others-- this just isn't an option for poor people. Posted Friday, March 19, 2004 by a psychologist at 09:24 AM
Yes, I agree with the link between mental health and
poverty. As a school nurse I deal with students on a
daily basis who have many different mental health
issues. For the most part these students come from
poor families. One of the biggest contributing factors as
I see it is..... we have a system which rewards people
(generation to generation) to remain at the poverty
level.... there is no incentive for these people to rise
above... they are basically going for the free ride... free
medical care, free medicine, food, free childcare, the
welfare checks, free housing, the list goes on and on...
It is pervasive in our society. Children are taught at a
very young age how to work the system... it becomes
their "norm"... they grow up believing that the rest of us
who do work, pay taxes etc... that, we owe them.... they
believe they are "entitiled" to these things.... it is afterall
their "norm" , their "world". The mental health issues in
the children I see are many and varied. Depression,
anger management, suicidal students, risky behaviors
(including drugs and alcohol), sexual promiscuity , low
self esteem, however the most prevalent of all is the
student who is so emotionally disrupted due to family
dysfunction .... I often feel as though I am fighting a
losing battle. The children have learned to expect the
help we provide....., whether it be feeding them because
they come to school hungry, or buying clothes for them
because they have worn the same ones for two weeks ,
or paying for special field trips, providing food for
holidays and gifts under the tree, the list is endless...
It is so sad to watch as these innocent children
become a part of the vicious cycle....
So.... what is the answer......., the problem and the
origins of the problem is sooooo layered..... the
answers will be just as complicated...... I will continue t
to help the young people that come to my office for help
with their problems....I can unfortunately, only provide
them with a "short term fix"..... Posted Thursday, March 18, 2004 at 09:49 AM
The difference between those moved out of poverty stricken area and those remained was motivation plus a strong faith/confidence that things would change. Those that remain probably did not think they could make it outside of the familiar environment. What we need to study is how to instill confidence and faith in the self and factors to maintain/strengthen it. Posted Thursday, March 18, 2004 by Social worker - ef at 09:31 AM
Economic conditions during the 1990s provided a period of good times that helped hide increasing income disparities, stagnation of real wages for most workers, and increased poverty among lower-paid workers. With that bubble bursting, we are again seeing rising poverty for children and for working families, as well as ever-increasing divergence between the economic fate of the better off members of our society and middle- to low-income folks. I believe that harder economic times will force us to take a careful look at our society and to puncture the illusion of self-satisfaction that we as a people seem to maintain. We live in a "free" society in which we imprison more people than any other developed nation, and possibly any other nation, period. Our income disparities are larger than virtually anywhere, and among developed nations, we have relatively astronomical levels of poverty and hunger. Are we actually pushing people down and stressing them out (with resulting social problems including mental health and substance abuse) quicker than we can improve how we "fix" them? It is ironic to me that many of the "new" approaches in mental health, those that recognize the need for community supports, recreation opportunities, respite, transportation, are actually efforts to provide some of the basics that people could purchase if they weren't so poor, or could have access too if "public" resources (funding for schools, parks, and recreational opportunities; clean air and water; access to transportation) weren't increasingly being underfunded or even fenced off, monopolized, or redirected to the use of more affluent people. Posted Wednesday, March 17, 2004 at 11:21 AM
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