Featured Discussion

Should low-income mothers receive mental health treatment?

Low-income mothers have high rates of emotional distress, but low rates of mental health service use. To explain this, research often points to external barriers: such as lack of insurance and transportation issues. However, an article in the latest edition of Focal Point suggests otherwise. It posits that the acceptability of the treatment available, rather than concrete barriers, is the primary reason as to why low income mothers do not get the mental health care they need. Treatment acceptability is the extent to which recipients of care perceive that the care they are receiving is reasonable and fair. In other words, it is not enough to make care accessible; it also has to be relevant to the consumer.

According to the article, low income mothers believe that their distress would be relieved by improvements in their life circumstances, not through counseling or medication. One mother is quoted as saying: “It was recommended that [I] go get counseling. …And that, like in itself, … in no way, shape, or form addresses the situation. I joked with my friend, I said, you know, that really irritated me. If they really want to make a difference here, throw $10,000 at me” (p. 935). These women viewed their depression and anxiety as natural responses to a difficult life, not as conditions that counseling would be able to improve.

Read the rest of the article online and join the discussion!

Questions:

• Do you believe that the primary causes of low-income mothers’ distress are external factors rather than mental illness?
  
• What might be the best way to support low-income mothers with mental health conditions?
  
• Have you had particular troubles or successes in engaging low-income women in treatment? What has or has not worked for your organization?
• Which do you believe is the most effective way to support a low-income mother with depression – to provide her with medication or to “throw $10,000” at her?
• Do you think that money and related economic factors are truly the cause of depression and anxiety in many individuals? Do you think that, without treatment, those mental health conditions would disappear if these women were simply given money?
• Can you think of any instances, in your experience, in which low-income fathers have experienced the same mental health challenges?

Your thoughts…

Comments:

The primary cause of low-income mothers? distress is mental illness caused by external factors and opression. Many poor families are happy when they don't feel opressed. The US culture is such that being low income places you in a position in comparison to the median income families that eventually leads to Mental Illness.

The best way to support low-income mothers with mental health conditions is to treat them with dignity and respect, findout what specific needs they have, recognize what we can do as professionals and how we can them connect them with resources. I cannot tell you how many times I talked to a single mother who felt therapy was not going to do any good but after a few weeks of treatment they realized that I truely care to help them. Cultural sensitivity and cultural humility need to be part of treatment especially when working with this population.

Successes in engaging low-income women in treatment did not occure automatically. I had to do extensive introspection and truely commit to helping them. I never felt sorry for them because they taught me that pitty does not help. I felt they benefited from honesty and genuiness. Treatment was alwasy shaped by the uniqueness of each client. What has worked for the organization I used to work for was recruit and train clinicians who had a philosophy of Cultural Humility.
From the 2 choices you provide that could prove to be the most effective way to support a low-income mother with depression ? to provide her with medication or to ?throw $10,000? at her. I would have to say it depends. In part this is the problem. Your questions are linear and simplistic. The problem is more complex than that.
Money and related economic factors are factors that worsen depression and anxiety in many individuals but they, alone, are not the cause. The cause is a feeling of hopeless that we as a profession are failing to transmit through are treatment. If the mental health condition is situational maybe would disappear if these women were simply given money, but the reality is much more complex and demanding. The mental health field is very paternalisitic and this is gradually changing. Money is not the solution but having money available to support clinical interventions out in the community that can help the individual and her family can definitely help but not only as another resource or tool, not the solution.
Can you think of any instances, in your experience, in which low-income fathers have experienced the same mental health challenges? Posted Thursday, August 7, 2008 by Juan M. Escutia, M.S. at 12:31 PM

I am a professional and I say that if the proper assistance and that is not coerced or forced care of any kind is there that people, and I mean all people do much better. Some people are born with silver spoons in their mouths and in better situations and take that for granted. Some people purposely bring hardships on people so that they can treat them and some people don't have the sense that a goose does when it comes to relating to other people in responsible, empathic, and meaningful ways. Some people struggle ahead like the immigrants that settled this country with all of the hardships and find a way of coming out of it. Posted Sunday, July 27, 2008 by Janie Lee, M.Ed. at 01:47 PM

At risk of being tagged unprofessional, I'll make my first reactive comment anyway..... DUH! Are we really having this conversation? I am almost shocked that we need scientific research to indicate that people struggling to make it past the bottom of Maslow's ladder have mental/emotional disorders. Are we really niave enough to presume that all mental health disorders are NOT affected by psychosocial issues? Do we just ask these questions on typical intakes for fun? Of course financial stability increases someone's sense of self efficacy, esteem and overall functioning. Of course living inside a 'survival' mindset could distrupt the normal chemical conditions of the brain and encourage mental concerns. Of course not all all depression and anxiety is simply medical. Of course 'throwing money' at people won't make their life better. I am really praying that us 'educated folks' aren't to ignorant to see the responsibility America has in helping one another walk up the ladder of emotional, social, mental, financial, relational, educational and spiritual maturity. A better system of financial and educational support would surely reduce the rate of mental health disorders amongh low income individuals. And I'm certain that my community's Emergency Crisis Response Mental and Medical Care System aren't the only in the community that can see the need for better intervention programming. Really now... Posted Tuesday, July 1, 2008 at 08:35 AM

I care about this and thank you too, because it is so easy for anyone to slip into this poverty mode and the poverty disability mode, especially in this day in time, especially when the economy is so bad for all of us. I thank you for paying attention! I care about this and think I am right and want to make a difference when and where and if I can. Some folks are very disparaging and they do it on purpose, that is not a good thing, but here I feel that my voice can be heard and that I can carefully consider what I am saying. That is a good thing, we need to really think before it is too late. Not knowing things doesn't make us bad or frauds or mentally defective, but not learning new things and when we do not taking them into consideration is a poor way to run this world I think? Posted Friday, June 27, 2008 by Janie Lee, M.Ed. at 12:05 PM

Editor's Note: The phrase "throwing money" is a direct quote from one of the women who were interviewed for the study highlighted in the "You'd Be Depressed Too" article. The author of the Featured Discussion used that particular phrase and concept because it was suggested by a study participant. It was not meant to be disparaging.

Thank you for the excellent discussion. Posted Wednesday, June 25, 2008 by L. Kris Gowen at 09:05 AM

Economic Income should not be an indicator of a "brain disease" or "mental disorder or illness" requiring medical "treatment", but rather a lack of basic needs that require more possible physical and financial assistance.(/br) Janet Walker says, "Rates of depression is said to be between 5 and 25%, for mothers of low income it goes up to 40 to 60%. I wonder if emotional and behavioral disorders set the standards of needs resources being made available to families or are set by the standards expected of those with these needs? If emotions and behaviors (not a disease at all) are affecting people in a negative way they have choices=change the behaviors or don't. Perhaps some people don't because they are not aware of them at the moment for one or another reason or their situation may not allow them to. If they are not clear on their own behaviors then making people aware isn't always cut and dry or easy. None of us like it no matter who we are, even those of you professing to counsel these parents don't like to admit when your behavior may be problematic or the problem in and of itself. It is a basic human instinct to protect ones self. So sometimes we need to be shown our behaviors in clear constructive and supportive ways.Options for change should be discovered, weighed, and supported not coerced or forced, without the use of one upmanship games. Often that is a perceptual thing that happens as a result of ones work or pay status, but it is not useful. Psychiatry is medical and not the way to go about resources and skills development. It is a waste of money that could be better spent in different areas and different ways. Sitting in someone's office is time consuming and many times unhelpful, being put out of mainstream activities no matter what they are is often harmful, it detracts from the opportunity to do something better more then it promotes doing something better. Since long hours of office sitting is usually what gets these families in terrible binds and in these systems and being "treated" for these kinds of things, I can't see it as a good thing. I don't believe that it can ever be a ""good job"" do you? If these issues are considered as a "diagnosed disease" the people have to be "sick" and getting treatment and "staying sick" to keep getting that "treatment" or the resources and support that they actually need, rather then being well and being supported to find their way clear of the problem situations, it is a skewed perception or misperception of needs. Many of these families have been taught the only way they can get the actual support and adjustments made that they require is to have their child in special education, and to do that one must have a "diagnoses". That often waste medicaid dollars, when medicaid is going broke and becoming a burden that it never should have become. It is not solving the actual issues and eventually it may not be there to get children the basic and actual health care they may need, if a child gets in such a shape that they can actually die from a disease and there is no money to pay for treatment then that is going to be a big problem, isn't it. One of the requirements for being in these programs and the way that this is being paid for now is that it must be medical so medicaid will reimburse for the services and it mostly isn't. All people deserve good medical care, the same rights with their choices to medical care, and I know well enough that it can be a worry to need medical care and not have the resources available to get it. Getting the medical care one needs is different then being government mandated into getting "medical care" and "treatments" of any kind because that can be corrupted by the ones who provide the services and must recover cost. Not to say that there are not some good and decent service providers. I have met some I trust. However, many times these people come from a different background or they forget their background once they start getting paid well and that hurts families that are still poor and facing poverty situations or just barely beginning to come out of them. Posted Sunday, June 22, 2008 by Janie Lee, M.Ed. at 12:26 AM

With the article, "You'd Be Depressed Too" I wondered what the actual set in stone guidelines are that say someone has a "mental health problem or disorder"? Doesn't the perception of these things often vary by the person that is perceiving these things to be a problem? If not, where is the proof that is set in stone or written down about this exact behavior and the exact problems? Let's not say medicaid and other state data bases because the people that are in them are poor and can not pay cash, and if one can pay cash they don't go in them, they don't get counted no matter what their behaviors or problems are. I feel the article was written to say there is a battle being sought to get the mothers "treated" and the validity of what the mothers say is discounted because they are not for being treated, because they are asking for what they really see the issues as being to be addressed and in some honest ways. Posted Sunday, June 22, 2008 by Janie Lee, M.Ed. at 12:26 AM

I also read, "A Daughter...and a Mom", and have to say I have never known of a "foster parent" having to go through what some moms go through. They get money or stipends to spend time lolly gagging with the kids and don't have to try to figure out ways to support them, often alone and not having time to spare, and maybe even having problems or acting out because of it. This gets many poor people into trouble, then they can not find good jobs that help make ends meet. So they end up doing what they think they must to survive and to do those kinds of things makes them feel bad inside so they want to pop pills and drink to forget about it. Stories like this with mistakes like a sister being a half sister or a step sister for example only serve to reinforce the negative stereotypes of what a woman or mother with so called mental illness is supposedly like, and not all mothers are like that and it doesn't half describe the issues the mother has or family preservation issues either. I don't believe in screening people, because if the truth is known there are many psychiatrist, counselors, social workers, teachers, and others that are working in the feild that have had problems and still do have problems and issues and sometimes even take them out on their clients and deny it. There is not much accountability in the feild of mental behavioral social health and it serves to traumatize families rather then be supportive of them. Posted Sunday, June 22, 2008 by Janie Lee, M.Ed. at 12:25 AM

Yes, money changes things. Stop calling them mental health conditions and start getting them the money that they need, the assistance or education or jobs that they need without making more problems for them to have to deal with, without taking away their rights. I have seen some good programs that got women engaged and motivated that were not mental health based, very successful ones in fact. ""to provide her with medication or to ?throw $10,000? at her?"" This question is phrased in a negative way, hopefully not purposely in a leading way. To pay money that she could use for basic needs to get a car and clothes and decent housing and on her feet is much better then giving her medication to get addicted to! To give her the same support and respect as you would a foster parent that ""doesn't have to be perfect"" to take one of the many billions of children warehoused in facilities, would make the biggest difference in the world. When people have money to pay bills and meet their needs and not be in debt no matter where it comes from they are seen differently and they can do different things. They can buy new clothes and take care of themselves better and their community respects them differently in most cases, unless it is someone that decides to trash a person as being lazy and no good for being needy. I can tell you affirmatively that it makes the biggest difference, but if a person is forced or coerced into doing things against their better judgement and or taking treatments or pills then some would rather do without that money and that can be harmful to them in many ways. If they had the money and support in other ways that they needed and were being given along with these pills and could mutually and trustingly support one another it would go a long way. Many times the treatments only make the problems more severe, and just because you give them the treatments along with the money or other supports that doesn't mean it is the ""treatments"" that are changing things for them, it is the money and other supports in my humble opinion. Do you think you could do your job or be successful if you were not getting money for it? If you spent all day talking to someone and no money was being given to you for it, would you be the same person that you are now? I see it as problems of living, but men are more taught to work or make money and most have a better advantage at that. They have more support and acknowledgement when in that situation. I am not sure why that is, but I think it is so. So they have that advantage. Posted Sunday, June 22, 2008 by Janie Lee, M.Ed. at 12:24 AM

I find it ironic that if we are talking about economic disadvantage there is even a question as to whether 'throwing money" would help. Economic disadvantage is in fact just that - money. 10K may not be enough, certainly not enough to purchase child care and family insurance and decent housing, but having enough to purchase all those items will certainly help. We perpetuate problems by making poor people get those services from social welfare agencies, rather than giving them the money to just purchase the services as the middle class does. It's almost a certainty that if you are worried about feeding your children, having them shot on the street, etc. you yourself will be stressed, you are at high risk for poor health outcomes (most health care disparities relate to income at the root)and at risk for depression. If this is a serious question then lets do a controlled experiment. Give low income women who are diagnosed with depression the US median income, and have as a control group low income women who get medication for depression, and then let's measure results after a year - do they still qualify for the diagnosis and what is their level of functional impairment. Posted Wednesday, June 18, 2008 at 07:48 AM

Some of the questions posed here seem to imply that simply giving money is an adequate way to redress economic disadvantage. Perhaps it is more useful to think of many poor people as oppressed rather than simply economically disadvantaged--they do not have the same opportunities to control their lives as many in our society, their efforts to do so are often thwarted, and, at the same time, they are branded by society as losers, people who can't make it. Mostly these are people who have grown up with fewer opportunities--the greatest determinant of your eventual economic status in life is the status of your parents. While our society believes in the fantasy of social mobility and equal opportunity, the reality is quite the contrary. Poor people no doubt have a greater awareness of this than others, but often still contribute to their suffering by feeling, at some level, responsible. In order for people to thrive, they need to feel that they have some control over their lives, and that they can provide a basic sense of security for their families. Furthermore, people's sense of well being is tied not to their absolute level of economic resources, but to their level relative to others'. As long as the gap between "winners" and "losers" in our society continues to widen (and with budgets for social services and social supports shrinking), offering mental health "treatment" to the economically disadvantaged will be like bailing a sinking ship with a teaspoon. Posted Tuesday, June 17, 2008 at 03:48 PM

Your questions about the relationship between money (or lack of) and depression suggest a more simplistic relationship that probably exists. Poverty does not just equal lack of money - lack of money is also often associated with working long hours, having inadequate housing, transportation, health care, etc., AND sometimes being treated as less worthy or less important than those not in poverty. There's probably a reciprocal relationship between the experience of being poor, and depression. Conditions associated with being poor can contribute to hopelessness and despair. On the other hand, depression is characterized by feeling hopeless and helpless, and often by the inability to get the simplest things done. So, people who are depressed and poor probably need better resources, housing, food, health care, working conditions, child care, and social support. They may also need medication to help lift them out of the trough they are stuck in, so they can move forward with their lives, and successfully parent their children. Once people are depressed, probably neither money alone nor medication alone will be sufficient. Posted Tuesday, June 17, 2008 at 03:47 PM

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