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The Vicious Cycle of Poverty and Behavioral Health
By Steven S. Kast

In America today, 44.7 million adults live with a mental illness, 20.1 million adults and teens have a substance use disorder, and 8.2 million people struggle with both. Recent school shootings in Sante Fe, Texas and Parkland, Florida bring a spotlight on mental health services. While behavioral health problems can affect people regardless of race, religion, location, or income, the most vulnerable population is those living at the poverty level. Understanding the vicious cycle of poverty and behavioral health issues can help us develop programs and interventions that can address the root causes and heal those in need.

According to the U.S. Census Bureau, 43.1 million Americans live in poverty. Of those, 18.5 million live in deep poverty, with a household income of less than half the poverty threshold, which is $12,486/year for a single individual and $24,339/year for a family of four with two children. In Virginia, 39 percent of households struggle to afford basic household necessities, defined as ALICE, an acronym for Asset Limited Income Constrained Employed.

Locally the ALICE population reaches as high as 57%, and with little financial resources available, it is easy to see how, if faced with substance use or mental illness, this population would have a hard time getting the treatment they need. The most recent Greater Virginia Peninsula Homelessness Consortium (GVPHC) ‘Point in Time Count’ reported 13 percent of the 439 persons who were identified as experiencing homelessness reported having a serious mental illness, which is a major reason for housing insecurity or homelessness.

In fact, this population may actually be more susceptible to addiction than other populations. According to the Centers for Disease Control and Prevention (CDC), people on Medicaid and other people with low incomes are at a higher risk for prescription drug overdose than others. That may be because people on Medicaid are prescribed opioids at higher doses and longer durations (thus increasing their risk of addiction) than those in higher income brackets. Or it may be because they struggle with relationships, have become isolated from strong family and social ties, and turn to drugs or alcohol for relief.

Whether they need help with substance use or mental illness, this population may struggle to afford a car or other transportation to get to a doctor or treatment facility. Even with federal subsidies, they may not be able to pay for insurance that could cover the treatment or medication they need. They may simply not be able to afford to take time off from a job, pay for treatment or buy medication, even if they have insurance.

Research shows that as income increases, the percentage of those with serious mental health problems decreases. While 8.7% of adults with income below the poverty line have serious psychological distress, only 1.2% of those with income at or above 400% of the poverty line do. This leads us to believe that having greater income can lead to living healthier lives and experiencing less behavioral health issues. United Way of the Virginia Peninsula is working to help individuals living in poverty access treatment, increase social supports and build stronger more equitable communities.

Those who struggle with depression, anxiety, bipolar disorder or other mental illness, or are using drugs or alcohol, will find it difficult to work effectively and consistently and may not be able to hold a steady job. Due to their illness or disorder, they may also lose or cut ties with family and friends who might be able to help them financially or otherwise. With this social isolation often comes increased substance abuse or mental health problems.

The good news is that we are starting to see a wave of new innovative programs at a federal and at a local level. Recent decisions at the State level should enhance mental health services and help connect those with serious mental illnesses to critical services. United Way of the Virginia Peninsula has dedicated its resources to alleviating poverty, and in conjunction with government, corporations and not for profit agencies, is working toward ensuring everyone has access to sufficient and respectful health care services.

Mental illness and substance use impact all communities, and we know that it will take the community to help address this problem. A major step has been the proclamation by local councils and boards to promote a region of kindness to tap into the human spirit to lift others and strengthen our community. United Way realizes kindness alone will not heal the mentally ill or alleviate poverty, but change is possible through the generosity of the community and willingness to work together. "Always be kind, for everyone is fighting a hard battle”- Plato.

Steven S. Kast is President and CEO of the United Way of the Virginia Peninsula

 





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