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Hi, welcome to Mental Health Matters. I'm Shannon Eliot. It's my pleasure today to chat
with an expert on the relationship between poverty and mental illness.
Donita Diamata is the Project Coordinator for Financial Self-Sufficiency at Mental Health
America of Oregon. Donita began her career in mental health advocacy over 20 years ago
as an employee for a drop-in program. A few years later, she collaborated on a new drop-in
program with a philosophy that all would be welcome. Having personal experience with both
poverty and mental health challenges, Donita continues to advocate for change within the
system.
Welcome, Donita. Thank for coming down from Portland today.
>>Thank you.
>>What is your personal experience with poverty and mental health issues?
>>Well, I grew up in some level of poverty, but I don't think I really felt the full brunt
of poverty until I was in my early 20s. And really it was after I first engaged in the
mental health system. So what happened was after a couple of hospitalizations and going
in an getting services, I started getting this message that although I was working at
the time, I should quit working and go on SSI. I kind of fought against that for awhile,
but when you start getting the message again and again from people you believe are experts,
you start buying into it. And that's what I did. I actually did not quit my job, but
I lost a job while I was in the hospital. And so when I got out I decided I would go
for what they're saying is a good thing for me to do. And what I found, living in that
kind of poverty, first of all I brought in less than my rent. So I supplemented having
to pay rent and utilities with my food stamps. So every month I was making these hard decisions
of which to do -- keep a roof over my head, keep the lights on, or eat.
The things that ended up on the bottom as far as what choices I was going to make and
how I was going to spend that little bit of money I had were things centered around making
it to appointments because I didn't have transportation costs — I had no bus fare — and of course
social stuff. I couldn't go to movies and I couldn't go to eat. So I lived in increasing
isolation. And so what they were trying to prevent me from living a life of stress, but
poverty brings on way more stress than actual working ever does, I think.
>>And that social isolation you just mentioned to go with it.
>>Absolutely. That was brutal. That was really where I got a good firsthand account of what
poverty can do to a person. And I ended up more miserable than when I worked the worst
jobs I ever had. I'm glad I finally decided to go against the grain, not follow medical
advice, and I started working. And I thrived. And that's what most people do when they find
something they're passionate about. Most people will thrive.
>>How did you feel when the therapist first told you to just go on SSI, don't bother working?
>>I was shocked, really. Because again, I was working at the time in a job I was pretty
good at. So I thought, are they seeing something I'm not seeing? And it starts messing with
your head, I think. Here I was, really believing that maybe I'm kind of not thinking in reality.
You start questioning yourself with "maybe work is more stressful than I realize." Or
something like that. And you start buying into it. It's really difficult not to, I think
if you're told that enough from people who you're seeing who are supposed to be educated.
And they're supposed to have some expertise in this.
>>What kinds of statistics exist that show the percentage of people who live below the
poverty line who also have mental health issues?
>>The sad fact is that there really aren't very good statistics. There are poor statistics
on just how many people have mental health challenges in this country. We tend to look
at who is presenting at mental health clinics. We lose a lot of people with just those statistics.
And when we look at statistics on poverty in general -- and there's nearly 50 million
people in this country living in poverty -- we don't really have a clue about how many people
really are struggling with mental health challenges because many of them are not presenting at
mental health clinics. They're not presenting in places. So we're just down to who presents.
It's kind of like the unemployment rate, what we're looking at there. We're looking at who
is collecting unemployment. We're not counting all the people who are not. So I think that's
changing, which is good. There is starting to be more and more studies that are coming
out. And just a couple years ago when I started looking at this topic, it was really hard
to find information but we're starting to come together. There is some conjecture about
how many people are probably living in poverty who also have mental health challenges, but
there really isn't any hard fact data.
>>Do you think more studies and these new studies that you're mentioning will lend a
certain credibility to the mainstream about this issue that hasn't really existed in the
past? It seems like such an obvious and important link, but it's not something that people really
know about or talk about.
>>Yeah, it's true. And I think part of it too is I think people, sometimes, we do look
at it certainly. When we think of somebody who is homeless, the first thing most people
think of is somebody who is either struggling with an addiction or somebody who has a mental
illness like schizophrenia. That's the first stuff people think of. Those are the images
that are ingrained. So I think we as a society, we put the two together, but we've come to
an acceptance of it, which is not ok. And I think that's the stuff we really need to
start challenging. What is the connection between poverty and mental health challenges?
>>Not to be complacent. That's a really good point. A really good point.
>>Yeah.
>>So how does a lack of basic resources contribute to one's mental health?
>>Sadly in this country, the way we dole out services tends to be on a per capita basis.
So if a city or a community has 20,000 people and let's say this is how many social workers
you'll get, this is how much you'll get in mental health services. That's kind of how
they dole it out. But what happens is the poorest communities are the ones that have
the highest needs for these services. They tend to need more mental health services,
especially community-based services, and they're not getting it because it's doled out evenly
and how we tend to do things here is wherever you live, that's where you go for your services.
So you don't get to go up the hill where the nicer services might be and you might actually
be able to walk right in or something. You get to go to services where the likelihood
is you can present and you are struggling and what you're given is an appointment slip
for 6 weeks to 3 months later.
>>So if you're in crisis, hypothetically they could say to come back in 90 days.
>>Yes, or more. Not unusual. So it's really shocking that this is how we treat people.
And I think that people think that oh, on the outside there are all these great services,
but they are really difficult to get to. And even if we have services available for people,
they are really poorly funded, and they need some kind of revamping, I think too in what
we offer. So minority communities, for instance, they tend to get the worst services that are
the least effective for them. And they tend to have services that are not really very
well-crafted. So you end up with a situation where people like African Americans who live
in poor communities, they are more likely to present in an ED situation, like in an
emergency department or in custody of criminal justice system as their avenue towards mental
health services. And that's not ok that that's how we treat people.
>>So whether or not one has a diagnosis, how does not being able to meet basic needs contribute
to one's mental health or lack thereof?
>>Yeah, and I think that's the crux here. If you look at Maslow's hierarchy of needs,
when you are struggling with your income and with paying bills, keeping a roof over your
head, and you are also struggling with where food is going to come from next, you are kind
of stuck tending to that first pillar, maybe the second one. And those top tiers don't
get addressed because you're so busy with the other stuff. So your chances of existing
in a state of constant anxiety goes up. Your chances of struggling with things like depression
goes way up. That's the reality for people. And what happens sometimes is when people
do present for mental health services, they do get the diagnosis. Now you've got Generalized
Anxiety Disorder, for instance. But what they're forgetting is there's a reason the person
is anxious. They're living in stress every day, everyday stress. So people get the diagnosis
when it's really something that if you remove the stress, the anxiety goes away. It's magic.
>>So obvious.
>>Yeah.
>>So you mentioned this country, or much of this country, delivers services in a way that
you go where you live. And insurance is a whole other tricky thing. Are there good examples
of community resources out there that folks can go to if they're in a city, not necessarily
by exact zip code or the exact block they live on, but something more communal?
>>Yeah, definitely. Peers support services, support groups, things like that are embedded
in a number of communities across the country, so you have those kinds of things. Drop-in
centers are popular sometimes for people. And for some people, they will get their treatment
in the form of what everyone else does. They go to work and they have relationships with
people that mean something to them. And they build families and that's the stuff that is
the most supportive to them. So their support comes really from natural supports around
them rather than the traditional treatment model. So there's a number of people that
live that way. There are a lot of options actually for people who are outside of the
traditional mainstream mental health services that we think of.
>>What has research shown regarding the connection between low economic status and mental illness?
>>So a few years ago, there was a study that when Chris Hudson went into it, tried to figure
out if mental illness caused poverty or whether poverty caused mental illness. And what they
found after 7 years -- it was a 7-year exhaustive study, it was really amazing what they found
-- there is absolutely a strong correlation between poverty and mental illness but it's
not what we expected to see. What they expected to see was mental illness causing it, but
it's really the other way around. It's poverty. And poverty isn't necessarily the cause of
mental illness, but it definitely contributes to mental health challenges. And what they
found is you're more likely to experience mental health challenges and are more likely
to be labeled with some kind of mental illness if you have grown up poor. And the longer
the lineage goes with that poverty -- generational poverty -- the harder it is to actually get
out of that poverty situation. So there's a strong correlation. And I do want to point
out, though, just from my own perspective of working within the system, within and out
of the system 20-plus years and getting to know a lot of people over the years, I don't
think that my story is unique of being told hey, go the SSI route. And the problem here
is that the federal poverty rate is $11,490 a year for an individual. And SSI puts you
just below 75 percent of that. So you are really living in extreme poverty when you
go that route. So this is what we're guiding people towards. And that continues to happens
across the country. So I don't know if it's actually having mental health challenges that
can potentially bring you to poverty. I think it's having some engagement with the system
sometimes in a wrong way can lead you down that path. I just wanted to throw that out
there as a personal note.
>>How would mental health services change in light of the Affordable Care Act?
>>There are a couple of things happening. You couple this with parity. Mental health
and addictions now can no longer be something they charge more for. You cannot be turned
away from insurance. You can not be denied insurance because of a pre-existing condition
like mental health challenges. That's a common thing people had been experiencing across
the country, so there's that. And of course it opens it up for people who have been edged
out of insurance just by way of cost. So people will now have some avenues. And there's one
more great thing, too. It's kind of a mixed bag. There are definitely pros and cons, but
the idea is to have more integrated care. So what we can start seeing potentially is
mental health services being more embedded with medical services and having more of that
sharing. The pros are the continuity of care. The cons are if you have mental health challenges
and you would rather not have your primary care doctor and your dermatologist and whoever
you go see for unrelated reasons know about those, you may not have that option. They're
going to share.
>>So you mentioned this a little bit earlier, but I am going to ask you the question straight
up. Does poverty lead to mental illness or does mental illness lead to poverty?
>>The studies say, particularly that study that I cited, Chris Hudson's study, that poverty
leads to mental illness and mental health challenges. I still stand behind my reasoning
and rationale of just seeing and knowing what I know. It's not the mental health challenges
itself necessarily that can potentially lead somebody down the road toward poverty, but
its just the kind of messages that we may get that send us that way. But the truth is.
72 percent of the people who have mental health challenges and college degrees make less than
$10 an hour. So I'm not clear exactly what's happening here. But I think what happens sometimes
too is that those of us who do want to get back into work -- and maybe we've been on
disability for awhile and living on SSI for awhile and haven't done it -- so there are
people out there with college degrees who when we go through some kind of employment
services, what we are fast-tracked to do is go toward working those entry level jobs.
And I've worked with people who when I met them, they were working as janitors and had
masters degrees. They were making minimum wage. So there's that issue as well at play.
I think we're doing a lot of disservice to people when we are sending them down those
roads and not letting them explore what they are passionate about, what they're good at,
and also what they're educated to do.
>>So you mentioned earlier your own experience as well as just a very common experience for
people who are in the system, the therapists telling them, "You shouldn't work. You should
just be on SSI. Don't think about re-entering the workforce." Thankfully, you were a little
spunky and said, "No, I am going to enter the workforce, thank you very much." But there's
a lot of people out there who would just accept it. In your experience, how common is it (friends,
acquaintances, etc.) -- how many of them actually did end up re-entering the workforce and getting
a job again?
>>Well, not a lot. I've gotten to know in the 21 years I've been doing this work....
I've gotten to know people over that time span, the relationships I've built over 15
to 20 years. Many of the people I was working with then who were living on SSI are still
living on SSI sadly. It's very difficult to break out of that cycle. And the longer it
goes, the harder it is I think to break out of that. You start losing confidence in your
abilities and yourself. You don't recognize your owns strengths anymore and you become
reliant on other people calling the shots and making these decisions.
>>What kinds of mental health care options are out there for folks on SSI and what is
the quality of these options like?
>>I think it depends from community to community. There are some communities who have decided
to invest. There are whole cities who have decided to really invest in these services
so more money is put into these services and they're protected. Even when cuts happen,
there are very few that get hit with mental health services as far as cuts. Then there
are other communities, where they are sorely underfunded. When you look at what people
are going to be reliant on who are really living in poverty, particularly people who
have no insurance because there are plenty of people out there who live in poverty too
and do have insurance so they are going to go the private sector route. So let's say
we're just talking about people who are reliant on public mental health services. It depends
on the community, as I said, but what they generally can expect from most communities
is either to make that initial phone call or present and then possibly get an assessment
within a couple f weeks or so. But that's not really an appointment. That's just an
assessment that doesn't do anything other than give the information to the people who
are working in the system. And then an appointment comes where they truly get to start talking
about what their needs are, 90 days or more later. And what they might be facing is working
with a case worker who has 100+ other people that they work with. You will have t fight
for your needs to be met. You'll really have to become an excellent self-advocate.
>>And that's tough when you're in the throes of crisis and self-esteem issues.
>>Absolutely.
>>Why is affordable housing so important to one's recovery and well-being?
>>It's crucial. People shouldn't be paying more than 30 percent of their income towards
housing, first of all. But you've got people across the country paying 50, 60, 70, 80,
even 90 percent of their income is going towards housing sometimes. So there's problem number
one. It leaves you ever little left over for other things, like food, utilities, and if
anything should go wrong, you have nothing in reserve to handle those issues that come
up. So it's important that we have affordable housing, of course. It's important that people
not only have a place they can go that they can afford, but I think the other piece of
the puzzle that I really want to make a plug for is safe housing and housing of someone's
interest, something somebody would want to live in. So when we start putting everybody
in the worst, poorest neighborhoods that are high-crime, low services, the walkability
is nil, and we lump everybody together in those circumstances and say they can afford
their housing, I don't think that's good enough. And there's one other thing I want to say
about this. I think that a lot of people believe that if you're on SSI, you get to live in
subsidized housing. While some people do live in subsidized housing, the reality is that
subsidized housing has waiting lists that are months or years long sometimes. It's not
uncommon for the waiting list to be 4, 5, 6, 7, 8 years long or be cut off altogether.
You are left to free market and try to figure out how to live on $700 a month when the average
rent in your town for a one-bedroom is $800 or $900.
>>How are children growing up in poverty affected?
>>Children who are growing up in poverty are affected by the stress of the situation. They
sometimes are living in very high-crime neighborhoods and that's stressful and causes anxiety, and
so are actually more likely to be at the very least labeled with a diagnosis of some kind
of mental health challenge. So their odds go up there. They are more likely to miss
school. Poor children are more likely to be expelled or excused from school, forcibly
removed from school, that kind of thing. And as we know, the education piece of it, when
you lose that and you have somebody who hasn't made it through high school, the odds of them
not breaking out of poverty go up. So you combine all of these things -- mental health
challenges, a poor performance in school or being left out of the educational system altogether
-- you don't really get much of an opportunity to thrive in that situation.
>>It's an uphill battle.
>>It is, yeah.
>>To wrap us up, what would you tell someone who is currently on SSI who wants to enter
for the first time or re-enter the workforce, but might be struggling with confidence or
internalized stigma issues?
>>This is a great question because I would have loved for somebody to tell me this. What
I would tell this person is first, believe in yourself. Surround yourself by people who
believe in you. If you have someone telling you that you shouldn't work, find somebody
else to work with. I would definitely say that wholeheartedly. And explore what your
passions are. Just because you have been labeled with a diagnosis of mental illness of some
kind -- no matter the illness, I don't care—just because you've been told you shouldn't work
or can't work, none of that needs to be a barrier, actually. The world is out there
to you as far as I'm concerned. I see potential in everyone. And look at what your skills
are. You have them. You have talents. You've had to develop them. If you're in the mental
health system, you've had to learn to be a people person, a self-advcoate. You've had
to learn of amazing skills. Patience, things along those lines. These are great skills
for any kind of job.
>>Thank you, Donita, so much for joining me today and for your wisdom and for your really
inspirational stories. I really appreciate it.
>>Thank you.
>>Money Basics is a financial self-sufficiency course designed for people who experience
mental health issues. It is interactive, peer-taught, and person-directed. Learn more on the Money
Basics website at www.money-basics.info.
Project OPEN is a network of Peer Employment Specialists in Oregon. To find resources tools
for peers who are seeking employment or supporting others who are seeking employment, visit Project
OPEN's website at www.peeremployment.com.
To learn more about the issue of mental health and poverty, be sure to read an article by
Esther Entin in THE ATLANTIC titled "Poverty and Mental Health: Can the 2-Way Connection
Be Broken?" You can read it online at www.theatlantic.com.