There are many good reasons for Congress to enact President Obama’s proposal to raise the Federal minimum wage to $9 per hour. Many of these reasons, from economic stimulus to possible reductions in gaping income inequality to much-needed financial relief for working families, have been extensively discussed in the public sphere. However, one important benefit of increasing wages has not received enough attention: improving mental health.
Numerous studies show that poverty is associated with an increased risk of having a psychiatric disorder, including depression, anxiety, and even schizophrenia. While people with severe mental disorders are more likely to become poor, innovative studies have shown that poverty actually significantly increases the risk for mental illness.
Growing up poor is especially harmful to mental health. Children living in poverty are much more likely to develop learning problems, attention deficits, depression, serious behavioral problems, and an array of other troubles. Mental health problems in childhood often last into adulthood, causing lifelong suffering, lower functioning, and poor overall health. In addition, living in an impoverished neighborhood (area-level deprivation) has deleterious effects on mental health. Geographically concentrated poverty hurts communities by eroding trust and making people less willing or able to collectively invest time and resources in public health and wellbeing.
Treating people individually after they have already developed a psychiatric disorder — while necessary and important — is time- and resource-intensive, and is unfortunately not always effective. It would be far more efficient and humane to prevent mental health problems in the first place by addressing basic “social determinants” of mental health — such as poverty and area-level deprivation. There is strong evidence that increasing income conveys mental health benefits to poor people.
One of the most compelling examples is the Great Smokey Mountains Study, conducted by Jane Costello and colleagues in a high-poverty, rural area in western North Carolina with a large American Indian population. In 1993, Dr. Costello began following a group of 1,420 children between the ages of nine and thirteen years old. They designed a longitudinal cohort study, with regular psychiatric assessments to determine how mental health problems emerge over time in this unique population of children. During the course of the study, a casino opened in the area that provided an economic windfall to some families, but not others. This “natural experiment” provided a unique opportunity to measure the effects of rising income on mental health outcomes.
Before the casino opened, poor children had higher counts of psychiatric symptoms than non-poor children, but for those children who rose out of poverty after the casino opened, psychiatric symptom scores improved and became, on average, equivalent to symptom scores of children who were never poor. Children who remained poor unfortunately enjoyed no mental health improvements. Further analysis of parents’ reports showed that the best predictor of improved psychiatric symptoms in children was that the extra income allowed parents more time to supervise, monitor, and parent their children.
Although increasing the Federal minimum wage will not be a panacea, it will significantly increase income for millions of working families. Research gives us ample reason to expect that this extra income would relieve financial stress and time constraints on families, thereby making them more resilient. It would also reduce poverty rates and perhaps decrease area-level deprivation, which we can predict will improve individual well-being and strengthen communities, therefore bolstering mental health. Economists agree that the costs of increasing the minimum wage would be low and quite manageable, and that doing so would likely even spur economic growth, leading to a healthier and wealthier society. The future economic and social benefits of a mentally healthier population in the generations to come are easy to imagine.
Marc W. Manseau is a psychiatrist and member, Prevention Committee of the Group for the Advancement of Psychiatry (GAP).
