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interviews

Poverty and Mental Illness

by Annie Harper
February 29, 2020

This conversation with Dr. Annie Harper was conducted and condensed by franknews.

Dr. Harper has a PhD from Yale University in cultural anthropology. She conducts research on how vulnerable populations, particularly low income people with mental illness, cope with poverty and financial difficulties, and how to support them in this area. She is particularly interested in understanding how the financial services and retail industries could better serve low income people generally, and people with mental illness in particular. 

DR. HARPER | Just so you know from the outset, I'm not a mental health provider. I don't have any health care qualifications. I'm a cultural anthropologist. I study individuals and how individuals connect with wider systems, and I also study poverty. I study poverty, finance and banking in particular. I mostly do research on how that relates to mental health, as well as some financial counseling with individuals. But I don't sit in a mental health setting and provide mental health care to individuals. Just so you know.

frank | Yes.

So I can't really speak from that perspective, but I do work with people who do that. 

What does your research focus on most closely?

I very much focus on people who don't have much money.

What I've tried to understand in my research, particularly for people who have mental illness and are poor, what type of financial problems do they have, which are the most pressing, which problems bother them most? What are the root causes of those financial problems? Is it mental health symptoms? Is it the fact they don't have enough money? Is it that the banking industry doesn't serve them? Is it that the disability benefit system doesn't work properly? Or even some combination of all those things. Then I try to understand what kind of strategies people use to get over the challenges they have, and then I try to understand what our mental health system currently offers people who have financial difficulties, as well as mental illness.

Most recently I'm really looking at what the financial services industry does to meet the needs of this population, or let's be frank, what the financial services industry does that can actually be harmful for this population.

What are some of the broad conclusions of the work? It seems to me from the outside, that it's a combination of factors that keep people poor and sick. What do you see?

Yeah, absolutely. It is a combination. One of the main findings of my research that I think is particularly important and I like to get out there, is that when somebody has a mental illness and is poor, most of the support they get is channeled through the frame of mental illness. We tend to interpret their financial difficulties as a mental health problem.

What I've been able to show is that actually most of the financial problems that people with mental illness have are because they're poor, not because they have some symptom that messes up their finances.

That has been a big finding, in that if we can address financial issues that poor people have, generally, we'll be going a long way to helping people with mental illness be more financially healthy.

That's really interesting.

That's been a big finding. Then a second piece is recognizing that when you're on disability benefits, it's great because you have a secure source of income, but it's terrible because of the ways policies limit people's ability to be financially healthy. There's a whole set of government policy around disability benefits that make it really hard for people to do the right thing financially. 

The third problem is that when people do have specific mental health related financial problems, whether that's over spending, being exploited, things that happen to people who are particularly vulnerable, we don't have good systems to deal with that, and the banking industry in particular is really unhelpful in that regard. Those are the three buckets. People are poor, that's a problem. Disability benefit policies are a problem, and we don't have good systems to help people who do need help with their money.

Within the second bucket, disability benefits that are problematic, what are some examples of that?

The main problems are related to income and asset earning limits.  

Particularly for people on SSI, which is supplemental security income, it's what you get if you don't really have much of a work history, it's very low income in the first place, around $750 a month, then if you earn more than $20 a month, you then begin to lose 50 cents of SSI for every dollar that you make from work. For people who are already very poor, but may have the capacity to work for a few hours a week, that rule really, really puts them off taking the steps into the workforce that they might want to take, and the steps into the workforce that might be really good for their mental health recovery. 

The second piece of that is the asset limits, which says that people on that particular benefit, if they have more than $2,000 in assets for any period of time that they have those assets, whether it’s money in the bank or other assets (with certain exclusions) they are not eligible for those benefits. People unwittingly sometimes go over that asset limit and then have to repay social security for any SSI they received during a periodin which they weren't eligible. I will just say here, it gets really complicated, really quickly as you can probably tell. Which is part of the problem because the problem isn't just the income earning and asset limits. It's the incredibly complicated rules and bureaucracy that you have to navigate when you're in that situation.

What would help? What policies work?

This really is fixable. Without mentioning any names, more than one of our current contenders for the democratic nomination have excellent policies to address it. The best policies out there are really around increasing those limits. They still have their set limits but rather than being able to have assets of up to $2000 you should be able to have access of up to $10,000, and rather than cutting off somebody's supplemental security income at $20 of earnings, you should allow some hundreds of dollars of earnings.

The best immediate policy recommendations that are out there are really around, keep the system as it is, but relax the limits so that it's easier for people to start working, to start saving money, without being penalized as quickly.

Then we can talk about ways to entirely reform the system around employment. There are larger conversations to be had about things like universal basic income, which I have concerns about that frankly, but there are things that are probably not realistic in the short run but that we need to think about in the long run.

What does your research show in regards to people getting out of poverty with mental health issues?

If you can alleviate poverty, generally it will take care of many of the problems that people with mental illness have. So generally, we need a higher minimum wage and more regulations and rules around job security. Better labor laws, more available, affordable housing, all of those things that are good against poverty generally will improve the situation of people who are poor and have mental illness.  Particularly for mental illness I think recognizing that just because someone has a mental illness doesn't mean they can't work or they can't contribute productively to society. 

The policies that we have in place really put people in two categories. You're either well and able to manage and learn. Or you're sick and need to be entirely dependent. Our disability benefits system kind of forces people into one category or the other.

The most effective way that we can help people with their financial management problem, is to have a system that recognizes most people are somewhere in between those two extremes, whether or not they have mental illness. 

In listening to all this, there’s a clear focus on policy. Outside of politics, what else is there to do? Are there solutions to be found in and out of bureaucracy? What about cultural responses? 

That's a great question. And it's something that I grapple with all the time. I really try and keep my eye and my attention and my research on the systems, structures, policies, because I think we do too much in the other direction. We put a lot of focus on individual recovery and individual empowerment, individual financial literacy, individual X, Y, Z. I tend to focus my research away from that. But that doesn't mean that it's not important. We might be able to change a policy in five years, but in the meantime people need to live the best life they can live.

I think there are some things you can do. We have, thank goodness here in New Haven, recently managed to get funding for, and now have a financial counseling center free for residents. There's a place where anyone can go mental illness or other or not, and just get advice about their finances. I mean, that's a systems change thing but it's available, it's targeting individuals. Helping individuals understand what their financial decisions are, helping them towards their financial goals, helping understand their debt and manage it.

I think that's important. Making sure individuals don't just have access to good mental health services, but also have access to good financial advice services. Culturally you mentioned, that's a big thing. There's so much shame and stigma around financial failure. People are sometimes more willing to talk about their psychosis or their schizophrenia than they are about their debt.

Right.

For me, that's something I think we all need to be thinking about.

Understanding that financial failure is very often nothing to do with individual decision making.

We have a societal level problem with debt and the more we talk about it and acknowledge it and talk about our difficulties and our solutions, the more we all learn about how it can be different.

Right. Do you feel like poverty is politicized? Can bills around the issue be bipartisan?

It's actually a great question because the area where I work, with financial management, depending on how you frame it can be entirely bi-partisan. The idea that we all need access to good financial services to be able to make the best financial decisions about our spending, about our investments, et cetera, et cetera. The importance of access to good education and of being educated about your financial options so you can be responsible are things that people would tend to agree on. 

I think where it tends to diverge is in the area of individual responsibility. Some people would argue that in order to change the situation, we really need to emphasize individual responsibility. We need to provide more education and training so that people don’t make such bad spending decisions. Where I would fall in a slightly different place in that, I believe individual responsibility matters, but individuals are also facing a set of decisions that are shaped by systems beyond their control.

When we focus excessively, in my opinion on individual responsibility and then when people fail to do well, our assumption, if they have mental illness, is they don't have the capacity to be responsible. So we have to remove control from them. And that for me is a big problem. When we think that people aren't responsible and they have a mental illness, we basically take away control from them through either assigning a representative pay or conservator.

That way of thinking fails to recognize that the challenges they are having may not because they are not capable of making good decisions, but because there is no good decision for them to make.

That's a really clear way of phrasing it. Mental health and self care have become so forward facing. But it can also feel like a privileged person's game.

Yeah, absolutely.

What are the arguments you found effective in terms of discussing the limits of personal responsibility?

It always surprises me just how much that argument needs to be made over and over again in different ways. It's either because I'm wrong or because it's so ingrained that it's super hard to get people to see something differently.

You can talk about race, right? You can talk to someone about income inequality and wellness equality in the country and they'll just say, "yeah, well these people work harder than these people". But when you add the racial dimension – racial income inequality is horrendous. Racial wealth inequality is just, I mean, it's almost unbelievable how large it is. There's few people who would acknowledge and I think actually believe that there's something about people of color, which makes them work less hard. 

Right.

That narrative certainly still exists in the country, but I think it's much, much less powerful than it was. How can you expect somebody who's started off from a position of so much less  wealth and take that back through history and explain why people of color have much lower wealth. How can we imagine that an individual starting in that position has the same opportunity as the person who doesn't?

Right.

And then you acknowledge continued racism today, the fact that people who have black sounding names are less likely to get jobs than people with the same qualifications with white sounding names. There's tons of research that shows that racism still exists. I think that argument can help people understand the limits of what individuals can do. Because it's so obvious that there's nothing about race that shapes, you know what I mean? That's not about people working hard or not working hard. It's about systems and cultural norms that keep certain people back and let other people ahead.

You always want to point to the non-anecdotal information.

Oh yeah. Because people will always point to the black millionaire.

Right.

And say “Well that can't be true because this person managed to be successful”.

Right.

But I think that's where looking at aggregate data really matters and there's such a wealth of great data, of really fantastic visuals, that help people understand the extent to which inequality is foundational, the foundations of inequality in this country and why we need to change things on a systemic level rather than expecting individuals to continue pulling themselves up by their bootstraps.

Where would I find that information? 

It's Pew, P-E-W charitable trust. They have some great charts and stuff based on research they've done. There's also EPI Economic Policy Institute. They have some really fantastic charts. You could just kind of scroll through the website and find charts that visually represent what I'm talking about.

Those would be two good places to start.

Do you think you have to have a conversation about the limits of personal responsibility repeatedly because thinking anything else negates the ‘American Dream’?

Absolutely.

You’re British. If you zoom out can you see clarity in this issue?

Yes. Obviously this is a particularly American process and I'm not sure that I'm best placed to actually be an effective communicator in that regard because althoughI am actually American, my mom's American, but I was raised in the UK, so I was raised in a different cultural context. Sometimes I just feel like I'm banging my head against a brick wall like, "why don't you see this"? And that's totally unhelpful. Especially because I'm also a Yale academic.

Right.

So many probably thinkt she's just a foreigner, who's an academic and doesn't get the real world. I think what is helpful is to maybe talk about the enabling context. That all of this is about empowering people to be who they can be, and that it's not taking away individual agency. It's providing the conditions for people to live in so that they can flourish as individuals and you know, pursue their dreams and fulfill their potential.

It's not taking away people's choices, it's making sure that people have as many choices as possible.

I'm not very good at making that argument, but I think that's what I need to actually get better at.

It’s easy to get tongue tied in that explanation. My parents are immigrants, I can easily say, "look what they could accomplish, how uniquely American. How exciting". But there’s so much more. So many layers of why. 

I think what you said is important because one of the things I'm starting to do more and more when we talk about poverty, when we talk about people who are vulnerable, and I'm guilty of this as anyone, we tend to focus on understanding their lives. I spent a lot of my time doing qualitative research with people who are poor and have mental illness, who've been in prison and understanding the trajectory of their lives and how it's been so hard for them to get ahead, et cetera, et cetera, et cetera.

In fact just when you called, I'm working on this article about people who've had mental illness and have been in prison and their debt. It's all of these sad stories about the multiple barriers that people face. 

What we don't do enough of is getting similar narratives from people who've had privilege, had opportunity. I'm experimenting with telling my own story or the stories of people who live in my neighborhood. I was able to do a PhD because I didn't have any student loan debt, and I got into Yale because I went to a good university before that, and Yale is rich so they paid for me, and then I was able to buy a house without any savings because my dad helped me with the down payment. The trajectory of people with privilege helps us understand that my success is not just because I worked hard.

Yes.

I had the support in place to enable me to work hard and to make the decisions I made, and I think we need to be doing more of that. Rather than just getting endless narratives of people who are struggling, getting narratives of people who aren't, to get a better sense of what was it beyond their individual hard work that helped them get to where they are.

I think about that all the time. What luck.