POVERTY AND MENTAL HEALTH
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Chronic Poverty and Psychological health consequences
Children growing up in toxic environmental conditions tend to develop behavioral and mental health issues, which continue to persist in their entire life. Poverty leads to mental health and developmental problems that in turn prevent individuals and families from leaving poverty, creating a vicious, intergenerational cycle of poverty and poor health. Children fail to develop to their full "genetic potential" not just because of the deficiency of the basic needs but also because of the environment both at home and outside (social deprivation) the deficiency has given rise to.
Chronic and acute stressful life events exposure, lead to hypothalamic-pituitary-adrenal (HPA) axis changes, and other brain circuit changes for example, language processing and executive functioning. (Addressing Poverty And Mental Illness June 28,2018 by Kevin M. Simon, MD, Michaela Beder, MD, Marc W. Manseau, MD, MPH Psychiatric Times, Vol 35, issues 6, Volume 35).
Poverty is considered as an adverse childhood experience. It leads to repeated stress in the environment, and every time the stress response (fight-or-flight) system gets activated, there is increase release of stress hormones like Cortisol, Adrenaline, Norepinephrine etc., resulting in increase heart rate, respiratory rate, blood pressure, muscles tightening and so on. The stress response system goes back to normal if the situation is addressed, but if there is nothing to buffer the ongoing stress, the response system continues to remain activated and has long-term effects.
In children, the areas of the brain like in learning and reasoning, there should be more neural connections. Instead children raised in environments of low socio-economic status (SES), the neural connections comprising the brain architecture are weaker and fewer in number. Studies show consistent reductions in cognitive performance across many areas, particularly language function and cognitive control (attention, planning, decision-making, not being able to concentrate because of hunger). These deficits may represent the first step on the "poverty ladder", setting back educational attainment with potential knock-on consequences for employment prospects and psychological factors such as self-esteem and self-efficacy (belief in one's competence and ability to succeed). These results highlight the crucial importance of early interventions to offset the stressful environment of poverty, as the long-term consequences of early deprivation are severe, irrevocable and potentially fatal.
Stress leads to cognitive symptoms like constant worrying, racing thoughts, forgetfulness and disorganization, inability to focus and poor judgement. Resource scarcity induces a "scarcity mindset", characterized by increased focus on immediate goals at the expense of peripheral tasks and long-term planning. This may contribute to perpetuating the cycle of poverty. (Stress Symptoms by Hedy Marks; reviewed on August 19th, 2012 https://www.webmd.com/balance/stress-management/stress-symptoms-effects_of-stress-on-the-body; Psychological Perspectives by Ben Fell and Miles Hewstone 4th Jun 2015, http://www.who.int/mental_health/policy/development/1_Breakingviciouscycle_Infosheet.pdf).
Studies have shown that the effects of socio-economic status on three categories: Schizophrenia, mood and anxiety disorders, and alcohol and substance abuse. The prevalence of schizophrenia is significantly higher among low-SES individuals. The complex array of causal factors and symptoms for schizophrenia and most psychological disorders means that this association may result from a number of possible causal factors. One theory with relatively consistent evidential support is the 'social drift' hypothesis, which notes that the decrease in SES associated with schizophrenia often occurs shortly after the onset of symptoms. This suggests that the disease may constitute a risk factor for falling into poverty rather than the other way round, as predicted by the 'social causation' hypothesis.
Anxiety and depression have also been associated with a social drift effect. However, the causal role of stressful life events associated with poverty appears to play a much more central role in triggering depressive symptoms.
The association between substance and alcohol abuse and socio-economic status, though prevalent in poverty stereotypes, is somewhat inconsistent. Problem of drug and alcohol use is higher among low SES individuals, but overall addiction rates are still relatively low within this population. There are also significant variations in alcohol and substance use, depending on the length of poverty. For example, one study showed that alcohol consumption decreases following short-term unemployment, but increases with long-term unemployment. Although unemployment is not analogous to poverty, this finding is consistent with explanations of poverty-related behaviors from other areas of psychology, in particular behaviors relating to low self-efficacy and perceived helplessness in the face of stressful situations.
Perceptions of those in poverty are extremely negative; they are stereotyped as lacking competence. Society tends to believe that poverty results from personal failings. Such negative perceptions affect how people experiencing poverty see themselves. They show significantly lower levels of confidence in their own ability to succeed. This has negative physical and psychological health consequences, along with reduced educational and professional attainment. This presents an impediment to policy-makers seeking to tackle poverty. Social contact with negatively regarded groups can help to combat these views and improve attitudes and relations. The prevalence of negative stereotypes of those in poverty may also adversely affect those suffering from economic hardship. Studies show 'self-stereotyping' effects, where stereotypic perceptions of a particular group can influence group members' self-evaluation and actual psychological performance. In the context of poverty, these self-stereotyping effects may be particularly problematic for perceptions of personal responsibility and self-efficacy. Research has shown significantly reduced levels of self-efficacy in people of low SES, and has been associated with poor physical and psychological health as well as reduced educational and professional prospects.
The psychology of poverty has recently changed from conceptualizing poverty as a specific condition affecting a select population. Instead, scarcity (of any resource) is characterized as psychological state that everyone experiences from time to time. When resources (e.g. time, money, food) are scarce, this 'scarcity hypothesis' states that people's attention focus narrows, concentrating on the immediate task at hand (replenishing the limited resource) at the expense of peripheral tasks or long-term planning.
Steps to prevent poverty and mental health issues
CHANGE DEPENDS ON POLITICAL POWER AND DEMOCRATIZATION OF DECISION-MAKING.
Whatever efforts we put toward preventing poverty and mental ill-health, the ultimate goal must be employment.
- Screen patients for poverty.
- Mental health access for low-income children and families in the Primary Care setting; help communities build health clinics, train health care workers and invest in equipment and medicine, so children can grow up healthy and strong, both mentally and physically.
- Invest in high quality childcare and early education
- Improve food security and access to clean water. Eating three meals a day and getting healthy amount of calories and nutrients can go a long way to addressing the cycle of poverty. A person who is hungry cannot concentrate, and lack the strength and energy needed to work. Contaminated water can lead to debilitating illnesses. Studies have estimated that women and girls all over the world end up 200 million hours everyday walking to fetch drinking water.
- Efforts to advocate for better housing and more income equality.
- Child participation: Children must learn their rights and take active roles within their community. Child participation helps children engage in citizenship, express their views and make decisions that will shape their future and influence the people around them.
- Equality and Representation for all: One of the causes of extreme poverty is marginalization; the systemic barriers that lead to groups of people going without representation in their communities. In order for a community or country to work its way out of poverty, all must be involved in the decision-making process, especially when it comes to having a say in the things that determine their place in society.
- Economic security: It means people have the skills and resilience they need to withstand hard economic times and grow their incomes. Everyone should work toward to overcome poverty by helping communities around the world and gain the economic security they need to thrive, this includes training people living in poverty to acquire the skills and knowledge they need to secure a livelihood, and support their families.
- Actively support individuals to get back to the work force when they are unemployed.
- Social safety net: Government interventions during the unemployment phase, financial-support like unemployment benefits and health insurance benefits must be implemented in developing and underdeveloped nations; but also equally important to remain vigilant so that the government aid is not taken undue advantage of by unscrupulous individuals.
- Social support: Anxiety and depression have also been associated with a social drift effect. One common remedy for mood and anxiety disorders is social support. For someone in poverty, however, maintaining strong social networks may exert a negative influence, because members of those networks are also likely to be experiencing poverty. As the same stressors are likely to affect those in the person's social network, this might lead to 'stress contagion'. Further research is needed on why this effect occurs, to find ways to improve the efficacy of social support interventions for low-SES individuals.
- Prevent stereotyping: A potential tool for reducing the negative impact of stereotyping is intergroup contact. One approach, which ties into the benefits of intergroup contact, might be to encourage social support networks that include people from a range of socio-economic backgrounds. These negative stereotypes of people in poverty can potentially severely disrupt attempts to reduce poverty. Social contact with negatively regarded groups can improve attitudes, promote positive emotions such as empathy, and disrupt negative stereotypes. It may be advantageous to include those in poverty as a key target group in attempts to promise social integration.
- Non-financial support for those in poverty could involve boosting appraisals of self-efficacy.
- Only 2% of national health budget is dedicated to mental health.
- 31% countries have no specified mental health budget at all.
- It is estimated that 76% to 85% of people with serious mental health disorders do not receive treatment in developing countries.
- 69% of the beds for mental care health are found to be large psychiatric asylums, instead of general hospitals and community settings; these mental asylums are mostly associated with wide range of human rights' violation.
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