Universal Basic Income and Mental Health

What the history of social psychiatry tells us about preventing mental illness.

Posted Nov 04, 2019

After my lecture to the mental health charity Mind in York, England in July, I've been asked to give a couple more talks on Universal Basic Income and mental health. One was in Dunblane, Scotland for the Royal College of Psychiatrists; another was my inaugural lecture at the University of Strathclyde, in Glasgow. I've copied a link to the talk: here in case you'd like to hear the full lecture.

Essentially, there are four main social psychiatry research projects (concluding that poverty, inequality, and social isolation can lead to mental health problems). In my view, Universal Basic Income can help to alleviate these problems. 

There were four primary research projects that underpinned ideas about social psychiatry and how to prevent mental illness in the United States during the years after the Second World War. The first, Robert Faris and H. Warren Dunham's Mental Disorder in Urban Areas was a study of Chicago and found that people diagnosed with schizophrenia tended to come from the impoverished, chaotic, and transitory areas of the inner city. 

The second was Frederick Redlich and August Hollingshead's Social Class and Mental Illness, which focused on class and inequality in New Haven, Connecticut. The third study was the Stirling County Study, which concentrated on a county in Nova Scotia, Canada, and was led by Alexander Leighton. This study found that social isolation could trigger mental health problems, including anxiety and depression.

The final study was Mental Health in the Metropolis, a project centering on Manhattan, which also found that social isolation could be problematic for mental health, even within a bustling city. Led by Leo Srole, Marvin Opler, and others, the study found that urban centers were not pathological in themselves, despite claims in favor of this idea during the period. The Midtown Manhattan Project also emphasized the role of poverty and established a link between poor physical and mental health. Overall, these studies found that poverty, inequality, and social isolation were all factors in poor mental health outcomes. Although some attempts were taken to address these issues during the 1960s, by the 1970s, much of the momentum behind social psychiatry had waned.  

Today, there are renewed concerns about the rising rates of mental illness, but few people are talking about what's required in order to prevent mental illness. When I think of solutions that might address the poverty, inequality, and social isolation implicated in poor mental health, I increasingly think that Universal Basic Income—or UBI—might be a possible solution. 

UBI provides a guaranteed basic income to every citizen, intended to lift them above the poverty line. Although there are different models of how a UBI would work in practice, the main idea is that the income would be unconditional and that everyone—rich or poor—would receive it (the rich would obviously support such a policy through taxation, so, in effect, would not be getting a net increase in income).

I am also increasingly convinced that one of the factors we need to consider in assessing whether UBI would work is determining its effects on mental health. When UBI pilots have been conducted in Canada, Finland, or elsewhere, mental health is not usually something measured, but it emerges anecdotally when people are asked what it is like to have a guaranteed income. Perhaps not surprisingly, they report that it tends to improve their mental health.

Why might this be the case? Well, UBI helps to address the three social factors implicated in mental illness by social psychiatric research. First, it reduces poverty and, moreover, eliminates the anxiety associated with changes to the welfare system. People simply get their UBI, no questions asked. 

Second, it reduces inequality partly because it is given to everyone, no matter their income, but also—and more importantly—it gives people an opportunity to move up the social ladder by accessing education, starting their own business, engaging in creative or artistic endeavors, and switching careers. It provides an economic buffer so that people can make positive changes in their life. It erodes the despair and hopelessness that is associated with being on the lower rungs of the social ladder.

Finally, it provides people with economic means to engage more in their communities. If people find volunteering on a project to be meaningful or want to spend time caring for family members, UBI allows them to do that. It provides us an opportunity for social and emotional growth, rather than just economic growth.

If the welfare system wasn't bound up so much in determining who deserved benefits and screening those who were deemed to be unworthy, the people working in the system would be able to spend their time actually helping their clients. It would free up a huge amount of human resources to deal with more intractable problems, such as addictions, abuse, and other mental health problems. UBI would also be an enormous benefit to those currently suffering from mental illness and struggling to make ends meet while they try to get better. UBI wouldn't prevent all mental illnesses or solve all of our social problems, but it would give take an enormous load off the system so that it would be easier to deal with the more recalcitrant problems.

Many people in the United States are beginning to hear about Universal Basic Income from Democratic presidential candidate Andrew Yang, who is proposing a $1000/month "Freedom Dividend" for all Americans. As I explain in my lecture, Peace of Mind, it is crucial to consider not only the potential economic benefits of UBI but also the health—and especially, the mental health—benefits. 

Just as mental health professionals, campaigners, patients, and charities need to get bolder about pushing for the progressive social changes needed to prevent mental illness, Universal Basic Income advocates need to start incorporating mental health assessments into their pilots. Most of all, we need to start talking about and trying out progressive new social policies that might help curtail the massive cost of mental illness on society.

References

Smith, Matthew. (2016). A Fine Balance: Individualism, Society and the Prevention of Mental Illness in the United States, 1945-1968. Palgrave Communications. https://www.nature.com/articles/palcomms201624