Mental Hralth Matters: Who should pay for more mental health programs?
June 4, 2015
I trust you noticed the eye popping Executive Compensation packages for 2014.
David Zaslav of Discovery Communications received total compensation of $156 million; Mario Gabelli, CEO of Gamco Investors, hauled in $89 million; and, rounding out the top tier of 14 executives, Joshua Sapan of AMC Networks and Marc Benioff of Salesforce tied at a paltry $40 million.
And that's just for one year!
Well, you say, so what? First of all, they were "paid only what they are worth." And, " You're just jealous." And, "Anyway, it's no skin off your back." And so on, and so forth.
Maybe. But when you measure the pay packages of the top 200 highest paid executives, and then add in the even more astonishing income of the top 25 hedge fund managers who took in a combined $11.62 billion last year, you're talking some very serious money.
Looking only at the Wall Street bonus pool for 2014 we learn that it was roughly twice the total annual income of all Americans working full time at the federal minimum wage level!
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I'm not picking on any person or group here. The numbers are illustrative of how the 1 percent got there.
And in one sense, bully for them. It's nice to have all that money. And wouldn't you know, the higher your financial worth, the lower the incidence of mental illness. It turns out that money can buy happiness after all.
Here's where it gets interesting. There is a constant finding in social science research about wealth and mental illness and it's this: The prevalence of mental illness is highest among those with the lowest family income and lowest among those at the highest income levels.
Those in the lowest socioeconomic strata are two to three times as likely as those in the highest strata to have a mental disorder (U.S. Surgeon General, 1999).
Researchers correctly note that association does not imply causation. A minority viewpoint holds that mental illness results in the drift of people into poorer socioeconomic circumstances.
Certainly, there is some clinical support for this theory. Mental health clinicians see clients who were doing relatively well socioeconomically, developed a mental disability, and then fell down the socioeconomic ladder.
But most of the research concludes that low socioeconomic status is a powerful predictor of subsequent mental illness.
If you have ever done mental health work in a poor neighborhood, and I have, you know that socioeconomic conditions like rundown and overcrowded housing, drug dealers, inferior education, disconnected youth with few skills and contempt for low wage work, low income, a sub culture of violence, and absent parental supervision or knowledge about healthy parenting, contribute to the stresses causing mental illness.
OK. Now we know that poor people have much higher rates of mental illness and that socioeconomic conditions contribute to these disorders.
We also know that public metal health services at all levels of government have been decimated in these last 40 years.
So, assigning more dollars to mental health programs would be helpful. But that's just tinkering, and, inefficient tinkering at that.
For one thing, many of the mental health problems of low and moderate income people are situational and stem from things like job loss or inadequate wages.
"Talk therapy" and pharmaceuticals are much less effective in these circumstances than supplemental income.
For another, the severely mentally ill, who presently consume out sized resources, need medication and housing and proper nutrition.
In theory, I really don't care how much the 1 percent have. I do care about the mental wellbeing of people though, and I know that many of the socioeconomic causes of mental illness are correctable. But it will cost money, a lot of money.
Nicholas Kristoff, writing in the New York Times on May 3, 2015, says, "We as a nation have chosen to privatize tax shelters over minimum wages, subsidies for private jets over robust services for children to break the cycle of poverty. And the political conversation is not about free rides by corporations, but free rides by the impoverished."
He then adds that Congressional leadership continues to support the carried interest loophole for billionaires while hoping to slash estate taxes on couples with estates worth more than 10.9 million.
There aren't many Mother Teresas of this world and, so far as I know, greed is part of the human condition.
Charity is wonderful, but it only gets you so far. Indeed, America is arguably the most charitable nation on earth, yet material poverty remains stubbornly endemic in our democracy, ultimately wrecking havoc with how we see ourselves and how the rest of the world sees us.
To counter the anguish of mental illness on the front end before life falls apart, I offer a Marshal Plan For the Masses. My plan provides decent jobs at livable wages, massive injections of aid to education, armies of health care worker's to assist and educate parents and families in need.
And how to pay for this? Extract a progressive tax on the 1 percent or 2 percent or more, whatever the number needs to be, to help those most in need of help.
Call it "class warfare" or "income redistribution," but I see it as a continuation of national policy, but now, instead of offering a leg up to the wealthiest among us, we offer a leg up to those who actually need it.
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. His column focuses on drugs, mental health and substance abuse in an effort to raise better awareness. He can be reached for comment at email@example.com.