A looming recession threatens Americans’ already precarious mental health

Story at a glance

• When the economy takes a turn for the worse, deaths of despair — or overdoses, suicides, and substance abuse-related deaths — tend to rise.

• As the nation struggles to meet increased demand for mental health care resulting from the pandemic, a potential recession could exacerbate these challenges.

• But improving communication and broadening access to services can help mitigate negative health repercussions likely to take place should the economy continue to decline.

In the past, recessions and economic strife have been linked with worse mental health outcomes, higher rates of substance use, and in some cases, increased suicide rates.

Now, as the nation already grapples with heightened inflation, the threat of a recession, and any lingering effects of the COVID-19 pandemic, the United States’ mental health care system finds itself understaffed and poorly positioned to meet any additional demand.

“The mental health system has yet to be able to meet the demand of communities since its beginnings,” said Benjamin Miller, a psychologist and president of Well Being Trust in an interview with Changing America. “We’re always playing catch up.”

The Well Being Trust is a foundation that works to advance Americans’ mental, social, and spiritual health with a specific goal aimed at addressing deaths of despair.

The term “deaths of despair” was first coined by economists Anne Case and Angus Deaton who began researching the reversal of life expectancy gains seen around the year 2000. These deaths were largely driven by alcohol-related liver disease, drug overdoses, and suicides, and were concentrated among middle-aged, white American men with less than a four-year college education.

According to Case and Deaton, loss of manufacturing jobs in rural America played a big role in the life expectancy declines.

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“Destroy work and, in the end, working-class life cannot survive. It is the loss of meaning, of dignity, of pride, and of self-respect that comes with the loss of marriage and of community that brings on despair, not just or even primarily the loss of money,” they wrote in their 2020 book on the subject.

Even as the racial makeup of overdose deaths has diversified in recent years, deaths of despair consistently take a toll on men’s life expectancy.

U.S. men also happen to have overall worse health than those residing in other high-income countries, and higher rates of completed suicides than women due to the often-lethal means employed.

Taking all this into account, major events like COVID-19 and recessions “put more pressure on an already fragile system,” Miller said. “If you want to see the most significant fissures, the most significant cracks, watch what’s about to happen.”

One study published in 2018 in the British Journal of Psychiatry found the 2008 Great Recession was linked with at least 10,000 economic suicides in the two years immediately following the downturn.

More recently, published studies have documented Americans’ high anxiety rates over inflation and overall worsening mental health.

At the beginning of the COVID-19 pandemic, Miller and colleagues used the 2008 recession as an almost proxy to anticipate what toll financial repercussions would take on the United States’ psyche.

But because the economy recovered relatively quickly from initial COVID-19 shutdowns and job losses the country now finds itself at a “unique moment” for mental health, Miller said.

Increases in depression, anxiety, and drug use that occur during economic downturns could be due to worries often coupled with financial insecurity, but also a lost sense of purpose or community among those who lose jobs. High consumer debt resulting from home buying difficulties, not to mention home foreclosures, could also contribute to these conditions and behaviors.

For some men, these economic challenges lead to particularly acute responses, as many see themselves as the primary breadwinner for their families. Men are also more reticent to talk about mental health issues in general, Miller said, “and that’s just due to the social stigma that’s been so pervasive.”

These risk factors underscore the importance of tailoring interventions to certain populations and open a window of opportunity to better address Americans’ deteriorating mental health.

Since researchers began investigating deaths of despair in the early 2000s “we’ve learned which populations are at higher risk. We’ve learned what certain risk factors are that could lead to a death of despair,” Miller explained. “But what we have not done yet is robustly move to a place where we’re changing the system so that it can accommodate all these people that are in need.”

This includes improving access to mental health care by increasing affordability and bolstering the workforce, but it also constitutes better communication of mental health risks accompanying economic downturns and being proactive to target at-risk populations.

In 2020, less than half of U.S. adults with a mental health condition got care, while in 2019, just over 12 percent of those with a substance use disorder who needed treatment received it at a specialty facility.

“One of the greatest mistakes that we’ve had as a country is that we don’t often message the power of mental health, especially in these moments, and we don’t point people towards the solutions that can help them,” Miller added. However, the national roll out of the new suicide prevention hotline this month does mark a step in the right direction, as does passage of the Bipartisan Safer Communities Act.

The act, which became law in June 2022, calls for expansions of community and school-based mental health services.

But in addition to all these solutions, Miller stressed the most important action one can take is talking to others about mental health.

“We need to be comfortable sitting down at the dinner table and telling our loved ones what’s really going on in our lives,” he said. “Even if you don’t know what to say, or you don’t know what to say to the person who’s talking to you, being there and listening has power unto itself.”

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