The blog of the Urban Institute
November 25, 2013

Poverty's toll on mental health

November 25, 2013

One of the most insidious effects of living in high-poverty, chronically disadvantaged neighborhoods is the severe strain these areas have on residents’ mental and emotional health. New research shows that poverty imposes a psychological burden so great that the poor are left with little mental “bandwidth” with which to perform everyday tasks.

The constant anxiety and stress resulting from witnessing and experiencing trauma and violence in distressed neighborhoods, negotiating the sacrifices and trade-offs caused by food insecurity, living in unstable housing conditions, struggling to pay bills, and dealing with numerous other worries burn up cognitive capacity that could otherwise be used for productive activities like navigating public assistance systems, providing for an entire family on a limited budget, and helping children with schoolwork.

For children, the long-term mental health effects of poverty are even more alarming. In addition to occupying cognitive resources needed for education (arguably the clearest path out of poverty), poverty is toxic to children. Persistent stress and exposure to trauma trigger harmful stress hormones that permanently affect children’s brain development and even their genes. The damage to childhood development is so severe that medical professionals now describe the early effects of poverty as a childhood disease.

Bringing mental health services to poor communities

Because of the debilitating cognitive effects of poverty on both adults and children, clinical mental health services are a central component of the Urban Institute’s Housing Opportunities and Services Together (HOST) demonstration. HOST is testing an intensive, dual-generation, case management model for children and adults who live in public and mixed-income communities suffering from concentrated poverty, chronic violence, and low levels of trust and social cohesion. HOST’s coordinated and comprehensive place-based intervention aims to stabilize whole families and improve a range of educational, health, and employment outcomes.

Baseline survey data from the first two HOST sites—Chicago’s Altgeld Gardens, a large public housing development that has high rates of crime, and Portland’s mixed-income New Columbia and Humboldt Gardens—clearly illustrate a relationship between distressed neighborhoods and mental health. Rates of elevated worry among HOST adults in both sites are up to six times higher than rates among adults nationwide, and depression among adults in the Portland site is nearly four times more prevalent. Even more disturbing, youth in the Chicago HOST site experience long-term anxiety and worry at levels seven times higher than those of youth nationwide.

What the findings from the HOST baseline survey and the research on the cognitive effects of poverty make plain is that mental health services are desperately needed in poor communities. Addressing trauma and mental health problems is critical to facilitating healthy brain development in poor children, freeing psychological bandwidth for schoolwork, and preparing children to overcome the challenges associated with extreme poverty. Similarly, adults need help coping with the mental taxation, stress, and anxiety of poverty so they can focus on becoming self-sufficient.

HOST families are offered mental health services designed to address the multiple chronic stressors that exist in their communities. As worry and anxiety decreases, we hope to see greater education and employment outcomes among adults, and, among children, increased academic achievement, and fewer incidences of risky behavior. Lessons learned from HOST will help inform policymakers who are interested in lessening the mental toll poverty exacts from the most disadvantaged.


Photo by Charles Rex Arbogast/AP


As an organization, the Urban Institute does not take positions on issues. Experts are independent and empowered to share their evidence-based views and recommendations shaped by research.


Any financial stress adds difficulty and anxiety. The problem is with today's programs, we are very likely to simply export the problems of one are to another. Seen it in my town. Our mayor about 15 years ago took a growing area and destroyed it as she moved section 8 housing closer to the "better" areas. Drugs and crime followed the housing. The key is safety. Everyone, poor or rich, deserves the protection of our government from predators. We seem to be able to provide shelter and food, but not safety. These anxieties are not limited to the most disadvantaged. You are blind if you think those in poverty are the only ones experiencing it.
Agreed, but it isn’t enough to treat kids after they have been exposed to toxic stress.
I am happy that the conversation and research has begun. It has been apparent to me for many years that entire communities are experiencing behavioral health challenges as a result of the culture of poverty. It has also been my clinical assessment that most individuals in these communities are not aware that they are experiencing behavioral health challenges because so many others around them demonstrate a similar affect and demeanor so they tend to view their feelings and behaviors as normalcy.
Agreed, but it isn't enough to treat kids after they have been exposed to toxic stress. Why are we are leaving kids in damaging environments? Every poor family living in an high poverty neighborhood should be offered a chance to move their kids out of harms way if they wish to do so, i.e. through mobility vouchers, building affordable housing in higher opportunity areas, etc. This is a feasible task if we start with families who have kids under six, the most critical age for brain development, now living in neighborhoods with >30% poverty.
I am curious in finding out what will result from intervening mental health issues with financial coaching skills. This is great knowledge to have as I strive to combat poverty over the long run.
I don't know what Susan means by "mobility therapy" and perhaps she is just using the term rhetorically. If she means mobility counseling programs, there a large and quite successful programs currently operating in Dallas and Baltimore, as well as earlier programs in other cities. Also, HUD and PHAs rarely, if ever, relocated public housing residents to "opportunity neighborhoods" when they demolished public housing and displaced the residents. As a rule, they were displaced/relocated to other public housing or nearby distressed neighborhoods. To say that public housing residents then 'wrought damage' to those developments and/or neighborhoods is urban myth, not supported by evidence.
I agree with Barbara. If the cause is poverty why are we providing mental health services and not more substantial structural changes that would help allieviate poverty and strengthen children and families? This boils down to the old argument of giving a fish (or mental health counseling) or teaching folks how to fish successfully. Of course poverty has long ranging effects that take up bandwidth; however this vicious cycle will continue unless we do something drastic to reverse it.
The answer to poverty is higher wages and better schools. Mobility therapy has been an abject failure. The so-called culture of poverty is a fiction designed to cover lack of restraint of the truly pathological sectors of our society, especially investment funds and banks that have stolen literally millions of homes and wrecked our economy. These folks should be held accountable for all of the damage they have wrought in the alleged "opportunity neighborhoods" where former public housing residents were relocated.