Mental health is often viewed as something that impacts individuals. But mental illnesses and the stigma surrounding them don’t exist in a vacuum. Numerous societal factors color the experience of those living with mental health challenges, and disparities beyond an individual’s control can determine their ability to pursue stability.
Issues such as poverty, lack of affordable housing, inadequate access to health care and racial discrimination often converge to create a mountain of hurdles for many who deal with mental health conditions. Let’s take a look at three examples that demonstrate how challenges bigger than any one person make mental health a matter of social justice.
Lack of Affordable Housing
Having a safe, stable place to live is a major factor in a person’s ability to build healthy habits and stick to a treatment plan. The poverty faced by many dealing with serious mental illnesses severely limits their options for secure housing, which in turn puts them at a major disadvantage in pursuing stability. Many are unable to work and rely on public assistance, receiving no more than $841 a month, and rent is out of reach.
According to the National Low Income Housing Coalition, only 37 affordable and available rental homes exist for every 100 extremely low-income renter households nationwide. In the Dallas area, even fewer units exist: just 21 for every 100 households that need them. This lack of low-income housing presents a serious challenge that often forces those struggling with serious mental illnesses into homelessness.
The impact of this housing shortage is seen in the high prevalence of mental health conditions among the homeless population. In the 2021 Metro Dallas Homeless Alliance point-in-time homeless count, 24% of North Texans experiencing homelessness said they lived with a serious mental illness—four times the rate of these conditions within the general population. And the daily challenges of housing insecurity further impede these individuals’ ability to manage their illnesses. “It’s incredibly difficult for someone without a safe, consistent place to live to take steps toward stability,” says Alice Zaccarello, Executive Director of the Well Community. “Homelessness ties their hands and robs them of options.”
Jacob’s House, the Well’s City of Dallas licensed boarding home, plays a small role in addressing the challenge of housing for those living with serious mental health struggles. It provides a place to call home for up to eight men who would otherwise be homeless, as well as offers support from caring staff and an environment where other understand and accept them.
Inadequate Access to Care
A study conducted by the Cohen Veterans Network and National Council for Behavioral Health revealed that 53 million American adults (21%) have wanted to see a mental health care professional for themselves at some point but were unable to do so for reasons outside their control. This study cites the cost of care as the top barrier. A quarter of respondents have had to choose between getting mental health treatment and paying for daily necessities, and one in five have had to choose between seeking care for a physical health condition and a mental health condition due to cost.
Lack of equal coverage for physical and mental health issues often makes mental health services unaffordable, but even those with excellent insurance frequently struggle to receive care. The National Alliance on Mental Illness (NAMI) states, “People who seek treatment must navigate a fragmented and costly system full of obstacles. As a result, many people cannot access mental health care when they need it most.”
The nationwide shortage of mental health care providers—a problem that’s especially pressing in Texas—makes it difficult for many seeking treatment to find a doctor in their area who’s accepting new patients. Many are forced to travel long distances or pay more to see an out-of-network provider. And many others simply go without care.
Incarceration in Place of Treatment
Lack of access to affordable care is closely linked with another factor that stands in the way of stability: Far too often, those who need and want treatment end up in jail instead. When symptoms worsen because individuals are unable to obtain the right medications or participate in therapy, those struggling with mental illnesses are more likely to have run-ins with law enforcement.
Compounding this issue is fact that law enforcement agencies aren’t designed to serve as first responders to mental health crises or as providers of mental health care over the long term. Yet doing both has become the norm. NAMI reports that people living with serious mental illness are booked into jails about two million times each year. Among those who are incarcerated, two in five have a history of mental illness, making mental health conditions twice as prevalent among those in prisons and jails as in the general population. For many, problems with the law begin early: 70% of youth in the juvenile justice system have a diagnosable mental health condition.
Once someone is behind bars, there’s a high probability that they won’t receive the care they need. According to NAMI, about three in five people (63%) with a history of mental illness do not receive mental health treatment while incarcerated in state and federal prisons. This lack makes it incredibly difficult or impossible to pursue mental health stability.
However, there’s a silver lining. If mental health is an issue of social justice—one that impacts everyone in society—then everyone can play a role in helping to address it. Each one of us can take steps to become better educated about the systemic factors that compound mental health challenges, fight stigma and advocate for those who deal with mental illness. The more of us who do, the more we can pave the way for those who are struggling to pursue stability.
The Well Community continually works to address the overlapping issues facing those living with mental illness, seeking to be a place where they are welcomed and served with equity. In 2021, 43% of those served by the Well were Hispanic, 28% were Black and 28% were white. “We’re grateful to be able to continue to provide a place where they belong and are seen as whole people dealing with multifaceted challenges,” says Zaccarello.
By providing ongoing support and resources, the Well helps members achieve stability, positioning them to better overcome the societal roadblocks in their path. And through advocacy and increasing understanding of mental illness, it’s helping to fight the prejudices that contribute to these challenges.