Hannah Barker

Mental Health Services for Low Income Families

Introduction
This paper will focus on identifying the lack of mental health services
for low income families, as well as the effects of this disparrity. Mental Health
Services include having access to a mental heath provider on a regular basis,
receiving crisis counseling, and getting access to available family and
individual resources. The purpose of this review is to highlight that low
income individuals, both children and adults, are generaly lacking proper
access to mental health services.
In King County, the Department of Community and Human Serivces
offers behavioral health and recovery services to those with low income,
however, there are restrictions put on these services (Community and
Human, n.d.). A person must have an income below a certain level and have
a recorded mental health diagnosis that imparis their daily life. Certainly
many people go day to day through their routines, while still suffering from
mental illness. Additionally, children are sometimes in need of counseling
and resources, to the same extent as the adults are. Looking across the
literature at commonalities found for this population and this subtopic with
exemplify the problem being faced. The city, state, and national level of this
disparity will be examined in this review. After evaluating what the problem
is, steps can be taken to evaluate how the issue can be faced or resolved.
Population Impact

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The population being looked at are adults and children (families) with
legal low-income status. These impoverished families are at higher risk for
mental illness, yet it is shown that they are less likely to receive proper
access to services (Gonzalez, 2005). It is also possible that the families or
adults unisured status may cause less utiliation of the mainstream mental
health resources (Busch, 2004).
In King County population, 12%...are considered very low-income (A
Look, 2014). The mediam income in King County for a family of four is
$86,000 (A Look, 2014). The mediam income for an individual in king county
is $60,700 (A Look, 2014). Households which earn 30% of the area mediam
income or less than that are the population that are considered to be very
low-income. Overall for the United States, the Department of Housing and
Urban Development, or HUD defines what is extremely low income as a
household income below 30% of the area median income (DeNavas-Walt,
2015).
In Washington state, as of 2014, one in seven people, or 14.1% in
Washington State are living below the poverty line. For reference, a family of
three that is earning less than $19,530/year meets the poverty line (A Look,
2014). Additionally, child poverty in Washington is currently at 18%
(DeNavas-Walt, 2015). At an even higher percentage, about 20%, of children
live in a household with food or basic need insecurities (DeNavas-Walt,
2015).

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On the national level, poverty can be looked as a something that
affects a significant portion of the population. The official national poverty
rate for the U.S. is 14.8%, and equating to as many as 46.7 million people
(DeNavas-Walt, 2015). Looking specifically at children, the national poverty
rate is 21.1%( DeNavas-Walt, 2015).
Relating this data to mental illness, data support that children across
the country do not receive proper mental care. Research suggests that, only
one in five children in need of mental health treatment will receive care and
that the current needs continue to be unmet (Gonzalez, 2005). Additionally,
urban children of color have more built barriers in terms of economic
disadvantage and overall health disparities. Certain barriers such as
economic deprivation and poor access to culturally competent health
services are specific to this group and others suffering from poverty and
deprivation (Gonzalez, 2005).
Mental Services are necessary for the whole population, however,
those who are experiencing poverty and are categorized as low income may
not have proper access to mental health services. In addition, low
socioeconomic status can have a negative effect on mental health. Within
the U.S., almost a third of the population suffers from a mental health
disorder. Upwards of eight million Americans with serious mental illness do
not receive the proper preventative and ongoing treatment, commonly
because of lack of insurance or limited benefits (Community and Human,
n.d.). On average, one in five U.S. households has at least one uninsured

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member, which can cause serious financial drain when that individual needs
care (Community and Human, n.d.). Untreated mental illnesses may end up
costing the individual and the government much more than preventative
care would have. The U.S. loses $150 billion in lost productivity due to
untreated and mistreated mental illness every year (Community and Human,
n.d.). Recognizing the harm of ignoring mental illness, especially in
vulnerable populations such as those with limited financial means, is
necessary in order to make changes to policy to address and correct these
problems.
Commonalities Across Literature
Looking through the avaialbe literature, commonalities can be found
between articles addressing the issue of mental health services and mental
illness plaguing low income individuals. Each article offers a unique
perspective on the issue, and oftentimes they focus on different aspects of
the issue. This section of the paper will summarize some of the relevant
literature, as well as identify similar findings found across research.
Busch et al. looked at the effects of uninsured children not having
access to mental health services. The data shows that estimates of the
amount of children suffering from psychiatric disorders falls around 20%,
however, only 4-7% of children are utilizing services (Busch, 2004). Busch
suggested the two major financial components that impact childrens access
to the care they need are set mental health care financing and limited
budgets for state-funded programs for mental health services. This study

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used surveys to evaluate childrens insurance status, usage of mental health
services, and demographics. The study found that children who had mental
health visits were more likely from a family with a single parent, have no
foreign-born relatives, and were free of any serious health condition that
could effect daily life and functionality (Busch, 2004). Having foreign-born
relatives associated with a lower number of mental health visit touches on
issues of refugees experiencing poverty, and consequently increased
incidence of mental illness (Kaltman, 2011). On behalf of insurance, the
results showed that those who were uninsured were less likely to report
mental health needs, and they had an overall reduced amount of access to
services (Busch, 2004). Goodman also discusses lack of economic means as
a barrier for treatments for both adults and children living in poverty.
A second article on access to mental health serives for low-income
children written by Manny Gonzalez explored similar issues as Busch.
Gonzalez introduced the problem of access to mental health services for
children living in urban setting (and particularly for children of color) as a
social problem. These children are disproportionately affected by an array of
mental health disorders, including depression, ADHD, and anxiety (Gonzalez,
2005). Gonzalez identified the barries to mental health care by for these
children as lacking access to material and community resources, lack of
health insurance, unflexible work hours for parents, a lack of culturally
competent mental health serivces, and stigmatization of mental illness
within the family and the community (Gonzalez, 2005). Similarly, Goodman

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points out that issues within the health care system that are inherently
disciminatory may cause negative effects on the population. Gonzalez
suggests that moving forward, various changes in practice and written policy
could be enacted in order to provide more competent care. A special
emphasis is put on the usefulness of utilizing social work as a mediary for
providing this care.
Goodman et al disucsses the shortcomings of current mental health
practice when it comes to addressing needs surrounding poverty. The article
highlights the lack of effort on behalf of mental health professionals at
developing new and creative intervnetions surrounding mental health
specifically for the unique experices of low-income families. Current
utilization rates of mental health serivces for poor communities is much
lower than the middle-income or high-income communities. However, the
stressors that accompany poverty are known be associated with poor mental
health. Goodman highlights that the psychosocial implications of material
deprivation can have a great impact on mental health. Specifically, chronic
stress and strain from issues such as food insecurity or unsafe living
environments have been linked to traumatic experiences and onging
negative emotional responses. Gray and Price, and Kaltman all touch on the
importance of addressing traumatic experiences or events within
implemented mental health programs. Social isolation and social exclusion
for people in poverty causes a lack of necessary emotional and material
support. Additionally, feelings of powerlessness due to a limited number of

Hannah Barker
ways to have control over their lives lead to mental health issues and
psychical health issues over time. The barriers to treatment pointed out in
this article include practical barriers such as lack of insurance and cost of
treatment, and social and psychological barriers including distrust of
authority figues. Overall, those in poverty experience many sociocultural
stressors that may give way to mental health difficulties, and these complex
needs should not be ignored. The suggestions made for future improvements
by Goodman highlight the need for class-competent practice so that each
individual sociocultural setting can be considered sensitively. Suggestions for
community-level interventions were also included in this article, much like
the program researched by Gray and Price.
Gray and Price tested implementing an evidence-based intervention for
providing mental health services to a maternal and child home health-visiting
program. Not getting proper access to care and support for their condition
may lead to a worsening of their mental health or an effect on other aspect
of their lives like job stability, ability to care for children, and more. Like
Gonzalez, this article highlighted an intervention based in social work as a
feasible intervention to address this issue. This research tested the
Enhanced Engagement model, with a focus in community-based
participatory research. This model includes a social-emotion assessment and
life events checklist to help track the flow of mental illness and the care still
needed. Reminiscent of the suggestions made by Gonzalez, the model was
optimistic about utilizing social workers ability to reduce mental health

Hannah Barker
stigma and provide short-term mental health care when within low-income
communities for women and children.
Kaltman et al found that mental health issues that are known to affect
low-income immigrant populations include depression disorders, anxiety
disorders, ADHD, and general psychosocial dysfunction. Added trauma for
immigrant/refugee families, which make up a significant proportion of lowincome families, may reflect in PTSD rates for this population. Much like nonimmigrant low-income populations, stress due to food insecurity and an
increased risk for traumatic experience can lead to mental health stressors,
which is a relatively consistent finding across the literature. In order to
effectively engage this population, researchers tested the collaborative care
model, which utilized different health professionals over an extended period
of time to treat mental illness, such as depression. The research found that a
stronger focus on community-based mental health care was needed for this
population, and that policy changes could contribute to future successes in
this field. Incorporating the need for cultural competency within this
presented framework for change would support the same suggested
intervention as Goodman.
Identifiable Causes
There are multiple factors that contribute to the disparity in mental
health occurrence and access to services among low-income families.
Insurance status, poor relationship with providers, added stress from
financial strain, and a lacking of cultural competency in the medical field all

Hannah Barker
contributes to the issue. Not being insured makes it more difficult to access
mental health services, which is a common issue faced by low-income
families (Busch and Kaltman). Uninsured individuals often have to pay out of
pocket for their expenses, which can be quite costly and unobtainable for
many people. Additionally, a lack of preventative care can cause the issue to
exacerbate, creating a more serious issue to deal with later on in the illness
progression. Treating mental illness that has progressed to this more serious
level may be more difficult for doctors and therapist, as well as cost more for
more intensive treatment. Experiencing poverty comes along with many
stressors including food insecurity, living paycheck-to-paycheck, and
struggling to cope with sociocultural settings (Goodman). All of these
poverty-associated stressors contribute to mental illness prevalence in
particular populations with this predisposition. Distrust for mental
professionals on the basis of prior experience or discrimination may play a
role in why these populations are lacking proper services (Gross). Previous
visits to doctors who do not speak the same language, or understand cultural
traditions surrounding medicine may lead to negative experiences. A lack of
understanding by medical staff could stem from ignorance or stigma
associated with certain races, religions, or signs of low socioeconomic status.
Not all current mental health services have cultural competence to deal with
immigrant and refugee populations, which are commonly found in lowincome housing (Kaltman). It would be important to address these issues in

Hannah Barker
order to truly get at the causes of the mental health disparity seen among
low-income families through research.
Conclusion
Overall, the economic cost of not getting mental health services to lowincome families and children in poverty would result in those individuals
experiencing a failure to thrive and contribute to society. With the burden of
mental illness, individuals may have more difficulty going about with day-today life. If mental health status interfered with the ability to do a job, then it
could hurt the individuals on a financial level to not get treated. Statistics
shown earlier exemplified the financial burden of untreated mental illness on
individuals, families, and even the government. Providing mental health
services to uninsured people, for a low cost or free of charge may be costly
to fund; however, the financial savings overtime would allow for monetary
returns in the areas currently being drained.
There are long-term health impacts that go along with mental illness as
well as a worsening of mental status that can occur if the issue is not
addressed and treated. These impacts not only affect the one suffering, but
they can have a negative impact on the family of the individual, all of their
dependents, and their community as a whole (Gross). Children in these lowincome families are especially vulnerable. Children in poverty have shown to
have higher rates of depression, anxiety, social withdrawal, peer conflict,
and aggression (Gonzalez). This, in turn, affects the ability of these children
to perform well in school, on standardized testing, and make it to graduation

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(Gonzalez). In order to see future generations thrive, and rates of mental
illness to go down (or rates of stabilization to go up), the approach taken
should be proactive and immediate at addressing the most at-risk and
underserved populations.
Relevancy and Research Gaps
Looking at the findings of this review in the context of the work I am
engaging in at Ballinger Homes highlights the importance of providing
mental health services to children in low economic settings from a young
age. The program in which I participate would make a great setting for this
kind of work to begin early on. Attacking the issue in a preventative manner
would help reduce the overall rates of mental illness in the population, while
continuing to focus on the most vulnerable groups. Gaps still exist in the
research in regards to evidence-based results of community vs. individual
intervention programs within low-income groups, and divided into child
programs and adult programs. Each new study done is one step closer to
finding the best method to deal with this widespread issue.

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References
A Look at the Challenges Facing Low Income Kids and Families. (2014,
September). Retrieved March 9, 2016, from
http://budgetandpolicy.org/schmudget/WA_poverty_factsheet.pdf
Busch, S. (2004). Access to Mental Health Services: Are Uninsured Children
Falling Behind? Mental Health Services Research, 6(2), 109-16.
Community and Human Services, D. (n.d.). Behavioral Health and Recovery
Services. Retrieved March 30, 2016, from

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http://www.kingcounty.gov/healthservices/MentalHealth/Information.as
px
DeNavas-Walt, C., & Proctor, B. D. (2015). Income and Poverty in the United
States: 2014. Current Population Reports. Retrieved March 8, 2016,
from
http://www.census.gov/content/dam/Census/library/publications/2015/d
emo/p60-252.pdf
Gonzlez, M. (2005). Access to mental health services: The struggle of
poverty affected urban children of color. Child and Adolescent Social
Work Journal, 22(3), 245-256.
Goodman, L., Pugach, M., Skolnik, A., & Smith, L. (2013). Poverty and Mental
Health Practice: Within and Beyond the 50Minute Hour. Journal of
Clinical Psychology, 69(2), 182-190.
Gray, L., & Price, A. (2014). Partnering for Mental Health Promotion:
Implementing Evidence Based Mental Health Services Within a
Maternal and Child Home Health Visiting Program. Clinical Social Work
Journal, 42(1), 70-80.
Gross, D., Belcher, H., Ofonedu, M., Breitenstein, S., Frick, K., & Chakra, B.
(2014). Study protocol for a comparative effectiveness trial of two
parent training programs in a fee-for-service mental health clinic: Can
we improve mental health services to low-income families? Trials, 15,
70.

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Kaltman, S., Pauk, J., & Alter, C. (2011). Meeting the Mental Health Needs of
Low-Income Immigrants in Primary Care: A Community Adaptation of
an Evidence-Based Model. American Journal of Orthopsychiatry, 81(4),
543-551.

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