Is There a Link Between Poverty and Schizophrenia?

Mental health and poverty have a cyclical relationship, but people affected by schizophrenia are often worst hit.

Schizophrenia – among the spectrum of mental health disorders, it’s this word that fires up our imagination the most. The imagery associated is one of someone unhinged and dangerous, and is often confused with split personality, thanks to the many media portrayals.

In short, we think of someone who needs to be kept at bay to protect ourselves.

But when has ostracising someone ever helped? Rajvi Mariwala, director of the Mariwala Health Initiative tells FIT that the stereotypes are misleading and harmful.

TLDR? Listen to the story here:

‘Unpredictability’ and violence are dominant stereotypes associated with schizophrenia and persons labelled as such may find themselves being distanced and risk being monitored or seen by others as threatening or dangerous. An Adivasi man from Kerala, Madhu, was killed by a mob - because he was labelled and seen as abnormal. 

Rajvi Mariwala

But What Does Poverty Have To Do With It?

In our 1.24 billion plus country, over 42% lives below the poverty line. According to a 2018 study by Dr Sriram of the University of Southern California, mental health disorders affect 13.7% of us, and because we aren’t addressing this enough, it has been called India’s silent epidemic.

If an individual is associated with a label of schizophrenia - there is social exclusion from neighbourhood, community,  as well as employment, housing and public services including physical healthcare.

Rajvi Mariwala

A Cyclical Relationship

Mental illness, especially when undiagnosed, can cause homelessness and plunge the survivor into poverty because of the strongly associated stigma and ostracisation.

Mary Stella of The Banyan, an NGO that works with mentally ill homeless women, tells FIT that “Many people become homeless because of their mental illness. Some of the women we rescue have run away while in some cases the family does not care or cannot afford healthcare.”

The high medical cost is prohibitive to many people with mental illness. Mariwala breaks down the reasons they might become homeless.

1. “The average monthly costs of accessing mental health care and medication for conditions like schizophrenia can be a minimum of Rs 2500 per month which is unaffordable for many.
2. Additionally, a label that is connected to schizophrenia (many may never reach a stage of being diagnosed) would greatly affect family life, social interactions, possibilities for education and employment. Due to the prejudice and stigma, people may never be able to access employment in the first place.
3. Additionally, families may become hostile and violent towards persons with schizophrenia – which could lead to homelessness.”

Stella adds that a huge focus of the organisation she works with is to rehabilitate the mentally ill women with their families; “90% of the time they go back,” she says.

Most often, the women are untreated and run away, but after finding them and their families and consulting with them, it is possible to reunite them says Stella.

We provide free treatment for two months, and sensisitise the family so it is easier for the woman to go back.

Stella

The Other Side of the Cycle - Schizophrenia Worsened Through Poverty

Dr Sriram’s study also adds that it is worth looking at it in reverse as well, so investigating the reasons behind poverty can often bring up undiagnosed cases of mental health.

“Unaddressed poverty leads to common mental disorders or CMDs,” says the study.

Mariwala also adds that schizophrenia can often be exacerbated by poverty, in the other side of the cycle.

[Mental illness is affected by] Variables that are themselves related to poverty such as violence, neglect, adverse life experiences, trauma, unemployment and intersects with marginalisation by caste, gender, sexuality, ability and class. Such inequality may leave an individual with heightened vulnerability to chronic stressors and can be a significant range risk factors for schizophrenia.

Mariwala

The Way Ahead

Mr Bhakshy, president of NGO Schizophrenia Awareness Association (SAA), tells us that the law is built to help people overcome the high cost of medication, “People below the poverty line are entitled to free treatment for mental health illness in a government hospital. Additionally, anyone can avail free essential drugs.”

He also adds that the policies have improved with the new Mental Health Care Act (2017) which says that mental health has to be covered under insurance policies.

The 2018 study still asserts that government policies should do more, especially given that stigma and that mental health isn’t prioritized within the community, “the government should allocate more resources to improving access to mental health and take appropriate poverty alleviation measures.”

The study goes on to say that besides “protecting the human rights of its citizens,” this will benefit the strength of the country, as “improved mental healthcare will save costs and result in better economic gains and a healthier population.”

Non-governmental organisations like The Banyan and SAA and many more, are also instrumental in bridging the health care gap.

Mr Bhakshy offers a case study example saying that one Radha Rane* (name changed) from Pune, Maharashtra, is a caregiver of her two children, both living with schizophrenia. Her husband is a construction worker on daily wages, and SAA has waived the tuition fees and travel charges of their daughter who attends SAA’s rehab Center.

Another way to move forward is to create a care economy, where community members are sensitised to the survivor and their needs, and so through awareness and empathy the stigma slowly fades away.