Dealing with the current global pandemic isn’t easy for anyone, but for people with mental illness, who are more likely than others to be poor and struggling financially, it is likely even harder. It is essential that banks and credit unions understand the particular difficulties faced by people with mental illness, and respond in innovative ways to ease the burden.
Some mental health consequences of the COVID-19 public health crisis are probably obvious to most of us. Anxiety about oneself, friends and family getting sick, loneliness due to social distancing and difficulty shopping for essentials; we all have some idea of what that feels like by now. But people with mental illness are likely facing additional challenges. People who are anxious at the best of times may be overwhelmed right now, and everyday loneliness that people usually manage through going out regularly and interacting with people they pass by may be particularly acute. It may no longer be possible for them to attend regular healthcare appointments or participate in therapeutic groups. While service providers are doing their best with telephone calls and zoom meetings, it is not the same as the in-person connection.
There is a strong association between mental health and poverty (Vick et al 2012, Richardson et al 2017). People who are poor are more likely to develop mental health problems, particularly when there is high inequality. People with mental illness often become poor, even if they didn’t grow up in poverty. Like all poor people, many people with mental illness don’t have cars and so rely on public transportation, and live in crowded accommodations with no outside space, so they have to deal with the anxiety of not being able to effectively practice social distancing. Many don’t have the luxury of being able to choose when to go shopping – cupboards are bare by the end of the month, so shopping has to be done as soon as SNAP benefits or income is received. Stocking up is difficult when you don’t have a car. Grocery store delivery could work, but most don’t accept SNAP, and many are booked up for weeks.
As bad as the immediate mental health impacts may be, the financial health consequences of this crisis may be equally severe, particularly for people who are poor already. People with mental illness are more likely to work in low wage and insecure jobs without benefits (ACL 2019). These are the jobs that are being lost as the crisis grows, and that cannot be done from home. Significant relief is available through expanded unemployment insurance, but applications can often only be made online, and not everyone has reliable internet access or is comfortable using it. Some people with mental illness receive disability benefits, which are not affected by this crisis, but others do not, and some who do supplement those meager benefits with work income – particularly people on Social Security Disability Income (SSDI) who can earn a certain amount of income without affecting their SSDI income. People on Supplemental Security Income (SSI) face much more stringent work income limits – though many still have to work under the table to make ends meet. In the university town I live in, many participate in research studies to earn a little extra cash. Those odd-jobs, and the paid research studies, have pretty much dried up. Some people rely on help from friends and family, and that too is harder to come by as so many people have lost their jobs. Strict SSI asset limits – which discontinue benefits if a person has more than $2,000 in assets – mean that this group is least likely to have any emergency savings.
One-off Economic Impact Payments (EIPs) are coming. Thankfully, after intense advocacy, both SSDI and SSI recipients will now automatically receive the EIP, which will help. However, recent recipients (since January 2020) who have not filed taxes in the last two years have to complete an online form before they can receive the cash. The many people who are struggling with mental illness who are not receiving SSI or SSDI (or may be awaiting a decision) and who have not worked or only earned very little so haven’t filed taxes in the past two years, also have to complete that form. This population is less likely than others to have internet access or an email address, both of which are required to complete the form. Additionally, people with disabilities, including mental illness, are disproportionately unbanked, which may mean they will have to wait longer to get a paper check. Paper checks may go astray, particularly when the addressee is homeless or housing insecure, and must be cashed in person if the person does not have an account. There’s a form where people can enter bank account, prepaid card or even cashapp information, but this is not widely known, and again, requires internet access. People with mental illness may be particularly vulnerable to scams.
The crisis is also making it harder for people to manage the money they do have. Most banks have shut down lobby service, so people have to use ATMS or drive-thru services. Inner-city branches where many people with mental illness live tend not to have drive-thru options. Many people are used to paying rent or bills in person or at payment agents rather than online; social distancing makes that more difficult. Managing benefits is harder too. Working through the bureaucracy of the Social Security Administration to deal with benefits applications, redeterminations, reporting work income, appealing overpayments and so on is hard enough under normal circumstances. As those offices have reduced to skeleton staff, services are no longer available in person, and it has become even more difficult to get help by phone. This is not easy for people who prefer to deal with issues in person, and who may have limited minutes on their phones.
While this crisis unfolds, the need for social distancing will continue to present challenges. But there is much that can be done to make it easier.
- Banks should offer quick and easy account opening online or by phone, without a need for an initial deposit, and offer overdraft-free accounts that meet BankOn standards to reassure those afraid of fees, or in the chex systems due to previous overdrafts.
- Banks should also freeze overdraft fees for existing customers; some already have.
- Banks should reach out to existing customers and let them know that they will do what they can to support anyone who has mental health related challenges that affect their ability to use services under current conditions.
- Banks should offer tools to enable people to get help with their money without having to interact in person.
- Local governments must work with internet providers to ensure that everyone has access to free or affordable high-speed internet.
- The Social Security Administration has already suspended continuing disability reviews and collections of overpayments; it should also simplify and speed up the application process.
- And finally, no-one should have to pay for healthcare right now – certainly not for COVID-19.
We are in the throes of a crisis which will deeply impact us in very unpredictable ways. But as it exposes both the faultlines of our current system, and reveals our ability to support each other in new ways, this is also an opportunity to change how we do things in the long term. For banks and credit unions, this means recognizing everyone needs access to basic banking services, and that they must actively listen to those they currently do not serve adequately in order to know what they need to do differently. Neither should be a function of a financial institution’s bottom line. And finally, none of us can any longer see poverty, exclusion and inequality as not our business; it is up to all of us to ensure that we are all healthy and well.
Dr. Annie Harper and Paul Hammer work at the Program for Recovery and Community Health (PRCH) at Yale School of Medicine’s Department of Psychiatry. Harper is a cultural anthropologist in studying how low-income people with mental illness, including those with incarceration histories, cope with poverty and financial difficulties. She is particularly focused on understanding the structural and systemic changes necessary to bring about financial justice. Hammer is a Research Associate at PRCH. His current work focuses on employment and self-employment for persons with mental health conditions.