20/20, May 1 – 1

Many people are talking about universal basic income (UBI) these days. Giving everyone a guaranteed income could be the solution to many economic woes. But one factor that hasn’t been mentioned much in discussions of UBI is how it might improve our mental health.

Social psychiatry research in the mid-20th century showed that mental illness was often caused by poverty, inequality and social isolation. Responding to such findings, the US Joint Commission on Child Mental Health published Crisis in Child Mental Health: Challenge for the 1970s in 1969. The report was the work of 500 child mental health experts. One of its chief recommendations to prevent mental illness was to provide all Americans with a “guaranteed minimum income”, or UBI.

Crisis in Child Mental Health was distributed widely to politicians, policymakers and physicians. But its message about UBI wasn’t heeded. Could it be revisited today?

Poverty

One of the main arguments for UBI is that it would bring people out of poverty. Recent research has linked the stress of poverty with inflammation in the brain, leading some to suggest that anti-inflammatory drugs could be the solution. But what about eliminating poverty altogether?

UBI could be set at a level to ensure that everyone’s basic needs are met. This would reduce much of the stress faced by the working poor or families on benefits. Today, these families are often forced to use food banks or go into debt to pay for necessities.

People today are also vulnerable to changes in the benefits system that may make them ineligible for benefits. The introduction of the “bedroom tax” in 2013, for instance, was found to worsen mental health. The consequences of these rule changes were also highlighted in Ken Loach’s film I, Daniel Blake.

Since UBI is universal, there is no means testing. It would increase in line with inflation to ensure that people were kept out of poverty. Other measures could also be introduced alongside UBI to prevent inflation. Governments could create schemes to provide better access to affordable fresh local food. Providing free public transportation in cities would also mitigate against people’s expenses increasing too much. Rent controls would help curb inflation, too.

Getting rid of means testing would also free up those running the benefits system. Benefits workers are typically gatekeepers – as is powerfully portrayed in I, Daniel Blake. Their time is spent screening out the ineligible, not helping those who need it.

I have personal experience that is comparable to this situation. During the late 1990s, I worked for a charity as a youth counsellor and career advisor in Edmonton, Canada. Although those were my job titles, I spent precious little time counselling or providing career advice to young people who were not in school or work.

What I actually did was determine whether my clients met the criteria for government funding to go back to school. The complexity of the application process and the numerous rules recipients had to follow to keep their funding prevented me from doing much else.

My time would have been much better spent helping these young people overcome the numerous barriers they faced. Many had psychological problems, had been victims of abuse, had criminal records and addictions. These problems tended to be ignored until they flared up and jeopardised the client’s funding status.

One of the reasons we persist in this gatekeeping approach is that the benefits systems in the UK, Canada and elsewhere retain the Victorian idea that there are “deserving” and “undeserving” poor. This idea inspired the New Poor Law (1834), which introduced the workhouse system depicted in Dickens’ novels. It persists in television programmes, such as Channel 4’s Benefits Street.

Benefits workers should instead be redeployed to help people deal with difficult, intractable problems, including mental illness and addictions. They could also provide people with career guidance and counselling. Such work would serve to improve mental health, not worsen it.

UBI would also help people, usually women and children, to leave abusive relationships. Domestic abuse occurs more often in poorer households, where victims lack the financial means to escape. Universal credit makes it more difficult for women to leave abusive situations.

Similarly, UBI might prevent the negative childhood experiences believed to lead to mental illness and other problems later in life. These include experiencing violence or abuse, or having parents with mental health, substance abuse and legal problems. Behind these problems are often poverty, inequality and social isolation.

Inequality

Inequality also encompasses a lack of opportunity, class bias, disenfranchisement, low self-worth and often racism. It results in hopelessness that can trigger depression, anxiety, addictions and other health problems.

Inequality has featured in recent studies on psychiatric epidemiology. This includes Pickett and Wilkinson’s The Spirit Level and The Inner Level.

Pickett and Wilkinson show that rates of mental illness are highest in the most unequal countries. Although mental illness is diagnosed differently in different countries, the authors also found that socioeconomic inequalities lead to higher rates of drug abuse, obesity, infant mortality, teenage pregnancy and other social and health problems. Put simply, inequality is bad for health.

UBI can erode inequality in many ways. Unlike benefits, UBI is provided to all, regardless of class or income. There would be no stigma or shame associated with receiving it.

UBI would also help with social mobility. It would facilitate further education, entrepreneurial activity, artistic endeavours and career changes. People intent on leaving unrewarding jobs could rely on it while they found something more meaningful.

Above all, UBI would prevent some of the hopelessness and shame associated with deprivation. It would help to prevent so-called diseases of despair, which include suicide, chronic liver disease and drug and alcohol poisoning.

Social exclusion

Social psychiatry showed that social isolation is bad for mental health. This was regardless of whether a person lived in Manhattan or rural Nova Scotia.

The link between UBI and social inclusion might be more subtle than that for poverty and inequality. But that doesn’t make it less important.

The COVID-19 crisis highlights how important social connections are for our mental health. We all need to love and to be loved. Alone time can be great, but being lonely can make life seem bleak and purposeless.

UBI could give people the means to focus more on engaging with their communities, rather than simply earning an income. This would include carers, parents and volunteers. A UBI provides proof to such workers that their labour is valued and appreciated.

UBI would shift our focus from economic growth, which doesn’t benefit everyone, to social and emotional growth, which would. It would allow people to reassess what matters most to them and give them a platform to live more meaningful lives.

To explore it further, I would suggest two ways forward.

First, those piloting UBI trials should explicitly measure mental health outcomes. Mental health improvements often emerge out of such pilots, but they should be automatically assessed from the outset. Cost savings of improved mental health could well outweigh the cost of implementing UBI.

Second, mental health professionals and charities should advocate more strongly for socially progressive policies to prevent mental illness. UBI is one possibility, but there are others as well.

Mental illness is caused by many factors. Many of these, such as childhood sexual abuse or other forms of trauma, are very difficult to prevent. The illnesses that emerge out of these experiences are also hard to treat.

UBI could ease the burden of mental illness faced by health services. It could allow researchers and mental health professionals more time to deal with more intractable cases.

UBI will not solve our mental health crisis. But it is a good starting point.