The story at a glance


  • When the economy gets worse, deaths from despair — or overdoses, suicides, and addiction-related deaths — tend to rise.

  • As the country struggles to meet the increased demand for mental health care resulting from the pandemic, a potential recession could exacerbate these challenges.

  • But improving communication and expanding access to services can help mitigate the negative health impacts that could occur if the economy continues to decline.

In the past, recessions and economic strife have been associated with poorer mental health outcomes, higher rates of substance use and, in some cases, increased suicide rates.

Now, with the country already grappling with increased inflation, the threat of a recession, and any lingering effects of the COVID-19 pandemic, America’s mental health care system finds itself understaffed. and ill-placed to respond to any additional requests.

“The mental health system has not yet been able to meet the demand from communities since its inception,” said Benjamin Miller, psychologist and president of Well Being Trust in an interview with Changing America. “We are still catching up.”

The Well Being Trust is a foundation that works to advance the mental, social, and spiritual health of Americans with a specific goal of addressing deaths from despair.

The term “deaths of despair” was first coined by economists Anne Case and Angus Deaton, who began studying the reversal of life expectancy gains seen around the year 2000. These deaths were largely partly due to alcohol-related liver disease, drug overdoses and suicides. and were concentrated among middle-aged white American men with less than four years of college education.

According to Case and Deaton, the loss of manufacturing jobs in rural America played a significant role in the decline in life expectancy.


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“Destroy labor and, in the end, labor life cannot survive. It is the loss of meaning, dignity, pride and self-respect that accompanies the loss of marriage and community that causes despair, not just or even primarily the loss of money,” they wrote in their 2020 book. on the subject.

Although the racial makeup of overdose deaths has become more diverse in recent years, deaths from despair consistently weigh on men’s life expectancies.

American men are also found to have poorer overall health than those residing in other high-income countries, and higher suicide rates than women due to the often lethal means employed.

Given all of this, major events like COVID-19 and recessions “put more pressure on an already fragile system,” Miller said. “If you want to see the biggest cracks, the biggest cracks, watch what’s going to happen.”

A 2018 study published in the British Journal of Psychiatry found that the Great Recession of 2008 was linked to at least 10,000 economic suicides in the two years immediately following the downturn.

More recently, published studies have documented Americans’ high levels of anxiety about inflation and general deteriorating mental health.

At the start of the COVID-19 pandemic, Miller and his colleagues used the 2008 recession as a proxy for anticipating the financial consequences that would weigh on the psyche of the United States.

But because the economy recovered relatively quickly from the initial COVID-19 shutdowns and job losses, the country now finds itself in a “unique moment” for mental health, Miller said.

The increase in depression, anxiety, and drug use that occurs during economic downturns could be due to worries often associated with financial insecurity, but also a loss of meaning or community among those who lose their jobs. High consumer debt resulting from home buying difficulties, not to mention foreclosures, could also contribute to these conditions and behaviors.

For some men, these economic challenges lead to particularly acute responses, as many see themselves as the primary breadwinner. Men are also more reluctant to talk about mental health issues in general, Miller said, “and that’s just because of the social stigma that’s so prevalent.”

These risk factors underscore the importance of tailoring interventions to certain populations and open a window of opportunity to better address the deteriorating mental health of Americans.

Since researchers began investigating deaths from despair in the early 2000s, “we have learned which populations are most at risk. We learned what are some risk factors that could lead to a death of despair,” Miller explained. “But what we haven’t done yet is vigorously move to a place where we change the system so that it can accommodate all those people who are in need.”

This includes improving access to mental health care by increasing affordability and strengthening the workforce, but it is also better communication of mental health risks accompanying economic downturns and being proactive. to target populations at risk.

In 2020, less than half of American adults with a mental health condition received care, while in 2019, just over 12% of people with a substance use disorder that needed treatment received it in a specialized institution.

“One of the biggest mistakes we’ve made as a country is that we don’t often communicate the power of mental health, especially in these times, and we don’t point people towards the solutions that can help them,” Miller said. added. However, the nationwide rollout of the new suicide prevention hotline this month marks a step in the right direction, as does the passing of the bipartisan Safer Communities Act.

The law, which took effect in June 2022, calls for the expansion of community and school mental health services.

But in addition to all of these solutions, Miller stressed that the most important step one can take is to tell others about mental health.

“We need to be comfortable sitting down at the table and telling our loved ones what’s really going on in our lives,” he said. “Even if you don’t know what to say, or if you don’t know what to say to the person talking to you, just being there and listening has power in itself.”

Posted on July 23, 2022