The burden of disease on humanity has shifted dramatically over the past 100 years or so. In 1900, infectious disease was the leading cause of death worldwide. Maladies such as pneumonia, tuberculosis, and diarrhea caused one third of all human fatalities. But through advances in science and technology and a renewed focus on hygiene, infectious diseases became less deadly. Chronic diseases took their places.


Due to the change of human lifestyle from a more laborious to a more sedentary one, chronic diseases have become the leading causes of death in developed countries and, to a lesser extent, in developing countries. An even more disturbing fact is that the most prevalent type of disease in developed countries is neither cancer nor cardiovascular disease but mental illness. Of course, there is a broad spectrum of diseases, of which some are trifling, such as stress, and some more penetrating, such as dissociative identity disorder. Yet whether the mental illness is negligible or severe, whether the country is developed or developing, one factor attenuates both kinds greatly: poverty.



Physiological, infectious diseases, such as HIV or malaria, are often amplified by poverty, as are psychological ones. In fact, the relationship between poverty and mental health is strongly positive and is bi-directional: those with low incomes are more likely to suffer from poor mental health and those with poor mental health are more likely to experience poverty. Though a lack of wealth is not indicative of mental health, it is generally accepted that poverty can heavily influence poor mental health. Substance abuse, anxiety, schizophrenia, suicide, and psychosis are all psychological disorders that are most prevalent amongst people of lower socioeconomic backgrounds. Moreover, cases of common mental disorders are about twice as frequent among poor as they are among the rich; additionally they are more prevalent among those living in poor or overcrowded housing. In this context, another factor, employment, markedly affects mental health as well.


Mental illnesses have unswervingly been shown to flourish among members of lower socioeconomic classes. Their pervasiveness was studied in a 1995 survey published by the Office of Population Censuses and Surveys. Unemployment explained much of the differences in the rates of all mental illnesses, from neurotic disorders to alcohol dependence. It increased the odds ratio of phobias, psychosis, generalized anxiety disorder, and depression. The effects of unemployment and poverty on mental stability, as shown by the study above, are daunting, revealing, and persistent. Something even more perturbing is that many studies like the one above have been done, but there has been a lack of initiative, or rather misuse of resources, to fix the issue of mental health, poverty, and unemployment. Arguably the most problematic of these issues, misuse of resources, occurs at disconcertingly high rates in developing countries and developed countries.


New York City is small in size but largely representative of what mental health issues a developed country is facing. The New York City Housing Authority’s (NYCHA) chairman, John Rhea, resigned after four years in office at the end of 2013, in which housing projects and lower-class residents saw a dramatic increase in the deterioration of housing environments and living conditions. During his tenure, NYCHA delayed nearly $1 billion of US federal funds allocated for fix-ups that would considerably increase living standards in projects around New York City. In part because of Rhea’s negligence, but also in part because of recent economic hardships, the number of individuals affected by mental illness has increased. More specifically, since Rhea took office, the number of self-reported cases of serious psychological distress in adults increased from 303,000 in 2009 to 348,000 in 2012. The government has responded in a variety of ways.


The Assertive Community Treatment (ACT) is a program run by the New York State Office of Mental Health that is designed to provide treatment and support services to individuals diagnosed with a severe mental illness. More importantly, ACT provides these services to those whose needs have not been well met by more traditional mental health services. ACT treats, rehabilitates but also collects data regarding variables that lead to a higher admittance rate in certain hospitals or medical facilities around the city.


Of the five boroughs of the city, the Bronx is the poorest and most crime-ridden. It also suffers from the highest rate of unemployment. An ACT report shows that the Bronx has the highest percentage (by borough) of psychiatric ER visits and also the highest percentage of ACT recipients with reported criminal justice involvement within six months of admittance. But the most significant figure here is that the Bronx has the highest percentage of ACT recipients who identified as homeless. The data shows that the link between mental illness, poverty, and unemployment is rigid with a strong positive correlation.


Though New York City is only a city, not an entire country, it typifies a developed nation’s mental health dilemmas. In 2011, almost 20 percent of New Yorkers experienced some sort of mental illness. That number falls in line with the percentage of Americans who experienced some sort of mental illness in the same year. In fact the prevalence of mental illness amongst Europeans is slightly higher, at 27 percent, and 24 percent of Japanese suffer from mental health issues. Developed nations face a great issue as the faster pace of life has shown to increase stress and anxiety over the course of the 20th century. As a country becomes more developed it comes out of poverty, but can also fall into pits that can be just as problematic, such as income distribution and equality and over competition. Poverty and mental illness are inextricably linked, and the case of New York City illustrates that the silent crisis does not limit its ominous effects to developing nations.