Mini Quiz: Poverty, Inequality, and Mental Illness

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Consider the following case: Sitting in the waiting room talking to herself, "Susan" looked exhausted and disheveled. Surrounded by her belongings, she waited for her psychiatrist. Since her last visit, she has become homeless following a rent increase, she has chronic medical conditions that have gotten worse, she stopped taking her prescribed psychotropic medications, and she has lost contact with the clinic. Thankfully, she has returned for care.

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The correct answer is D.

Discussion

Poverty is one of the most significant social determinants of health and mental health, intersecting with all other determinants, including education, local social and community conditions, race/ethnicity, gender, immigration status, health and access to health care, neighborhood factors, and the built environment (eg, homes, buildings, streets, parks infrastructure).

Psychiatrists may be hesitant to screen for poverty if they do not have ready access to interventions or referrals. Screening should not occur in isolation, especially because most of the remedies for poverty and other social determinants of health or social determinants of mental health lie beyond the health sector. To address the complex effects of poverty on mental health, a 3-level approach to socially accountable care can be used. Psychiatrists can assist patients living in poverty at the micro- (individual, clinical) level, at the meso- (local community) level, and at the macro- (policy and population) level.

For more information, see Addressing Poverty and Mental Illness, on which this quiz is based.