If there are two topics of conversation that are brushed under the rug to avoid discomfort, they are money and mental health. This is especially true in India, where both income inequality and the prevalence of common mental disorders are becoming increasingly worrying. While it has generally been accepted that the poorest among us suffer due to pronounced inequality, it’s time to accept that these disparities aren’t doing everyone else any good either.

When we think of at-risk groups, the wealthy elite are not the first to spring to mind. And why would they be? Multiple studies have found a positive correlation between poverty and mental illness. In a country where the average urban worker’s daily wage is a quarter of what one session with a therapist would cost, it is hard to feel sorry for those who can afford the ‘luxury’ of mental health.

Contrary to popular belief, though, the rich aren’t much better off. Studies conducted by Suniya Luthar, Professor of Psychology at Arizona State University, found that youth from high-income households are one-and-a-half to two times as likely as the national American average to display symptoms of anxiety and depression. Moreover, she found higher rates of substance abuse and delinquency in these groups, which face immense pressure to achieve, combined with a lack of sympathy and support from society.

Conventional wisdom has dictated that eliminating external stressors like poverty can go a long way towards making us happier. If nothing else, it can at least help people get the care they deserve. But if money can’t buy us happiness after all, what is the key to mental well-being? It turns out that while individual circumstances do have some bearing upon our overall physical and mental health, they pale in comparison to the damage that living in an unequal society can do.

To understand how inequality affects us, consider the example of Japan. In an era characterised by the rich getting richer, especially in the developed world, the Asian nation has bucked the trend, owing in large part to higher taxation on the rich and a hefty inheritance tax. This has capped the average household income of Japan’s top 1 percent to $240,000, which is in stark contrast to that in the USA -- $1,264,065. Consequently, both nations find themselves on opposite ends of the spectrum when it comes to the prevalence of mental illness.

In their book The Inner Level, British epidemiologists Richard Wilkinson and Kate Pickett studied the relation between income inequality and mental health, in addition to addictive behaviours and levels of trust and well-being. They found that the prevalence of mental illness was much lower in relatively equal societies like Japan, Belgium, Germany and Spain, compared to the USA, the UK and Australia, which have a wider income gap. They also found a direct correlation between inequality and status anxiety, which made people question their self-worth.

As a result, people in unequal societies tend to have more biased perceptions of themselves. This sense of exaggerated self-importance was found to be extremely high in South Africa, one of the world’s most unequal countries, whereas it was nearly non-existent in Japan. Combine this with the high levels of narcissism, schizophrenia and addictive behaviour that is seen in unequal countries, and it is impossible to deny that reduced social mobility creates a lose-lose situation.

Income inequality has also been linked to lower levels of trust within a society. This reduces the social capital, leading to unstable relationships and a consequent increase in risk factors like stress. This is especially worrying in the Indian context, where inequality is at its highest levels in nearly a century. A whopping 73 percent of the wealth belongs to 1 percent of the population, while the poorest half of the country saw their income increase by a measly 1 percent in 2017. Unsurprisingly, a WHO report found that 6.5 percent of India’s population suffers from some form of mental illness, with the situation only expected to get direr.

When we think of the mental health care gap, we think of the marginalised groups that are affected by it. Sexual minorities, religious minorities, women, senior citizens and those living below the poverty line come to mind. And while these groups have it the worst, we can no longer deny that disparity hurts us all.