On Basic Income and Mental Health

Why a universal basic income is likely to be good for mental health.

Universal basic income is fashionable right now. A lot has been written about the idea that everyone should be given enough money to live on, regardless of whether they work or not. There are worthwhile arguments to be had about whether it’s a good idea [1,2], whether we could afford it [3], and about what universal basic income is [4]. This blog isn’t about those things.

Here, I’m going to quickly review why a universal basic income could be good for mental health. In case anyone isn’t sure, poor mental health is a big problem. In the UK, around one in six people suffers with a common mental health problem [5]. Depression is the eighth leading cause of disability [6]. Suicide is the leading cause of death for men aged 20–49 and for women aged 20–34 [7], and self-harm is the ninth leading cause of early death [6].

Why money matters for mental health

Not having enough money to live on is miserable. People on low incomes or whose incomes fall suddenly tend to suffer worse mental health [8,9]. And when people’s income goes up, their mental health tends to get better. [10–14].

In England, areas with lower incomes have higher rates of emergency hospital admissions for intentional self harm. This is shown in the graph below. Admission rates for intentional self-harm (a common proxy for levels of poor mental health) are shown on the vertical axis, and average weekly income for the areas are shown on the horizontal axis. The red line shows the average effect, which is a £100 increase in average weekly income is associated with a drop in the self-harm rate of 19%*.

Rates of emergency hospital admissions for intentional self-harm are higher in areas with lower incomes.

The graph suggests that there are diminishing returns to mental well-being on increasing income, something we know from other studies [15]. So to get the biggest improvements in mental health, we should probably be thinking about increasing incomes at the very bottom of the income scale.

How a universal basic income might help

A universal basic income would alleviate poverty and the stress that goes with it. This would benefit people today, and would benefit future generations by reducing child poverty, stress on pregnant women and families, which should in turn reduce rates of family breakdown, domestic abuse and child neglect and abuse [16–19]. A universal income could also reduce the stigma associated with claiming benefits, which appears to moderate the relationship between unemployment and mental illness [20]. Increasing incomes may reduce crime rates in low income areas [21].

I’ve sketched some of these possible relationships below:

Sketch model describing some possible routes by which a universal basic income could improve mental health.

So it works in theory, but does it work in practice?

There have been a number of pilots of universal basic incomes, some of which have found significant and sustained improvements in mental health associated with universal basic income [11] or unconditional income supplements [13,14]. Other studies found improvements in diet, standard of living and debt levels [22,23]. A further controlled (but not randomised) study found that when people with existing mental illness were given a small unconditional monthly allowance, symptoms of anxiety and depression were reduced [24]. Further evidence comes from the observations that suicides rates in the US fall by between 7% and 8% upon reaching social security eligibility age, even though only 12% of adults actually stop working [25], and the relationship between unemployment and suicide is weaker in countries with more generous welfare policies [26].

So there are good theoretical reasons why a universal basic income might improve mental health, and some promising evidence that it might work in practice. The studies so far aren’t the final word: better studies using randomised designs are happening now. I will be interested to see if these trials find improvements in mental health (and possible savings in need for mental health care), but the evidence as it is now looks fairly persuasive to me.

Universal basic income is not a panacea

There are things about poor mental health that universal basic income probably won’t fix. A universal basic income probably wouldn’t improve access to mental health care. The evidence appears to be mixed on trust and social capital [27]. It wouldn’t address problems in the built environment. Nor would it eliminate differences in social status, which may also contribute to mental illness [28,29]**. A wider range of policies would be needed to fully tackle inequalities in mental health.

Universal basic income is just one way of improving incomes at the bottom of the pile. Increasing minimum wages would be another approach. Policies that aim for ‘full’ employment could achieve the same thing by increasing the demand for workers. These approaches would only benefit people with jobs. Other systems, like child benefits, also exist. And none of this is a substitute for high quality, accessible mental health care.

Footnotes

* This is a univariate regression on cross-sectional ecological data. Obviously it proves nothing on its own. For evidence linking income to mental health at individual level, see references. Areas are English Middle Super Output Areas. Admissions data aggregated over 2010–2014 (source: PHE Local Health, available at http://www.localhealth.org.uk/). Income data estimates for year ending March 2014 (source: ONS, avaiable at: https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/earningsandworkinghours/datasets/smallareaincomeestimatesformiddlelayersuperoutputareasenglandandwales)

** Although this evidence comes from experiments involve monkeys, so caution is needed in extrapolating to human social relationships.

References

1. Ten Reasons to Support Basic Income. In: Basic Income UK [Internet]. [cited 21 Feb 2018]. Available: http://www.basicincome.org.uk/reasons-support-basic-income

2. Rentoul J. Basic income is a bad idea that refuses to die. In: The Independent [Internet]. 7 Jan 2017 [cited 21 Feb 2018]. Available: http://www.independent.co.uk/voices/basic-income-pilots-scotland-ubi-glasgow-finland-canada-ontario-switzerland-referendum-refuses-to-a7505561.html

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21. Council of Economic Advisers. Economic perspectives on incarceration and the criminal justice system [Internet]. Washington D.C.: The White House; 2016. Available: https://obamawhitehouse.archives.gov/sites/whitehouse.gov/files/documents/CEA%2BCriminal%2BJustice%2BReport.pdf

22. US Department of Health, Education and Welfare. The rural income maintenance experiment: summary report [Internet]. 1976. Available: http://www.irp.wisc.edu/publications/sr/pdfs/sr10.pdf

23. SEWA Bharat. A little more, how much it is: piloting basic income transfers in Madhya Pradesh, India [Internet]. Unicef; 2014. Available: http://unicef.in/Uploads/Publications/Resources/pub_doc83.pdf

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28. Morgan D, Grant KA, Gage HD, Mach RH, Kaplan JR, Prioleau O, et al. Social dominance in monkeys: dopamine D2 receptors and cocaine self-administration. Nat Neurosci. 2002;5: 169–174.

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