The following opinions are my own and not those of the U.S. Department of Defense.

Job insecurity can have a powerful impact on health, particularly mental health.

A recent study of almost 17,500 U.S. working adults found that 33% of the workers thought that their jobs were insecure, and those who reported job insecurity were more likely to be obese, sleep less than 6 hours a day, report pain conditions, and smoke every day. When it came to mental health, those who were job insecure had a likelihood of serious mental illness within the last 30 days almost five times higher than those who were not job insecure (J Community Health. 2016 Sep 10. doi: 10.1007/s10900-016-0249-8 ). This study is one of many that highlights the importance of what I call “financial mental health.”

The notion of financial mental health merges two distinct, yet interrelated aspects of patients’ lives into a single construct that can be used to inform resiliency-building behaviors and identify gaps in institutional approaches to supportive services. Patients with strong financial mental health are able to build, maintain, sustain, and revitalize their resiliency across several domains, which include mind, body, spirit, and social indicators.

Financial mental health should be considered a construct in its own right, because the impacts are great. It acknowledges that socioeconomic status and mental health are interdependent. This does not imply, however, that wealth is a protector from depression or that poverty ensures it. Rather, the construct recognizes the interplay between those factors, which often are managed in silos.

Financial mental health and mortality

According to the World Bank , “Mental health issues impose an enormous disease burden on societies across the world. Depression alone affects 350 million people globally and is the leading cause of disability worldwide. Despite its enormous social burden, mental disorders continue to be driven into the shadows by stigma, prejudice, and fear. The issue is becoming ever more urgent in light of the forced migration and sustained conflict we are seeing in many countries around the world.”1 In the United States alone, the Consumer Financial Protection Bureau (CFPB) reports that almost one-third of Americans are touched by poverty and advocates for financial literacy and empowerment for our most vulnerable citizens.

Unfortunately, mental health clinicians rarely discuss a depressed patient’s financial planning aside from occasional referrals for housing, disability benefits, or subsistence allowances. Based on observations from the World Health Organization, mental health is tied to satisfaction with quality of life. Furthermore, it relates to the ability to cope with life’s stressors, to engage in meaningful and productive activities, and to have a sense of community belonging.

When Abraham Maslow, PhD, described psychological health through the lens of human motivation, he constructed a “hierarchy of needs”2 that at the base lies the physiological requirements for food, shelter, and clothing. Those items represent our most physical necessities, protect us from harm, and determine our survival. They also are related to our need for safety (i.e., job security), which is the second rung on Dr. Maslow’s hierarchy of needs. In many ways, our ability to feel safe is predicated on our ability to secure our environment with proper housing, healthy nutrition, and appropriate wardrobe (and the accouterments thereof), which, in turn, align us and our families to our culture, community, and socioeconomic status. But it costs money to stay healthy and protected. The CFPB recognized the intersection of these issues and developed a toolkit 3 for social service and related agencies aimed at enhancing financial literacy and education within the populations they serve so that those individuals can become more skilled and empowered.

The consequences of poor financial mental health are found in data related to mortality. The Centers for Disease Control and Prevention documents that lower socioeconomic status is related to higher rates of mortality.4 For Americans living in poverty, their social network, lifestyle, and access to medical care contribute to their inability to live longer lives. Without access to quality and timely medical care, and appropriately funded services, the impacts from trauma, depression, substance abuse, and suicide are more widely experienced. For example, the Department of Defense Suicide Event Report since 2008 has linked suicide and suicide attempts among Service members to failed relationships along with financial and legal problems.

Several of the economic issues relate to conflicts in the workplace that can determine promotions in rank/increases in pay, retention, or transition to civilian employment/unemployment, retirement pay and benefits, or disability compensation. Service members and their families also are subject to divorce and alimony, child support payments, student loan repayments, mortgage defaults, and other liens or judgments. As veterans, this younger cohort must secure new housing, enroll in college or gain employment. This means (often for the first time) financing a mortgage, hunting for a job, filing for GI Bill or other Department of Veterans Affairs (VA) benefits, updating insurance, and family budgeting, while also dealing with the stress of military separation and loss of service identity, and postdeployment health issues. The VA has studied increases in suicide rates, depression, and post-traumatic stress disorder within this population – which is not surprising given the level of social instability that they are experiencing.

Furthermore, for veterans who seek treatment, which can mean long inpatient hospitalization or rehabilitation stays, numerous outpatient appointments, and/or medication management, there will be an impact on their finances, because they will be limited in their ability to maintain gainful employment or enroll in classes. This, in turn, complicates family dynamics. Sometimes, spouses have to assume caregiver roles or become the primary breadwinner, which can have an effect on veterans’ self-esteem, sense of belongingness, and burdensomeness – factors associated with suicide.

Mental health also is affected by financial abuse. According to the National Network to End Domestic Violence , financial abuse is a means by which perpetrators can control their victims who are elderly, disabled, subjects of human trafficking, or their partners. Although financial abuse occurs across all socioeconomic classes, usually victims who are experiencing physical and emotional abuse also are being controlled by having their finances or assets taken or withheld from them. Survivors able to extricate themselves from an abuser often are dealing with depression, anxiety, substance abuse, or suicidality. Under that state of mind, they also must find ways to repair their employability and insurability, recover from debt or identity theft, restore their credit and rebuild assets, file for divorce or protective orders, or claim unpaid alimony or child support from the perpetrator and secure safe housing – all while managing their symptoms.

Concrete steps

Individuals can take steps to ensure their financial mental health. Looking at Dr. Maslow’s hierarchy, the pinnacle of the pyramid centers on activities that relate to self-efficacy and esteem. Financial planning is an activity that can foster those feelings but requires the right blend of knowledge and information. Investing in the market has been described as an emotional experience. When the market is up and risk is high, emotions are positive; but when it is low, despondency over a portfolio can set in, and emotions may run scared. Investing comes with its risks and rewards. The receptiveness that individuals have for financial planning and investing will depend upon their views about tolerating risk, as well as their lifestyle goals and objectives, retirement plans, and health concerns.

Trauma survivors who tend to experience anxiety, depression, guilt, or emotional numbing – and have a foreshortened sense of future – may find it difficult to focus on a long-term financial plan. In the early stages of therapy and recovery, finance efforts may need to be concentrated primarily on obtaining a job with benefits and proper housing. Reducing debt and restoring credit become secondary challenges, and investing and retirement planning may take an even further backseat. However, for those experiencing psychological challenges, financial planning can be empowering and reassuring, because it provides a sense of structure, identifies goals, and restores hope for a better future.

Communities and organizations that support individuals with psychiatric conditions may need to further consider embedding financial planning into a case management approach that is more holistic and concentrates on all domains of social resilience as recommended by the CFPB. Training clinicians about financial planning can be useful because of the tools it can offer patients who are working on their recovery and rebuilding their futures.

People contemplating suicide are known to first get their affairs in order and often will update their beneficiary status, sometime making multiple changes depending on their emotional state within a month of their death, so agents should be aware of these habits. When working with veterans, abuse survivors, or those with more serious mental illness, ensuring that they are knowledgeable about available government benefits and pairing them with private sector products can help people who might seem like they are in denial or procrastinating about investing but are actually feeling overwhelmed, confused, and lack confidence in their own decision making. Partitioning these goals into short- and long-term steps and providing more attentive case management that builds trust and addresses concerns can help people stay engaged in reaching their goals.

Financial mental health is a concept rooted in individual resilience and the approaches needed to maximize it. As mental health professionals, we can leverage our own knowledge with that of personal finance experts to help our patients build resilience skills and tools. As result, patients in the most disadvantaged and disenfranchised communities will not only survive but thrive.

References

1 “ Out of the Shadows: Making Mental Health a Global Priority ,” April 13-14, 2016.

2 Psychological Rev. 1943;50:370-96 . “A Theory of Human Motivation” is represented as a pyramid with the most fundamental needs at the base. Those needs are physiological, safety, love/belonging, esteem, and self-actualization in descending order.

3 “ Your Money, Your Goals: A financial empowerment toolkit for Social Services programs ,” April 2015.

4 National Vital Statistics Report, “Deaths: Final Data for 2014,” Vol. 65 No. 4, June 30, 2016 .

Ms. Garrick is a special assistant, manpower and reserve affairs for the U.S. Department of Defense. Previously, she served as the director of the Defense Suicide Prevention Office. She has been a leader in veterans’ disability policy and, suicide prevention and peer support programs; worked with Gulf War veterans as an Army social work officer; and provided individual, group, and family therapy to Vietnam veterans their families dealing with post-traumatic stress disorder.

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