Wealth inequality casts its shadow on everything from children’s early development to adults’ emotional well-being. It directly impacts education, housing, wellness and mental health. In fact, according to a 2020 study published in Science, individuals with the lowest incomes within a community are 1.5 to 3 times more likely to experience anxiety, depression and other common mental illnesses than those with the highest incomes.
This challenge appears to be compounded by a causal relationship between poverty and mental illnesses: Poverty exposes individuals to more factors that can lead to mental illness (such as stress, chronic health conditions, more exposure to violence and crime and reduced access to quality child development programs), and, in turn, experiencing a mental illness can lead to circumstances that may increase the likelihood of financial instability or poverty (such as poorer job stability and reduced child development and education opportunities).
Mental health care access is clearly critical for those who fall into a lower-income demographic. But with the high costs of therapy (without insurance, per-session estimates fall between $100 and $200), individuals in lower income brackets often face significant barriers to seeking help.
There is a bright side: Results from a recent Yahoo-commissioned survey on therapy participation conducted by AYTM, a technology-driven insights firm focused on independent testing and research, are encouraging. The survey, which included 750 participants who had undergone therapy, either at the time of the survey or in the past, found that the highest percentage of participants (27.6%) were from the lowest income group (earning up to $24,999 annually). This indicates that while the challenges facing lower-income demographics are substantial, and many barriers to mental health care remain, lower-income individuals are seeking and accessing therapy at rates on par or greater than those in other income brackets.
We spoke with Quint Boa, psychotherapist and company director of Synima, to hear his thoughts on therapy participation and the link with lower means. “As public discourse on mental well-being grows, more individuals in lower income brackets are recognizing the importance of seeking help, which may motivate them to pursue therapy despite financial constraints,” he explains.
Wealth inequality and the significant and staying impact of poverty on individuals and communities is a complex topic, but there are many reasons to pay attention to the importance of mental health access to lower-income individuals and to work to improve this access in the future. Here, we unpack some of the reasons lower-income individuals are more likely to struggle with mental illness, the reasons they may be accessing care in higher numbers than more well-off individuals and the ways in which mental health care access is improving for this demographic in the United States.
Factors for increased mental illness in lower-income individuals
When looking at the causal and multigenerational effects of poverty on mental health, it becomes clear that effecting real change requires more than simply telling people to “toughen up” or “pull yourself up by your bootstraps.” When children grow up in poverty, their educational resources are often more limited, their housing situation less stable and their exposure to crime or violence more prominent. These circumstances can affect perspectives and belief systems regarding their ability to effect change or control outcomes within their own lives. Moreover, limited access to high-quality education can make it challenging to secure stable or high-wage employment, ultimately making it more likely for those who grow up in lower-income or unstable environments to remain in these environments through adulthood. Of course, this isn’t a foregone conclusion, and many individuals who grow up below the poverty line are able to change their long-term financial circumstances, but it’s impossible to ignore the very real mental health challenges that often accompany the lived realities of lower-income individuals.
Barriers to high-quality and higher education
Education plays a crucial role in mental health, with studies showing that higher education levels can protect mental well-being for decades. Just one additional year of schooling lowers the risk of developing depression and anxiety, and individuals with more education generally report less severe mental health symptoms.
Yet children from low-income households face barriers to high-quality education, tutoring and extracurricular activities. According to a report from the Urban Institute, young people from families with high wealth (those with assets and financial resources totaling more than $223,500) are 1.5 times more likely to complete at least two years of college than those with low wealth (whose families have assets and financial resources totaling less than $2,000). These wealthier individuals are also more likely to achieve upward mobility, attaining higher income and status and a better standard of living.
Housing inequality and insecurity
Housing inequality further exacerbates mental health issues. One 2019 review study published in the American Journal of Preventive Medicine found that individuals who experienced any type of housing disadvantage (including overcrowding, mortgage delinquency, housing mobility and tenure, subjective perceptions of inadequate housing, eviction and physical housing conditions) were more likely to experience mental health challenges including depression, psychological impairment, anxiety or mental strain later in life.
Another study published in September 2024 found that young, urban Black adults who described themselves as living in unaffordable or overcrowded housing, or those who were “mostly unhoused,” were more than four times as likely to have symptoms of depression and more than twice as likely to report anxiety than those who reported living in more stable housing conditions.
Poorer physical health and shorter life expectancy
Financially disadvantaged people also frequently experience poorer physical health, with increased rates of chronic conditions and shorter life expectancy. In an eye-opening study published by researchers at the University of Florida’s College of Public Health and Health Professions in January 2024, results found that a combination of chronic inflammation (which is linked to the development of many diseases, including heart disease, type 2 diabetes, cancer and kidney disease) and poverty serves as a “double whammy” for mortality risk. Those in the study who had both conditions — a household income below the U.S. poverty line and an elevated level of C-reactive protein, a marker for chronic inflammation —were more than twice as likely to die from heart disease and almost three times as likely to die from cancer within the next 15 years when compared to individuals with neither condition.
Those at the lower end of the economic spectrum often lack access to quality health care, nutritious food and safe living conditions, leading to poorer overall health. And to add insult to injury, individuals living with chronic health conditions are more likely to be at risk for developing mental illnesses including anxiety and depression. This is linked to the added stressors and challenges surrounding chronic illnesses, the effects of medications on mental health and chemical changes that can take place in the brain related to some diseases.
Why a growing number of lower-income individuals are trying therapy
What’s clear from the data is that it’s particularly important for those in lower income brackets to have access to affordable and readily available mental health care. While this continues to remain a challenge, improvements in insurance coverage for mental health care and more options for flexible, free and discounted therapy services may help explain the positive presence of lower-income individuals participating in therapy, according to our survey. Here we touch on a few more factors that are likely playing a role.
Increased awareness and reduced stigma
Over the past few decades, there’s been a shift in how society views mental health. People are now more aware of the impact of mental illnesses, and in the past 20 years, the number of individuals seeking help has escalated.
“With an increase in awareness comes a reduction of stigmatization, which could have previously inhibited those from a lower-income household from choosing therapy,” says Boa. People are now better equipped to understand the importance of seeking help for emotional and psychological issues. He also explains that the stigma around therapy is twofold — stemming from the belief that therapy is a luxury only the wealthy can afford and from the broader societal stigma surrounding mental health care and its legitimacy.
Public campaigns, educational initiatives and the rise of mental health advocacy may have contributed to this awareness. Boa notes that high-profile figures like Prince Harry openly discussing their mental health struggles have helped break down the stigma surrounding therapy. Additionally, popular media, from films to documentaries, has brought therapy into mainstream conversation, offering mental health insights to audiences who might not have otherwise pursued it.
This shift has reduced the generational stigma tied to psychotherapy, fostering a more open and accepting attitude, particularly among young adults. As a result, therapy is no longer viewed through the lens of exclusivity or conservatism but rather as a valuable tool for well-being. In fact, roughly 76% of U.S. adults see mental health as being as important as physical health.
Accessibility and telehealth
Mental health care is increasingly available to all, with low-cost and free services ensuring no one is left behind. While pre-insurance therapy fees can be cost prohibitive, the 2008 Mental Health Parity and Addiction Equity Act requires health insurance plans to provide more equitable coverage for mental health care treatment, and expansions to therapist coverage within insurance programs are making it easier for those with health insurance to access care.
And for those without health insurance, like many individuals who fall into the lower income brackets? There are still resources to help. “Many organizations offer sliding-scale fees or free services, making therapy more accessible to those facing financial constraints. This can lead to higher participation rates from this demographic as health care communications can now specifically target low-income individuals,” says Boa. He adds that the reduction in stigma may spur more individuals to look for these resources as lower-income individuals feel more empowered to prioritize their mental well-being.
Telehealth is another key development in this shift. Boa explains, “Teletherapy has significantly transformed the mental health care landscape, increasing accessibility and affordability. As teletherapy continues to advance, it presents a promising solution to the existing disparities in mental health access.”
This is particularly important for those in rural communities — where according to the U.S. Department of Agriculture Economic Research Service, poverty rates reached 15.4% in 2019 compared to 11.9% in urban areas, and where telehealth can offer a more affordable way to access care that might otherwise be out of reach.
While our survey indicates that most people still prefer in-person therapy to online options (43.2% and 34.3%, respectively, with 22.5% showing no preference), the affordability, flexibility and accessibility of virtual therapy make it an avenue worth exploring.
Increased need due to environmental and socioeconomic stressors
And, of course, it’s impossible to ignore the fact that the increased levels of mental illness and distress in lower-income households lead to an increased need for care. “Those in lower income brackets may face more acute stressors, such as job instability, housing insecurity or family issues, prompting them to seek help in times of crisis,” notes Boa. Even in populations without health insurance or mental health care coverage, this immediate need for relief may lead to short-term sacrifices, even if it results in financial hardship.
Therapy participation in financially secure individuals
Conversely, the survey sample showed that therapy participation in financially secure individuals was noticeably lower than in those from lower-income categories.
Although wealthier individuals have the financial means to access mental health services, this doesn’t always translate into higher therapy participation. One study conducted in China suggests that household wealth often correlates with better mental health, meaning wealthier people might feel less need for therapy. However, at extreme levels of wealth, the opposite may hold true. Pursuing financial success can lead to overwork, high-risk activities and relentless pressure, negatively impacting mental well-being.
Moreover, individuals with higher socioeconomic status may be less likely to recognize or acknowledge their mental health struggles. The stigma surrounding therapy can contribute to this, as seeking help may be viewed as a sign of personal weakness or vulnerability, which could potentially damage their reputation or social standing. Research shows that people in wealthier groups are more inclined to attribute mental illness to internal, controllable factors, such as personal failings or lack of willpower. This mindset can lead to self-blame or blaming others for the onset of mental health conditions, further reinforcing the stigma and reluctance to pursue professional help.
Another possibility for low therapy participation is that wealth affords people alternative coping strategies, such as travel, leisure experiences or other distractions, which can diminish the perceived urgency for formal mental health care.
The takeaway
The relationship between income and mental health care is nuanced. As awareness around mental health increases, stigma diminishes and more economical therapy options emerge, providing more people of all socioeconomic backgrounds more access to therapy.
While individuals with restricted income often face more acute stressors that drive the need for therapy, they are increasingly able to explore low-cost options and telehealth. These accessible options ensure that financial limitations don’t hinder people from getting the support they need.
Conversely, wealthier individuals may feel less inclined to seek therapy. They may experience fewer mental health issues or shy away from counseling because of societal stigma and the assumption they can manage without professional help.
With growing mental health awareness and expanded access to affordable care, therapy is becoming an essential resource for everyone, no matter their income level.
Ready to try virtual therapy? Discover Yahoo’s best-rated options for best affordable online therapy providers, best online psychiatry platforms, best online therapy providers for anxiety, best online therapy for couples, best online therapy resources for the LGBTQ community and best culturally sensitive online therapy resources.
Related: From accessibility to AI: The surprising trends shaping mental health care
Related: Child-free adults are more likely to seek therapy than parents: Here’s why
