Editor’s note: This is National Suicide Prevention Week. Two frequent causes of suicide are depression and debt. Combine the two, and they’re even more lethal. Here’s a closer look – what you can do if this combination affects you or someone you love.
Two years ago, Kelsey Bell had a panic attack in her car somewhere on Interstate 55 outside of Chicago.
She stopped her 2012 Chevy Sonic underneath an overpass. She doesn’t recall exactly where she was, but she does remember staring at the toy snake she keeps on her dashboard.
Why do I feel like this? What’s wrong with me?
Feeling as if she were suffocating, she got out of the car, walked into a nearby field, and called 911. An ambulance took her to the closest hospital. Soon after, she was diagnosed with bipolar disorder.
“That was kind of my breaking point. I kind of spiraled out of control very quickly,” says Bell, a 24-year-old from St. Louis. “Even though looking back now, it seemed like it was leading up to that for a long time — at the time I felt like it was fine.”
One sign she wasn’t fine: How she handled money.
“I was spending a lot on music festivals and concerts, that was how I saw friends all over the country and was able to come up with some overarching theme to my life,” Bell remembers. “I was also traveling to have a place to stay, and it made me so happy. ”
But the expenses — and the anxiety that came with — piled up. She wasn’t getting ahead, and the happiness didn’t last.
“Eventually that all kind of didn’t matter anymore. It was no investment in myself, it was no way of starting to tackle my debts. It was just a coping mechanism,” Bell says.
Roughly one in five American adults, or about 45 million people, suffer some form of mental illness, according to the federal Substance Abuse and Mental Health Services Administration. And far more American workers have debt — 71 percent, according to Harris Poll research.
That can be a toxic combination. Yet according to Bell and mental health experts, money is seldom a topic in therapy. Bell says it should be. In fact, she’s a media producer who narrated her feelings about debt and depression…
An invisible problem
“It’s really annoying, infuriating, to me that people don’t talk about this much. People don’t talk about — first of all, just how mental health issues are something that everyone deals with,” says Bell.
“Second part is the fact that, your financial situation is huge. Part of the reason I got so far in debt, and how my mental stability contributed to that, was because nobody talked about it.”
That includes Bell herself, who’s been working to change that. Before her diagnosis, Bell was the envy of all her friends. Never feeling like she fit in at college, she left it to freelance on the open road. And from the outside, she seemed wildly successful and happy.
Banking on a steady stream of art and design gigs done out of coffee shops and her car (she still drives the same black Sonic hatchback — with three years of payments to go), Bell never stayed in one place for more than a couple weeks. She charted her course according to the next music festival, and as she chased them across the country, she made plans to start her own business.
“Owing money and not having enough … creates a lot of stress [we] don’t want to admit.”
—Dr. Steven Ronik, Henderson Behavioral Health
But in the back of her mind, having so many people cheerleading her lifestyle was deeply uncomfortable. At some level, Bell recognized she was spending recklessly, and knew her student loans probably weren’t in deferment anymore.
Like a lot of people, she got overwhelmed: unsure what else to do, or even how to talk about it. So Bell ignored that and kept on going — even buying tickets to a concert in the Dominican Republic when she couldn’t afford a flight to get there — up until she had a genuine nervous breakdown.
“I went to visit my family and travel, which was normal for me,” Bell remembers. One of her old high school teachers had even invited her to come co-teach a design course while she was in town. “But it had gotten to the point where I was afraid to do anything.”
Things might have gone differently if debt and mental health weren’t so taboo.
“Owing money and not having enough money, people can be embarrassed around that,” says Dr. Steven Ronik, CEO of South Florida-based Henderson Behavioral Health. “It creates a lot of stress they don’t want to admit.”
The not-for-profit community-based care provider he leads has been around for over 60 years, and helps 30,000 people of all ages per year with employment, homelessness, and medical and mental health treatment.
“If you’re young and just getting by and your peers are doing well financially, you might feel pressured to keep up with them,” Ronik says. “And that might precipitate overspending to keep up that lifestyle, without admitting you have less income and have to be more frugal and more thoughtful.”
Money, stress, stigma
It goes without saying those folks don’t think they can afford to seek help — and the not saying is part of the problem.
More than three quarters of American workers live paycheck to paycheck, according to Harris Poll research. A similar number admit they’re in debt, and more than half think they always will be.
Like Bell, they’re all one bad day from not being able to afford to live. It could be a natural disaster, a car accident, or a sudden injury or serious illness. Most Americans don’t have enough saved to cover even one month of normal expenses, according to a big Pew Charitable Trusts study.
So even if we’re not quite so adventurous, most of us can relate to living without any financial security, and having no clue how to fix it. Experts even have a term for that condition: “financial fragility.”
“When I was in treatment, the debt was always kind of at the back of my mind.”
—Kelsey Bell, 24
And the worst part isn’t that we aren’t equipped to deal with it. It’s that nobody knows how to talk about money. Even the professionals.
While in the hospital and in subsequent treatment, Bell says nobody talked about money.
“When I was in treatment, the debt was always kind of at the back of my mind, the last thing I wanted to think about — and the last thing anyone else cared about, including my doctor and therapist,” she says.
It’s not just a problem for millennials with student loans or people with diagnosed mental disorders. The American Psychological Association’s 2017 Stress in America survey found “money” tied for the top significant source of stress among all Americans — beating out work, politics, and “violence and crime.”
One of the biggest concerns: The cost of health insurance, which the study found is stressing out two-thirds of Americans across income brackets. Lacking access to mental health care is also particularly stressful to most millennials, to about half of Gen X, and to more than a quarter of Baby Boomers.
It’s a double whammy: Financial stress is part of the problem, and also prevents affording treatment. But despite that, few people are willing to talk about financial struggles or their mental health.
Treating the silence
The stigmas around both mental illness and money can feed into each other. Experts have found a definite relationship between financial stress — especially debt — and mental health. But there isn’t a clear cause-and-effect yet.
A few years ago, British researchers conducted a big meta study that analyzed and summed up 65 previous scientific papers about mental health (often, depression) and money. It found fewer than 9 percent of study participants without mental illness were in debt, while more than 25 percent with mental illness were in debt. That is to say: People with debt are almost three times as likely to be mentally ill.
“It is hard to say which causes which at this stage,” psychologist Thomas Richardson, the lead researcher at the University of Southampton, concluded. “It might be that debt leads to worse mental health due to the stress it causes. It may also be that those with mental health problems are more prone to debt because of other factors, such as erratic employment.”
“Equally it might be both,” he added. “For example people who are depressed may struggle to cope financially and get into debt, which then sends them deeper into depression.”
He has advice on addressing the issue: We need to talk more about it, study it more, and professionals need to take the lead. “Debt advisors should consider asking about mental health when speaking to members of the public,” Richardson says. “Similarly mental health professionals should ensure they ask about whether their patients are in debt.”
“People who are depressed may struggle to cope financially and get into debt, which sends them deeper into depression.”
—Dr. Thomas Richardson, University of Southampton
Professionals taking charge could go a long way to alleviating that anxiety, which Steven Ronik says can be a health problem all of its own.
“An extreme and traumatic example of this is when people have a general healthcare condition and get sick or hospitalized and have repeated outpatient appointments,” Dr. Ronik says. “What typically happens, because of copays or underinsurance or lack of insurance, people worry about their debt — and that can create anxiety and stress on its own, and we know emotional stress and anxiety can exacerbate physical health conditions.”
Ronik says he’s seen the “considerable stigma” around mental health starting to fade. He thinks outspoken celebrities have made a big difference.
“Folks who people look up to, it helps. Bruce Springsteen in his autobiography talked about several bouts of major depression and going to therapy, and those brave disclosures can be powerful and erode stigma,” says Ronik. “We’ve had a lot of celebrities and champions for mental health.”
He also cited Lady Gaga’s Born This Way Foundation, which is “specifically and intentionally dedicated to promoting mental health awareness and wellness for young people.” Gaga has been praised for revealing her diagnosis of post-traumatic stress disorder and promoting mental health.
Even if we don’t know the precise connection between debt and mental illness, we know both problems affect millions of people. And those people need solutions they can afford, according to Ronik.
“Without acting too political, that’s why health insurance coverage should be a right and not a privilege for the few. Almost the entire industrialized world sees it that way,” Ronik says. “Unfortunately the U.S. continues to have millions of Americans who avoid care and don’t follow up on recommended care and prescriptions because they can’t afford it. There’s something fundamentally wrong and perverse about that.”
Therapy in particular is quite expensive, Kelsey Bell says. She’s still paying off her medical debt from two years ago — along with her student loans, which she had defaulted on after being hospitalized. She couldn’t find a way to pay for continuing therapy. She says she would like to, “but my health insurance wasn’t going to cover even half of it.”
“I needed a lot of help just getting back to normal life, but after that it became way too expensive to keep going to therapy and getting regular treatment,” she says. “As I got better, I sort of weaned myself off it because the financial portion was a huge part of my problem. No one was going to let me be their regular patient without signing up to a huge program and paying for it up front.”
“Health insurance coverage should be a right, not a privilege.”
She tried group therapy, which she could afford but found much less effective. It was too broad, and, she says, not something you could use on its own as a cheaper alternative.
“They would regularly ask patients: ‘Are you feeling shame? Are you feeling worthlessness?'” she recalls. “Words like that are, when I feel overwhelmed about debt, those are the types of emotions I feel. How much shame do you feel when your student loans default?”
“I think if you go without someone who can help you make sense of it, it can make you feel worse,” she adds.
Getting help you can afford
Dr. Ronik says there are mental health resources for people without money or insurance, but they can be hard to find and to get.
Many communities have “something called a FQHC, federally funded clinics.” These federally qualified health centers are intended for low-income and uninsured workers, and there is a federal government website to find them. Those who qualify can get professional treatment they can afford.
“There are plenty of people like me who are not diagnosed.”
“Local community mental health centers around the country typically have a portion of their funding dedicated to people that are uninsured,” he says. And many communities have a local human services hotline. “Here in Broward we have 211, [a hotline] that can get you referrals and information for any need and that cuts a lot of red tape.”
Local colleges, churches, and community centers can also be starting points for finding resources. On the financial side of the problem, there’s free help in the form of credit counseling. You can speak with a professional from a nonprofit credit counseling agency for advice on your situation, and could be eligible for many options that can help bring your debt — and life — back under control.
Whatever you do, Bell cautions, don’t ignore your problems. Ask for help.
“After being diagnosed, it was surreal looking back on my decisions and everything I was doing. Now I can see a correlation between decisions I made, like ignoring my loans — a lot of those things became less about me and a lot more about a pattern that can come with mental illness,” she says.
“That was empowering, and a little disheartening, because everyone wants to think they’re in charge of their own life. But there are plenty of people like me who are not diagnosed, and there are a lot of things that can just screw you up.”