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The following is an interview with Professor Matt Smith, an expert in the history of mental health and psychiatry and fellow Psychology Today blogger. His new work explores Universal Basic Income (UBI) and how governments, health systems, and citizens might address both poverty and mental illness.
1. What's the story behind UBI and how does it fit in the history of mental health?
Universal Basic Income is a guaranteed income paid to every citizen with no strings attached. It lifts everyone above the poverty line and, because it is guaranteed, reduces a great deal of stress associated with unemployment and changes in the welfare system. It also allows people more opportunity to change their lives for the better, be that returning to school, becoming a musician, actor, or artist, writing the great American novel, volunteering for a cause they care about, or starting up a business.
It allows people to live more independently — paying full-time parents and carers an income for the valuable work they do, for example — yet it can also empower them to contribute more to their family and community. And it takes out all the red tape that hampers welfare systems all over the globe. If you don’t know what I mean, watch Ken Loach’s film I, Daniel Blake.
My current research is on the history of social psychiatry in the USA. Social psychiatry was a preventive approach to mental health that thrived after the Second World War and was based on psychiatric epidemiology. Large-scale, interdisciplinary research projects demonstrated that poverty, inequality, social isolation, and community disintegration all contributed to poor mental health. Those are the exact socioeconomic conditions that UBI can address. So, if you want to prevent mental illness, consider implementing UBI.
2. How did you come to support and research UBI?
I am a relatively recent convert to UBI. I first heard about it in 2014 in New Harmony, Indiana, at a conference celebrating the 200th anniversary of its founding by Robert Owen. One of the keynote lectures was by the late Erik Olin Wright. His title was something like: “Why Capitalism Won’t Exist by 2030” or something like that. I was losing patience with the talk until, towards the end, he mentioned UBI. And I could see where he was coming from. I have never been a dogmatist when it comes to politics or social policy. Although I lean left, I can see some of the rationale behind neoliberalism and certainly some of the shortcomings of hard-line left-wing policies.
The beauty of UBI is that it works for both left and right. It addresses the inequality and poverty that concerns the left, and it could be a powerful force for entrepreneurialism — something the right would support. Perhaps most importantly — and transcending politics — it could help us create a society that values production, rather than consumption, and that is essential if we want to repair our relationship with the environment.
3. How and why does UBI fill a gap in existing mental health treatment?
By preventing and reducing the impact of mental illness, UBI would be of benefit to mental health workers in three key ways that would facilitate: First, it would simply reduce the number of people in need of treatment, particularly those with mild or moderate mental illness. Second, since those coping with mental illness would be in receipt of a UBI, mental health workers wouldn’t have to spend so much time trying to ensure that the basic needs of their patients were being met. I know from experience that this can dominate one’s interactions with patients or clients, thus interfering with therapy or other forms of support or treatment.
Finally, if UBI could help prevent a considerable amount of fairly banal, environmentally-triggered mental health problems, mental health workers and researchers could have more time and energy to deal with the more intractable causes of mental illness, ranging from genetic factors to childhood sexual abuse. It’s like Archimedes and the bath (you know, that Eureka moment?): Archimedes represents all the mental illness that is caused or exacerbated by socioeconomic factors that UBI could mitigate. If we get Archimedes out of the damned bath, then the mental health system won’t always be overflowing — if that sudsy metaphor makes any sense!
4. Why does UBI matter in the age of Covid-19?
Covid-19 has changed the playing field when it comes to UBI in many ways. First, it has created a precedent of governments paying unprecedented amounts of money to ensure the financial security of the population. Why not go all the way and offer people UBI and the peace of mind that brings? Before you say that we can’t afford that, many economists argue that UBI would pay for itself in economic growth. I’m arguing it would also pay for itself in improved health outcomes.
Second, UBI has demonstrated that both physical and mental disease discriminates on the basis of income. Not only have poorer people been more vulnerable to Covid-19, they have also been more vulnerable to the hardships of lockdown and the resulting mental health problems. Historians of health and medicine have long demonstrated the relationship between poverty and poor health outcomes, but it often takes a pandemic to get this message through to politicians.
If we want a more mentally (and physically) healthier society, we need to start with the people who are struggling socioeconomically. This is not only humane, but it will also pay off in terms of health care costs. This lesson has even more resonance when considered in light of the Black Lives Matter movement, which has shone a light on the constant mental strain endemic racism places on the lives of people of color.
Finally, the pregnant pause that Covid-19 gave us all has made many people think a bit more about what matters to them. Nature, time with family (though not necessarily home-schooling), pursuing non-economic interests: all of these things really matter, but the daily grind obscures this fact. We’ve been forced to transform our lives temporarily in a way that has allowed many of us the opportunity to reassess our priorities. UBI could help us to make those changes permanent. And that would be good for mental health.
