Poverty, policy, and mental health inequities: Evidence, challenges, and opportunities

Poverty is a key upstream determinant of mental health and a driver of persistent inequities in the United States (US). There is growing recognition that we need to target upstream social drivers of mental health inequities, particularly through economic policies aimed at reducing poverty. This article describes the relationship between poverty and mental health and synthesizes evidence on the mental health impacts of major US income support policies, including the Earned Income Tax Credit, Child Tax Credit, Temporary Assistance for Needy Families, minimum wage laws, and unemployment insurance. Existing literature suggests that income support policies, especially those delivering reliable and unconditional aid, can alleviate psychological distress and promote mental well-being. The reach and effectiveness of these policies, however, are constrained by complex eligibility criteria, administrative burdens, restrictive conditions, and insufficient generosity—disproportionately limiting access for those with mental illness or those in deepest poverty. Additionally, lump-sum payments only provide temporary relief, underscoring the potential benefits of more regular disbursements. Significant gaps in the evidence base remain for several policies, hindering evidence-based decision-making. To fully realize the mental health benefits of income policies, clinicians, researchers, and advocates can take specific actions to enhance patient take-up of income supports, promote policy reforms that reduce administrative barriers and expand access, invest in improved data infrastructure, and integrate social policy training into mental health education. A multisector, equity-oriented approach is essential to support population-level mental health and advance health equity amidst an evolving policy landscape.