Op-ed: Why direct cash is a critical mental health strategy

During this past year of global health crises and economic pressure, we have seen a growing awareness of the importance of mental health. For many, the pressures of COVID-19 and its financial fallout have exacerbated day-to-day pressures. For some, this time has led them to seek out mental health resources for the first time.

As a practicing Psychiatrist and a Psychologist in training, we see every day the toll economic strain has on mental health. Unfortunately, the best therapeutic interventions often cannot take the place of the basic security of knowing you and the people you love will have a roof over your head and food on the table. In fact, this type of physical safety and security often provide an essential foundation for addressing mental health challenges.


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That’s why direct, flexible cash is critical to wellness, especially at this time of increased economic uncertainty. We believe state lawmakers can take an important step toward supporting the mental health of Washingtonians by passing House Bill 1297 and Senate Bill 5387, which would fund an updated version of the Working Families Tax Credit, a direct cash Recovery Rebate.

This Recovery Rebate, modeled on the federal Earned Income Tax Credit (EITC), would provide an annual base cash rebate ranging from $500 to $950 (these base amounts phase down as incomes increase) to half a million low- and moderate-income households in Washington state. And it would reach kids in 1 in 4 households. Importantly, it would have an outsized benefit on Black, Indigenous, and people of color, and it would extend the benefits to Individual Tax Identification Number (ITIN) filers – a group of taxpayers that includes undocumented immigrants who have been left out of our federal recovery efforts.

We know tax credit policies like the Earned Income Tax Credit and state-level equivalents can have profound health impacts. Increases in similar state tax credits have been linked to significant reductions in reported frequent mental distress, and even reduced suicidal behavior. The credits are also correlated with improved maternal mental health, healthier infants, and even lower blood pressure for new mothers. And children in families who receive these tax credits show improved behavioral health outcomes.

In our day-to-day practice as mental health professionals we understand the vital role of cash as it directly relates to the stories we hear from our patients. It’s evident in the woman with high blood pressure who is pregnant with her second child who wants to leave an abusive partner but fears supporting her children on her income alone. It’s apparent in the student who is struggling and whose grades are slipping because she has to work to support her parents’ modest income while taking online classes and helping raise her siblings.

The direct, flexible cash the updated Working Families Tax Credit would provide could allow this woman the option of raising her children separate from her abusive partner. It could help this student reduce work hours and focus on school, enhancing their future career opportunities. These are the kinds of economic resources, especially when complemented with other public supports, that can fundamentally change someone’s life situation and provide a foundation for stronger mental health.

As mental health professionals, we know the critical role of cash in supporting people’s mental health and wellness. That’s why we urge state lawmakers to invest in a Recovery Rebate and pass an updated Working Families Tax Credit this session.

Jesse Paulsen, MD, is a third year Psychiatry Resident at the University of Washington. Maeve Sloan is a third year Psy.D. Student at Antioch University Seattle and current practicum student in a local primary care clinic. Both are members of Washington Physicians for Social Responsibility.