Mental Health Problems Among Single Mothers: Implications for Work and Welfare Reform.

Rukmalie Jayakody [*]

Welfare reform's emphasis on work and self-sufficiency assumes that poor single mothers are similar in their status and functioning to the rest of the population. However, we find that their status is quite distinct. Logistic regression results reveal that the likelihood of working is 25% lower for those with a psychiatric disorder. Mental health problems may prevent women from undertaking the tasks necessary to find employment, or women with these problems may lack the self-confidence needed to take on new challenges. Our findings suggest that mental health problems among single mothers deserve greater attention as a barrier to self-sufficiency and highlight the need for more effective intervention and treatment efforts to improve economic and social outcomes.

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA; P.L. 104-193) focuses on moving women "from welfare to work" by ending entitlement to cash assistance and requiring work in exchange for time-limited assistance. After 2 years of receipt (or fewer at state option), recipients must participate in work-related activities. [1] Also, after 2 years of receipt (or fewer at state option) [2] families will be ineligible for federally funded cash aid.

Central to the political debates surrounding welfare reform is the idea that welfare recipients should be expected to work. The passage of work requirements and time limits indicates a clear shift in welfare policy from income maintenance to emphasizing work and self-sufficiency. Underlying this shift is the notion that since the majority of American mothers work, poor, single mothers should also be expected to participate in the labor force. This argument implicitly assumes that welfare recipients are similar in their status and functioning to the general population. Given recent changes in welfare and the need to move women off welfare and into employment within specified time limits, identifying the potential employment barriers that these women face is crucial.

Although differences in the personal characteristics of welfare recipients were well known to policy experts and program officials in the Aid to Families with Dependent Children (AFDC) program, variations within the caseload received little attention. Because the traditional AFDC system effectively provided open-ended assistance, heterogeneity was of little concern. The advent of time limits and work requirements, however, has forced researchers and program administrators to confront the great variations in personal problems and circumstances. The sharp caseload reductions experienced in many states make it likely that those remaining on the rolls experience multiple difficulties that hinder their ability to achieve self-sufficiency, even in a robust economy.

The traditional focus in studies of barriers to employment has been on structural barriers, including access to child care, transportation costs, the availability of jobs paying a living wage, racial barriers, and welfare disincentives. Discussions of individual barriers to self-sufficiency are often limited to demographic factors, such as the lack of schooling, job training, and work experience, and have made little mention of psychological difficulties (Olson & Pavetti, 1996).

Yet mental health problems appear to be an important barrier to self-sufficiency, and the existence of these problems may prevent some women from leaving welfare for work in a timely manner. A growing body of research suggests that mental health problems profoundly affect social functioning (Tweed, 1993) and result in lower rates of labor force participation, reduced work hours, and lower earnings (Bland, Stebelsky, & Newman, 1988; Ettner, Frank, & Kessler, 1997; Jayakody, Danziger, & Kessler, 1998; Kessler & Frank, 1996). Despite the lack of focus on the mental health problems of welfare recipients, recent research indicates that these women may experience higher levels of psychiatric distress than individuals in the general population and that these problems may affect their economic self-sufficiency. Because psychological factors play a potentially critical role in the success of welfare reform efforts, we focus on the mental health of women, and more specifically, the mental health of single mothers. Men tal health problems are a potentially important function of welfare receipt and female labor supply that has been overlooked.

Blaming the Victim

A long-standing controversy in poverty research has been the debate over individual responsibility versus structural barriers as the root cause of welfare dependency. Many researchers have been cautious about discussing the psychological status of welfare recipients, fearing that this lends credibility to the individual responsibility argument. Indeed, many sought to emphasize the similarities between welfare recipients and the general population, that is, "the poor are just like you and me, they just lack money." This was a rational course of action for supporters of expanded social provision in a society with a tenuous commitment to redistributive concerns. Many believe highlighting the psychology of the poor as distinctive constitutes "blaming the victim" and directly leads to arguing that poverty and welfare receipt results from poor motivation, the lack of adherence to middle-class social norms and values, and a general "culture of poverty" (Moynihan, 1965). Yet pointing out the mental health problems o f welfare recipients does not negate that societal factors may be the ultimate cause of these problems and that the lack of opportunities and structural barriers affect not only socioeconomic outcomes, but mental health outcomes as well.

Family Structure, Poverty, and Mental Health

Several lines of research suggest that welfare recipients have high rates of mental health problems. Women receiving welfare may be at a particularly high risk of experiencing mental illness because of the established relationships between (1) poverty and mental health, (2) family structure and mental health, and (3) welfare receipt and mental health. By focusing on the context of welfare recipients' lives and by discussing the relationship between mental health problems and a variety of demographic factors, we hope to make clear why mental health problems are important to consider and why recipients themselves are not necessarily at fault for the existence of any mental health problem, poverty, or welfare receipt.

The relationship between mental health and poverty is well established, showing that individuals in lower socioeconomic groups experience higher rates of psychiatric problems than those in higher socioeconomic groups. Although this relationship is widely recognized, the direction of causation is still debated. Some believe this relationship results from the "social selection" of the mentally ill into lower socioeconomic (SES) strata, whereas others argue that lower SES produces mental disorders (Bruce, Takeuchi, & Leaf, 1991; B. P. Dobrenwend & B. S. Dobrenwend, 1969; B. P. Dohrenwend et al., 1992; Eisenberg & Lazarsfeld, 1938; Feather, 1990; Hunter & Macalpine, 1963; Jayakody et al., 1998; Kessler, 1982). Regardless of the direction of causality, studies examining the prevalence of mental disorders by SES find that individuals in the lowest social class are two-and-one-half times more likely to have mental health problems than individuals in the highest social class (Neugebauer, Dohrenwend, & Dobrenwend, 19 80) and that prevalence rates decline monotonically with SES (Kessler et al., 1994).

Family structure has also been identified as an important factor related to mental health outcomes, with single motherhood emerging as …