Spend an afternoon doing mental health research with Annie Harper, PhD and you might find yourself checking out the prices at a local rent-to-own store, helping a client pull his credit report, or listening as Harper speaks on the phone, convincing a student loan collection agency to restructure someone’s debt. “Some of the things we think of as ‘mental health problems’ are actually poverty problems,” she explains. “If we solved people’s financial problems, I think many of their other problems would go away.”

It’s a radical thesis, one that Harper is uniquely equipped to test. An anthropologist by training (she earned her PhD from Yale in 2010), Harper spent many years working in international microfinance and has a Masters in Political Economy of Development. An Associate Research Scientist at the Yale Program for Recovery & Community Health in the Yale Department of Psychiatry, she studies “financial health”— the point of intersection between people with serious mental illness and their money.

What is the relationship between poverty and mental illness? Poor people may be more likely to experience mental illness, and having a serious mental illness makes a person much more vulnerable to poverty. According to the federal Substance Abuse Mental Health Services Administration, an estimated 9.8 million adults in the United States are living with a serious mental illness. Of this group, approximately 2.5 million live below the federal poverty line.

Harper’s mental health work began in 2012 at Connecticut Mental Health Center (CMHC), a large publicly funded clinic and training site within the Yale Psychiatry Department. Recognizing poverty as a serious barrier to mental health recovery and wanting to understand the problem better, the CMHC Foundation recruited Harper to interview clients about their financial situations and see what she could learn.

CMHC clients share two things in common: they have a mental health diagnosis, and they’re poor. Most survive from one disability check to the next. Some have no income at all and live on food stamps alone. Some manage their own money; others have a representative payee who makes financial decisions for them. In the current system, there is no middle ground: people receiving mental health services either navigate treacherous financial waters by themselves, or through legal means, they lose the freedom to manage their own money.

Poor people, Harper explains, are more likely than others to be “financially excluded,” meaning they lack access to formal financial services. They use channels outside of traditional banks, such as check cashing places and pawn shops, both of which charge high fees. Those who do use banks pay fees for minimum balances and overdrafts. If they get credit cards, they often pay some of the highest interest rates in the industry. These are a few of the hidden costs of poverty—costs that may be detrimental to a person’s mental health.

At CMHC, Harper set to work, and in 2015 she won a grant from the National Institute of Mental Health (NIMH) to launch a pilot study with clients who manage their own money but wanted some help with their finances. When she joined the Yale Psychiatry Department, she had no medical training and knew little about mental illness and addiction. She says her outsider status has been an advantage. “Clinical people are trained to diagnose and see patterns,” she explains. “Often, that’s exactly what is needed. But they tend to view things through the lens of the individual.” “As anthropologists,” she continues, “we study the interconnections between individual beliefs and decisions, and the broader environment people live in—neighborhood, city, systems, society. Yes, individuals have agency, but we’re strongly shaped by things much bigger than we are.”

Michael Rowe, PhD, principal investigator of the Citizens Community Collaborative and Harper’s co-researcher, agrees. He has been working with people in recovery from serious mental illness, addiction, homelessness, and incarceration for more than thirty years. He has developed a framework for “recovering citizenship”—supporting people in recovery as they rebuild their social and civic identities—and he says Harper’s work brings a real-world perspective to the field.

Read more at Psychiatry