Nearly every week for the past two years, I have gotten on the phone with a director of suicide prevention at a very large mental health system in the United States, and we review cases of suicides. For the dead, we go over their demographics, psychiatric diagnoses, how they died by suicide and all of their interactions with the mental health system, from clinic intakes to the last notes from their final therapy sessions.
It is grueling and depressing research for a book I am writing on suicide. Some people's files are filled with no-show appointments or drop-ins for medication refills. Others contain information from inpatient stays and crisis calls.
I came to realize over time how irrelevant diagnostic labels such as bipolar disorder and major depression are to understanding deaths by suicide. I noticed that all too often, these patients' troubles began with childhood trauma and frequently ended with economic deprivation. One person who later died by suicide told her therapist that she sold her jewelry to make ends meet; another asked his therapist how to get a couch for his apartment. So many people who died by suicide weren't just starving for therapeutic attention. They were starving.
There is no one cause for any suicide. But research shows that there is a connection between people's ability to pay rent each month and their mental health.
As politicians debated increasing the federal minimum wage to $15 per hour, I thought about the deaths I was reviewing. There's a moral argument that Democrats should be making, but are not. Along with increasing social mobility and addressing inequality, raising the minimum wage has the potential to lower the country's suicide rate. The COVID-19 pandemic has raised concerns about a coming mental health crisis, and a wage hike should be discussed as not just good economic sense but also critical mental health policy.
In their book "Deaths of Despair and the Future of Capitalism," Anne Case and Angus Deaton, economists at Princeton, found that people with a high school diploma or less education — a group that's more likely to hold minimum wage jobs than people with more education — not only are earning less than college graduates but also are less likely to marry and to find support in a church or a union hall. And they are more likely to report feeling disappointed in the way their lives have turned out.
Case and Deaton specifically endorse raising the minimum wage to $15 per hour as a way to help combat this despair. While they acknowledge it may not fix the social isolation of the unemployed or the overall career prospects of those with only high school diplomas, higher wages can help those at the bottom income rung by providing a stronger safety net. "The loss of good jobs for less educated Americans not only is hurting those who are directly affected but is also hurting others, through the devastation of many communities and the destruction of a way of life," they write.
It may not take all that much to begin to reverse that trend of despair. Last year, researchers at Emory University published findings suggesting that if the U.S. increased its minimum wage by just $1 per hour, the suicide rate could drop between 3.4% and about 6% among adults with a high school education or less — that key risk group. The findings are especially relevant during the pandemic, as the researchers write that the effects "appear greatest during periods of high unemployment."
While it's hard to definitively show that higher minimum wages would lower deaths by suicide, the Emory findings support earlier research with similar conclusions. A 10% increase in the minimum wage could reduce nondrug suicides among adults with limited education by 2.7%, a 2019 working paper from the National Bureau of Economic Research found. In another 2019 study, University of North Carolina at Chapel Hill researchers reported that an increase of $1 per hour could have resulted in approximately 8,000 fewer suicides from 2006 to 2016.
The association between higher minimum wages and fewer suicides could be due in part to fewer financial struggles that are known to cause significant stress. Oscar Jiménez-Solomon, a researcher with the New York State Psychiatric Institute and Center on Poverty and Social Policy at Columbia University, said that low wages can result in the inability to meet basic needs, repay debts and make plans. "These conditions can make people feel utterly under siege, full of shame and hopelessness and ultimately vulnerable to thinking that there's no way out," he said. "Increases in minimum wage can save lives."
Lessening household financial stress could also bolster mental health within families. From 2005 to 2010, Carolina Hausmann-Stabile, an assistant professor of social work at Bryn Mawr College, interviewed girls 11 to 18 years old in New York City who were receiving mental health services after suicide attempts. Her work showed how girls from immigrant families were affected by financial stress and absent parents who worked more than one job.
"The issue of inequality and poverty was something that eroded their family's well-being in a manner that impacted directly the girls' well-being and resulted in suicidal behaviors," Hausmann-Stabile told me. Many of the girls she interviewed said they felt like a burden or that their futures were hopelessly limited to the minimum wage grind, even if they dreamed of bigger goals.
Minimum-wage jobs are often first jobs or the jobs of last resort. Congress needs to understand that raising the minimum wage is about more than just giving these workers a slightly better paycheck. It would mean improving national mental health and sending a clear message that low-wage workers' lives have value.
Jason Cherkis is a journalist based in Washington, D.C. He is working on a book about suicide for Random House. He wrote this article for the New York Times.