Household poverty evolution associated with severe mental illness in China's development context

Abstract

Little is known about whether and how social drift may take place under a state of fast socio-economic development. This research was the first attempt to unravel the evolution of poverty associated with severe mental illness (SMI) at the household level in China, by proposing a context-specific research framework. This research applied a mixed-methods approach to capture the nature of poverty evolution. The first phase applied two secondary datasets from the Chengdu Mental Health Project (CMHP) to quantitatively examine poverty evolution. These datasets were derived from two mental health surveys in the same six townships of Xinjin county, Chengdu, in 1994 and 2015, where a total of 711 and 1,042 persons, respectively, were diagnosed with SMI. Three hundred and eight persons with SMI appeared in both surveys. Based on the available datasets, two quantitative themes were explored: (1) poverty trends from 1994 to 2015 based on two whole datasets, and (2) poverty transitions based on follow-up samples. For the first theme, poverty changes were identified and decomposed. Statistical methods were employed to examine factors associated with household poverty. For the second theme, the profiles of poverty transitions were identified and regressions were applied to determine the predictive factors for poverty dynamics. Twenty semi-structured interviews with carers were conducted in the second phase, to provide more nuanced contextual interpretations of the evolution of household poverty. The quantitative results showed that household poverty rate increased from 29.8% in 1994 to 39.5% in 2015. Without social welfare, the poverty rate in 2015 would have increased to 49.6%. Social protection played a significant role in poverty alleviation but it was still insufficient. Factors associated with household poverty changed during the period from 1994 to 2015. The work ability of persons with SMI, family size, social support and caring burden were significantly associated with household poverty in 2015. Results for the second theme showed that a larger proportion of households had escaped poverty rather than fallen into it. The work ability, physical health and mental disability of persons with SMI, as well as negative changes of these factors, were major predictors of household poverty dynamics. The qualitative results explained how social drift happened. Although development in Xinjin generated an overall improvement for people living there, it also required greater on personal abilities. SMI not only deprived those people with SMI, but also other family members, of trickle-down opportunities. As a result, these households became poorer as a whole. Without improved social protection, their economic status would have worsened. This study found that the poverty faced by households with persons with SMI become more pressing during China’s socioeconomic development. Poverty faced by them was unlikely to be alleviated automatically by promoting development. Instead, growth resulted in increased income inequality and further aggravated poverty. Social protection, as a typical form of redistribution, played a complex role in poverty alleviation during this period. Further, targeted anti-poverty policies and interventions are required as a development priority. (487 words)