Poverty harms brain power, hard to escape: study


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Poverty harms brain power, hard to escape: study

By Sheryl Ubelacker The Canadian Press

TORONTO – Dealing with poverty takes up so much mental energy that the poor have less brain power for making decisions and taking steps to overcome their financial difficulties, a study suggests.

The research, published Thursday in the journal Science, concludes that a person’s cognitive abilities can be diminished by such nagging concerns as hanging on to a place to live and having enough money to feed their families.

As a result, there is less “mental bandwidth” left over for education, training, time-management and other steps that could help break the cycle of poverty, the researchers contend.

“Previous accounts of poverty have blamed the poor for their personal failings, or an environment that is not conducive to success,” said Jiaying Zhao of the University of British Columbia, who led the study, conducted while she was a graduate student at Princeton University.

“We’re arguing that being poor can impair cognitive functioning, which hinders individuals’ ability to make good decisions and can cause further poverty,” she said.

The study had two parts. In the first, about 400 people at a New Jersey mall were randomly selected to take part in a number of standard cognitive and logic tests. The participants’ annual family income ranged from $20,000 to $160,000, with a median of $70,000.

Subjects took the computer-based tests after being presented with a hypothetical financial problem that they would later have to solve: how they would come up with the money to pay for having their car fixed when the cost was either $150 or $1,500.

With the lower amount on their minds, those with low incomes fared as well on the tests as better-off participants. But when the amount was 10 times higher, low-income subjects performed far more poorly on the tests, said Zhao.

On average, a person preoccupied with money problems showed a reduction in cognitive function equivalent to a 13-point drop in IQ or the loss of a night’s sleep.

“It’s a big jump,” she said of the dip in IQ. “It pushes you from average (intelligence) to borderline (mental disability).”

In the second study, the researchers went into the field to test their theory in a real-life situation — with about 460 sugarcane farmers in 54 Indian villages who earn all their yearly income at the time of the annual harvest.

“That creates interesting dynamics because in the months before the harvest, they’re really poor, they’re running out,” Zhao said. “Whereas, in the months right after the harvest, they’re rich.

“So you can literally look within the same individual at how he or she performs when poor versus when rich.”

The researchers found that farmers showed diminished cognitive performance before getting paid for their harvest, compared to after the sugarcane crop was gathered in, when they had greater wealth.

They said these changes in cognitive abilities could not be explained by differences in nutrition, physical exertion or stress.

“So the very context of not having enough resources impedes your cognitive function,” Zhao said. That reduces a person’s mental ability to address elements that could help them break out of poverty,
for instance, a higher level of education, a better-paying job and enrolment in social programs to help attain those goals.

“You are simply unable to notice those things when you are preoccupied by poverty concerns.”
The fallout from neglecting other areas of life can exacerbate already trying financial woes, said co-author Eldar Shafir, a professor of psychology and public affairs at Princeton.

Late fees tacked onto unpaid rent and other bills or a job lost because of poor time management can make an already-tight money situation worse, Shafir said in a statement. 

And as people become more impoverished, they tend to make decisions that perpetuate their financial hardship, such as excessive borrowing, he added.
The researchers suggest that services for the poor shouldn’t “cognitively tax” them. 

Positive measures could include simpler aid forms, more guidance for receiving assistance, and more flexibly structured training and educational programs.

“When (people living in poverty) make mistakes, the outcomes of errors are more dear,” Shafir said. “So, if you are poor, you’re more error prone and errors cost you more dearly. It’s hard to find a way out.”

Dennis Raphael, a professor of health policy and management at Toronto’s York University , said the findings are consistent with previous research on the effects of a lack of “attentional resources” among the poor.

The authors’ recommend that “services for the poor should accommodate the dominance that poverty has on a person’s time and thinking … so that a person who has stumbled can more easily try again,” he said.

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Once Suicidal and Shipped Off in what is known as Greyhound Therapy

David Theisen, a homeless man at the center of a lawsuit against the State of Nevada, said, “Technically, they shouldn’t have been allowed to send me anywhere. They should have put me in a little room until I got better.”

September 21, 2013
Once Suicidal and Shipped Off, Now Battling Nevada Over Care


SAN FRANCISCO — David Theisen keeps his legal papers in a frayed yellow envelope in his tiny transients’ hotel room, a toilet down the hall, the covers of his beloved comic books, with titles like “Dark Mysteries” and “Vault of Horror,” lining the drab walls.

A lot has changed in the year and a half since Mr. Theisen, 52 and homeless, threatened to kill himself with a butcher knife and ended up in a Las Vegas psychiatric center. After one night, Mr. Theisen found himself on a bus to San Francisco, several sack lunches and a day’s worth of medication clutched in his lap.

“Technically, they shouldn’t have been allowed to send me anywhere,” Mr. Theisen said. “They should have put me in a little room until I got better.”

Now, Mr. Theisen is at the center of a class-action lawsuit brought this month by San Francisco’s city attorney, Dennis Herrera, against the State of Nevada on behalf of 24 mentally ill and homeless people. 

They were all, like Mr. Theisen, bused out of Nevada and left on the streets of San Francisco with little or no medication.

But that is just a small sampling, Mr. Herrera says, of the estimated 1,500 people who were bused all over the country in recent years from the state-operated Rawson-Neal Psychiatric Center in Las Vegas and other Nevada institutions, 500 of them to California.

“It’s horrifying,” Mr. Herrera said. “I think we can all agree that our most vulnerable and at-risk people don’t deserve this sort of treatment: no meds, no medical care, a destination where they have no contacts and know no one.”

But what makes it “even more tragic,” Mr. Herrera said, “is that on top of the inhumane treatment, the State of Nevada was trying to have another jurisdiction shoulder the financial responsibility for caring for these people.”

Attorney General Catherine Cortez Masto of Nevada, who has several weeks to respond to Mr. Herrera’s lawsuit, has declined to comment in the meantime.

Mary Woods, a spokeswoman for the Nevada Department of Health and Human Services, laid out the state’s position in an e-mail. Outside a handful of instances, the state believes that its Client Transportation Back to Home Communities program was operated properly and that it is not dissimilar from programs in other jurisdictions, including San Francisco.

Hospitals in several cities have programs intended to reunite discharged psychiatric patients with their families and hometowns. Where abuses occur, Mr. Herrera and others say, is when patients are shipped off with little or no oversight about where they are going and what will happen once they get there.

Nevada officials say that besides a single, well-documented case, they believe that the Rawson-Neal staff followed proper release procedures in almost all of the remaining cases they have investigated.

That single case, involving a man named James F. Brown who was sent by bus to Sacramento, a city where he knew no one, from the Vegas hospital in February, was the subject of an article in The Sacramento Bee.

That newspaper article not only prompted the San Francisco city attorney’s office to look into the Nevada policy, but it also led to a federal investigation.

“This has certainly elevated attention of a practice that, frankly, has probably gone on for many years in a number of states,” said Ronald S. Honberg, legal director for the National Alliance on Mental Illness in Washington. “We’ve never done a study, and I’ve never seen one anybody else did, but we have certainly heard over the years a number of stories that this sort of practice goes on.
It’s something we refer to, euphemistically, as  Greyhound therapy.”

Mr. Theisen’s experience began when he and another homeless man tried to hitchhike across the Mojave Desert from Las Vegas to San Diego. They made it about 45 miles to the small town of Primm, little more than a cluster of casinos.

The two men, desperate and hungry, ordered a meal and then ran before the bill arrived. They did not make it. His friend was arrested, but Mr. Theisen went to a pay phone and called the authorities. “I told them I had a knife and was going to kill myself,” he said. “After the dine-and-dash, I just gave up.”

He begged not to be sent back onto the streets of Las Vegas, he said, and did not care where they shipped him. “They asked me what kind of work I had done, and I said I was a cook,” he said. “So some young woman said, ‘Well, there are a lot of restaurants in San Francisco.’ ”

Mr. Theisen said he eventually wound up at the Rawson-Neal facility, where he spent the night. 

The next morning, he said, his doctors sent him to a Greyhound station with seven sack lunches and a day’s medication for the 14-hour ride. 

He arrived with three lunches left and $30 on a food stamps card, and bounced from shelter to shelter until he managed to get a room in a downtown transients’ hotel.

Rumors of such journeys had become part of California homeless lore.

“In San Francisco, it’s been urban myth for decades that this sort of practice was going on,” Mr. Herrera said. “But this is the first instance that I am aware of where we have been able to document a state-supported and state-sanctioned effort.”

Ms. Woods, the spokeswoman for Nevada’s health agency, said that from July 1, 2008, to March 31, the state bought out-of-state bus tickets for 4.7 percent of the patients it discharged, an estimated 1,473 people. 

“The findings show there were 10 instances in the course of five years where there was not enough documentation to know for certain if staff confirmed there was housing/shelter and supportive services at the destination,” she said.

The federal Centers for Medicare and Medicaid Services, however, said last month that its inquiry showed a more widespread problem. 
About 40 percent of the mental patients discharged by the hospital went into local homeless shelters or were shipped elsewhere, the federal investigators said, and most of those were sent directly to a Greyhound bus station with a ticket but without proper documentation or instructions on what they should do when they arrive.

Some medical staff members at Rawson-Neal were fired after the furor following the Bee report, Ms. Woods said, and the hospital strengthened its discharge protocols. Gov. Brian Sandoval of Nevada pushed the Legislature to approve, which it did, $30.4 million in additional mental health spending, including $2.1 million for Rawson-Neal.

Mr. Herrera is not satisfied. He wants proof that the new protocols are in place, as well as compensation for all the city has spent to care for the patients from Nevada. He is also talking to other California cities about joining him in the lawsuit.

“I am hopeful that shining a light on this will also shine a light on other jurisdictions around the country to make the point that this is not going to be tolerated,” he said.

It has been a tough year for Rawson-Neal. In July, it lost its accreditation, a decision that it did not fight. Of greater concern is a move by federal officials to possibly end Rawson-Neal’s eligibility for Medicare financing.

Mr. Theisen now subsists on $100 in assistance from the city every month, which with his free room, is just enough if he is careful. He gets the medication he needs for his depression and spends his days at the public library or roaming the city looking for work as a cook. The important thing is that now, for the first time, he can see a way forward.

“I guess they shouldn’t have done what they did in Nevada, but I cannot say enough about what this city has done for me,” he said. “It’s awesome, really. I have to struggle, yes, but otherwise life is good. I don’t wake up sad anymore.”

Source: Once Suicidal and Shipped Off