Although Hüffmeier and Zacher (Reference Hüffmeier and Zacher2021) acknowledged the potential implications of a basic income for a variety of employee issues, they overlooked the possible positive benefits for employees who are experiencing a mental health condition. Amental health condition is defined as “both mental illness and symptoms of mental illness that may not be severe enough to warrant the diagnosis of a mental illness” (Kitchener et al., Reference Kitchener, Jorm and Kelly2017, p. 4). Mental health conditions affect 20% of working aged adults in any given year and up to 50% in their lifetime. Mental health conditions can arise from both genetic and psychosocial factors and may be temporary or lifelong. Research has demonstrated the rate of mental health conditions is increasing and has been accelerated by the global pandemic (Pierce et al., Reference Pierce, Hope, Ford, Hatch, Hotopf, John, Kontopantelis, Webb, Wessely, McManus and Abel2020). Employee mental health conditions are associated with decreased productivity as well as increased absenteeism, presenteeism, and turnover (Kitchener et al., Reference Kitchener, Jorm and Kelly2017). With this being said, work is a major determinant of mental health and plays an important role in recovery (Stuart, Reference Stuart2006).
Considering the prevalence and implications of mental health conditions for employees’ quality of life and work outcomes, Iargue that the provision of a basic income may benefit employees with a mental health condition by attenuating the significant personal, organizational, and societ al barriers that are associated with mental health conditions in the workplace. Idiscuss three implications for why this might be the case. First, a basic income may reduce financial barriers that prevent working adults from seeking help. Financial barriers include the direct cost of treatment itself such as talk and pharmaceutical therapies as well as indirect costs including insurance premiums. Second, a basic income may have implications for alternative work arrangements and return-to-work practices such as extended unpaid leave and gradual return to work. Third, a basic income may help attenuate the risk associated with disclosing a mental health condition. Due to deeply ingrained societ al stigma, employees with a mental health condition experience both formal and interpersonal discrimination (Follmer & Jones, Reference Follmer and Jones2018). Abasic income would attenuate some of the negative financial effects by compensating for wage discrimination. Abasic income also provides increased mobility and control if the employee experiences interpersonal discrimination by providing a financial buffer while searching for new employment.
Implication 1: Diminish direct and indirect financial barriers
Given the ever-growing disparity between high- and low-income earners (Dickman et al., Reference Dickman, Himmelstein and Woolhandler2017), financial barriers to help seeking among employees who are experiencing a mental health condition is an important extension of Hüffmeier and Zacher’s (Reference Hüffmeier and Zacher2021) arguments. Research suggests that financial barriers are one of the most salient factors that inhibit help seeking, particularly for low-income earners, young adults, and minorities (Cronin et al., Reference Cronin, Pepping, Halford and Lyons2021). Furthermore, financial barriers account for 25% of treatment dropouts, suggesting that it is a barrier not only to seeking help but also to maintaining treatment (Andrade et al., Reference Andrade, Alonso, Mneimneh, Wells, Al-Hamzawi, Borges, Bromet, Bruffaerts, De Girolamo, De Graaf, Florescu, Gureje, Hinkov, Hu, Huang, Hwang, Jin, Karam, Kovess-Masfety and Kessler2014). Given that low and middle earners pay a significantly larger proportion of their incomes for health care and cover than do high earners (Dickman et al., Reference Dickman, Himmelstein and Woolhandler2017), a basic income may help reduce the inequalities in disposable income by assisting employees with both the direct and indirect costs associated with getting and maintaining help for their mental health condition.
Direct costs include medical practitioner visits, pharmaceutical, and other treatments. For example, my own research suggests that employees who are experiencing a mental health condition often seek help first from a general practitioner who then provides a referral to another mental health practitioner such as a psychologist or psychiatrist, and sometimes both, which can be a significant financial barrier (Carpini et al., Reference Carpini, Chandra, Lin, Teo, Truong, Boyne, Wylde, Clifford and Ashoorian2020). In fact, in many medical systems around the world, a general practitioner referral is frequently a requirement to see a mental health specialist. The cost of treatment is further compounded by the fact that many insurance companies provide lower reimbursements for mental health consultations compared with those for other medical and surgical specialists (Melek et al., Reference Melek, Davenport and Gray2019). The COVID-19 pandemic saw the innovation of telehealth and teletherapy, which were lauded as cost-effective solutions to expensive consultations. This being said, an average teletherapy session costs between $60 and $90 USD a week, which is still beyond the financial ability of many employees (Melek et al., Reference Melek, Davenport and Gray2019). To put this into context, the weekly cost of teletherapy alone would represent between 12% and 30% of proposed basic income amounts (Hüffmeier & Zacher, Reference Hüffmeier and Zacher2021). In addition, the direct cost of pharmaceuticals and other treatments is often substantial for both the insured and uninsured (Dickman et al., Reference Dickman, Himmelstein and Woolhandler2017). The provision of a basic income could be a useful tool in overcoming the direct costs associated with seeking help.
The indirect costs of mental health treatment are also substantial. Of the various indirect costs, insurance premiums are often identified as a structural barrier to help seeking (Andrade et al., Reference Andrade, Alonso, Mneimneh, Wells, Al-Hamzawi, Borges, Bromet, Bruffaerts, De Girolamo, De Graaf, Florescu, Gureje, Hinkov, Hu, Huang, Hwang, Jin, Karam, Kovess-Masfety and Kessler2014). The rising cost of insurance premiums outpaces wage increases and further compounds inequities in access to health care and treatment (Dickman et al., Reference Dickman, Himmelstein and Woolhandler2017), resulting in a greater proportion of individuals forfeiting insurance all together (Melek et al., Reference Melek, Davenport and Gray2019). The cost of health insurance itself represents a significant barrier, let alone for those who go without insurance and then must absorb the full cost of mental-health-related consultations and treatments. Abasic income would also help alleviate wage compression that arises from employer-sponsored insurance schemes that see a growing proportion of salaries siphoned to growing insurance costs (Anand, Reference Anand2017).
Implication 2: Leave and return-to-work policies and practices
A basic income may also have implications for leave and return-to-work policies and practices because the supplemental income may reduce experiences of stress that are associated with missing work and a reduction in working hours. Employers frequently use planned absences and gradual return-to-work practices to support employees with mental health conditions (Stuart, Reference Stuart2006). Indeed, in a study examining the policies and practices of 170 employers, researchers found reducing working hours (51% of respondents) and gradual return to work (43%) were the most common workplace accommodations following depression-related leave (Bastien & Corbière, Reference Bastien and Corbière2019). Research suggests that planned absence and gradual return-to-work practices can be effective in reengaging employees in the workforce following a mental health condition (Kitchener et al., Reference Kitchener, Jorm and Kelly2017). Although a useful strategy, employees may experience stress due to losses of income and perceived job security that sometimes motivates a premature return to work or a reduction in planned absenteeism (Corbière et al., Reference Corbière, Bergeron, Negrini, Coutu, Samson, Sauvé and Lecomte2018). This is likely because a large proportion of those experiencing a mental health condition are employed on part-time and casual bases that do not afford them the same employment privileges as their full-time peers (Melek et al., Reference Melek, Davenport and Gray2019). Thus, the provision of a basic income may support employees in using available planned absence and gradual return-to-work policies by attenuating stress that is related to wage loss as well as avoiding compounding a reduction in working hours with financial barriers to seeking and maintaining treatment.
Implication 3: Attenuating negative consequences of discrimination at work
Formal and interpersonal discrimination are among the most frequent experiences of employees with a mental health condition, contributing to diminished career opportunities, social isolation, and marginalization (Follmer & Jones, Reference Follmer and Jones2018; Stuart, Reference Stuart2006). Interpersonal discrimination refers to verbal and nonverbal behaviors making up an interaction, whereas formal discrimination refers to “discrimination in hiring, promotions, access, and resource distribution.” (Hebl et al., Reference Hebl, Foster, Mannix and Dovidio2002, p. 816). Abasic income would have implications for both formal and interpersonal workplace discrimination by attenuating the negative consequences of formal discrimination and giving employees greater control over employment decisions and their exposure to interpersonal discrimination.
Although formal discrimination based on a mental health condition is technically illegal in many countries including the United States (Americans with Disability Act), Canada (Canadian Human Rights Act), and Australia (Disability Discrimination Act), research suggests that it still occurs. Discrimination is often due to negative stereotypes that are associated with mental health conditions such as being incompetent, emotionally unstable, uncooperative, and even dangerous—all of which are in stark contrast to the stereotypes of a desirable employee (Follmer & Jones, Reference Follmer and Jones2018). These stereotypes create perceptions of misfit between the attributes of employees with a mental health condition and those of the “ideal” employee, with profound career implications. For example, Baldwin and Marcus (Reference Baldwin and Marcus2007) found that those with a mental health condition had an average of 7.5% lower hourly wage compared with those without, with those reporting an anxiety condition experiencing the worst discrepancy at 14.8%. Additionally, those with a mental health condition are also perceived as less promotable (Stuart, Reference Stuart2006). Together, this research demonstrates the influence of formal discrimination on the career outcomes of employees with mental health conditions. Therefore, a basic income would at least attenuate the financial burden that is associated with their diminished work opportunity and lower hourly wages and reduce some financial strain.
In additional to formal discrimination, employees with a mental health condition are also subjected to interpersonal discrimination that has an equally negative, if not worse, effect on their mental health (Follmer & Jones, Reference Follmer and Jones2018). Experiences such as increased supervision, work deskilling (Bastien & Corbière, Reference Bastien and Corbière2019), social isolation, and rude and demeaning comments from coworkers are common (Kitchener et al., Reference Kitchener, Jorm and Kelly2017). Many simply accept these experiences of interpersonal discrimination because they feel powerless to change their work contexts (Stuart, Reference Stuart2006), often motivated by difficulties with obtaining initial employment (Baldwin & Marcus, Reference Baldwin and Marcus2007). This being said, a basic income may decrease the financial risk of leaving a toxic work environment by providing financial support while searching for new employment (Hüffmeier & Zacher, Reference Hüffmeier and Zacher2021). This non-work-contingent income would afford a greater sense of control over where and with whom employees with a mental health condition work that can bolster their self-confidence and offer new opportunities for social integration.
Although Hüffmeier and Zacher (Reference Hüffmeier and Zacher2021) acknowledged the potential implications of a basic income for a variety of employee issues, they overlooked the possible positive benefits for employees who are experiencing a mental health condition. Amental health condition is defined as “both mental illness and symptoms of mental illness that may not be severe enough to warrant the diagnosis of a mental illness” (Kitchener et al., Reference Kitchener, Jorm and Kelly2017, p. 4). Mental health conditions affect 20% of working aged adults in any given year and up to 50% in their lifetime. Mental health conditions can arise from both genetic and psychosocial factors and may be temporary or lifelong. Research has demonstrated the rate of mental health conditions is increasing and has been accelerated by the global pandemic (Pierce et al., Reference Pierce, Hope, Ford, Hatch, Hotopf, John, Kontopantelis, Webb, Wessely, McManus and Abel2020). Employee mental health conditions are associated with decreased productivity as well as increased absenteeism, presenteeism, and turnover (Kitchener et al., Reference Kitchener, Jorm and Kelly2017). With this being said, work is a major determinant of mental health and plays an important role in recovery (Stuart, Reference Stuart2006).
Considering the prevalence and implications of mental health conditions for employees’ quality of life and work outcomes, Iargue that the provision of a basic income may benefit employees with a mental health condition by attenuating the significant personal, organizational, and societ al barriers that are associated with mental health conditions in the workplace. Idiscuss three implications for why this might be the case. First, a basic income may reduce financial barriers that prevent working adults from seeking help. Financial barriers include the direct cost of treatment itself such as talk and pharmaceutical therapies as well as indirect costs including insurance premiums. Second, a basic income may have implications for alternative work arrangements and return-to-work practices such as extended unpaid leave and gradual return to work. Third, a basic income may help attenuate the risk associated with disclosing a mental health condition. Due to deeply ingrained societ al stigma, employees with a mental health condition experience both formal and interpersonal discrimination (Follmer & Jones, Reference Follmer and Jones2018). Abasic income would attenuate some of the negative financial effects by compensating for wage discrimination. Abasic income also provides increased mobility and control if the employee experiences interpersonal discrimination by providing a financial buffer while searching for new employment.
Implication 1: Diminish direct and indirect financial barriers
Given the ever-growing disparity between high- and low-income earners (Dickman et al., Reference Dickman, Himmelstein and Woolhandler2017), financial barriers to help seeking among employees who are experiencing a mental health condition is an important extension of Hüffmeier and Zacher’s (Reference Hüffmeier and Zacher2021) arguments. Research suggests that financial barriers are one of the most salient factors that inhibit help seeking, particularly for low-income earners, young adults, and minorities (Cronin et al., Reference Cronin, Pepping, Halford and Lyons2021). Furthermore, financial barriers account for 25% of treatment dropouts, suggesting that it is a barrier not only to seeking help but also to maintaining treatment (Andrade et al., Reference Andrade, Alonso, Mneimneh, Wells, Al-Hamzawi, Borges, Bromet, Bruffaerts, De Girolamo, De Graaf, Florescu, Gureje, Hinkov, Hu, Huang, Hwang, Jin, Karam, Kovess-Masfety and Kessler2014). Given that low and middle earners pay a significantly larger proportion of their incomes for health care and cover than do high earners (Dickman et al., Reference Dickman, Himmelstein and Woolhandler2017), a basic income may help reduce the inequalities in disposable income by assisting employees with both the direct and indirect costs associated with getting and maintaining help for their mental health condition.
Direct costs include medical practitioner visits, pharmaceutical, and other treatments. For example, my own research suggests that employees who are experiencing a mental health condition often seek help first from a general practitioner who then provides a referral to another mental health practitioner such as a psychologist or psychiatrist, and sometimes both, which can be a significant financial barrier (Carpini et al., Reference Carpini, Chandra, Lin, Teo, Truong, Boyne, Wylde, Clifford and Ashoorian2020). In fact, in many medical systems around the world, a general practitioner referral is frequently a requirement to see a mental health specialist. The cost of treatment is further compounded by the fact that many insurance companies provide lower reimbursements for mental health consultations compared with those for other medical and surgical specialists (Melek et al., Reference Melek, Davenport and Gray2019). The COVID-19 pandemic saw the innovation of telehealth and teletherapy, which were lauded as cost-effective solutions to expensive consultations. This being said, an average teletherapy session costs between $60 and $90 USD a week, which is still beyond the financial ability of many employees (Melek et al., Reference Melek, Davenport and Gray2019). To put this into context, the weekly cost of teletherapy alone would represent between 12% and 30% of proposed basic income amounts (Hüffmeier & Zacher, Reference Hüffmeier and Zacher2021). In addition, the direct cost of pharmaceuticals and other treatments is often substantial for both the insured and uninsured (Dickman et al., Reference Dickman, Himmelstein and Woolhandler2017). The provision of a basic income could be a useful tool in overcoming the direct costs associated with seeking help.
The indirect costs of mental health treatment are also substantial. Of the various indirect costs, insurance premiums are often identified as a structural barrier to help seeking (Andrade et al., Reference Andrade, Alonso, Mneimneh, Wells, Al-Hamzawi, Borges, Bromet, Bruffaerts, De Girolamo, De Graaf, Florescu, Gureje, Hinkov, Hu, Huang, Hwang, Jin, Karam, Kovess-Masfety and Kessler2014). The rising cost of insurance premiums outpaces wage increases and further compounds inequities in access to health care and treatment (Dickman et al., Reference Dickman, Himmelstein and Woolhandler2017), resulting in a greater proportion of individuals forfeiting insurance all together (Melek et al., Reference Melek, Davenport and Gray2019). The cost of health insurance itself represents a significant barrier, let alone for those who go without insurance and then must absorb the full cost of mental-health-related consultations and treatments. Abasic income would also help alleviate wage compression that arises from employer-sponsored insurance schemes that see a growing proportion of salaries siphoned to growing insurance costs (Anand, Reference Anand2017).
Implication 2: Leave and return-to-work policies and practices
A basic income may also have implications for leave and return-to-work policies and practices because the supplemental income may reduce experiences of stress that are associated with missing work and a reduction in working hours. Employers frequently use planned absences and gradual return-to-work practices to support employees with mental health conditions (Stuart, Reference Stuart2006). Indeed, in a study examining the policies and practices of 170 employers, researchers found reducing working hours (51% of respondents) and gradual return to work (43%) were the most common workplace accommodations following depression-related leave (Bastien & Corbière, Reference Bastien and Corbière2019). Research suggests that planned absence and gradual return-to-work practices can be effective in reengaging employees in the workforce following a mental health condition (Kitchener et al., Reference Kitchener, Jorm and Kelly2017). Although a useful strategy, employees may experience stress due to losses of income and perceived job security that sometimes motivates a premature return to work or a reduction in planned absenteeism (Corbière et al., Reference Corbière, Bergeron, Negrini, Coutu, Samson, Sauvé and Lecomte2018). This is likely because a large proportion of those experiencing a mental health condition are employed on part-time and casual bases that do not afford them the same employment privileges as their full-time peers (Melek et al., Reference Melek, Davenport and Gray2019). Thus, the provision of a basic income may support employees in using available planned absence and gradual return-to-work policies by attenuating stress that is related to wage loss as well as avoiding compounding a reduction in working hours with financial barriers to seeking and maintaining treatment.
Implication 3: Attenuating negative consequences of discrimination at work
Formal and interpersonal discrimination are among the most frequent experiences of employees with a mental health condition, contributing to diminished career opportunities, social isolation, and marginalization (Follmer & Jones, Reference Follmer and Jones2018; Stuart, Reference Stuart2006). Interpersonal discrimination refers to verbal and nonverbal behaviors making up an interaction, whereas formal discrimination refers to “discrimination in hiring, promotions, access, and resource distribution.” (Hebl et al., Reference Hebl, Foster, Mannix and Dovidio2002, p. 816). Abasic income would have implications for both formal and interpersonal workplace discrimination by attenuating the negative consequences of formal discrimination and giving employees greater control over employment decisions and their exposure to interpersonal discrimination.
Although formal discrimination based on a mental health condition is technically illegal in many countries including the United States (Americans with Disability Act), Canada (Canadian Human Rights Act), and Australia (Disability Discrimination Act), research suggests that it still occurs. Discrimination is often due to negative stereotypes that are associated with mental health conditions such as being incompetent, emotionally unstable, uncooperative, and even dangerous—all of which are in stark contrast to the stereotypes of a desirable employee (Follmer & Jones, Reference Follmer and Jones2018). These stereotypes create perceptions of misfit between the attributes of employees with a mental health condition and those of the “ideal” employee, with profound career implications. For example, Baldwin and Marcus (Reference Baldwin and Marcus2007) found that those with a mental health condition had an average of 7.5% lower hourly wage compared with those without, with those reporting an anxiety condition experiencing the worst discrepancy at 14.8%. Additionally, those with a mental health condition are also perceived as less promotable (Stuart, Reference Stuart2006). Together, this research demonstrates the influence of formal discrimination on the career outcomes of employees with mental health conditions. Therefore, a basic income would at least attenuate the financial burden that is associated with their diminished work opportunity and lower hourly wages and reduce some financial strain.
In additional to formal discrimination, employees with a mental health condition are also subjected to interpersonal discrimination that has an equally negative, if not worse, effect on their mental health (Follmer & Jones, Reference Follmer and Jones2018). Experiences such as increased supervision, work deskilling (Bastien & Corbière, Reference Bastien and Corbière2019), social isolation, and rude and demeaning comments from coworkers are common (Kitchener et al., Reference Kitchener, Jorm and Kelly2017). Many simply accept these experiences of interpersonal discrimination because they feel powerless to change their work contexts (Stuart, Reference Stuart2006), often motivated by difficulties with obtaining initial employment (Baldwin & Marcus, Reference Baldwin and Marcus2007). This being said, a basic income may decrease the financial risk of leaving a toxic work environment by providing financial support while searching for new employment (Hüffmeier & Zacher, Reference Hüffmeier and Zacher2021). This non-work-contingent income would afford a greater sense of control over where and with whom employees with a mental health condition work that can bolster their self-confidence and offer new opportunities for social integration.