In my office: “I didn’t expect it to be so hard,” says the mother who just gave birth, the parent who is raising young children, or the young adult trying to live independently after college. There are many psychological reasons these transitional times are difficult; I listen carefully to understand the stressors my patients are facing, and then use all the clinical tools at my disposal to provide support.
That said, I also recognize their worries are amplified because of a federal government that hasn’t always cared to invest in their well-being. It may be a more difficult transition due to a lack of infrastructure support.
No Infrastructure Support After Birth
Let’s start with birth. A family is sent home a few days after delivery, with some information and a 6-week OB-GYN follow-up. The addition of a baby adds financial and emotional stress; if you are lucky, you live in one of the 14 states, or Washington, DC, that provide mandatory paid family leave, or one of the nine that support voluntary leave, paid through private insurance. So many are left without support: There is no federal program protecting wages after childbirth.
Nurturing an infant is a high-intensity, 24/7 job. Family and friends may pitch in. If you have resources, you can pay for help and child care. Families at the poverty level are eligible for Early Head Start or Medicaid, which can provide additional family and infant assistance, but the services don’t erase the stress of a new baby on a limited income. Most people reside in the middle, making too much to qualify for Early Head Start but not enough to access the care they need
A small smattering of states (MA, NJ, OR) and local areas offer some postpartum clinical care, but universal federal support is lacking.
The outpouring of female support for Lindsay Clancy, the mother who murdered her children while in the throes of postpartum psychosis, reflects how many women understand the feeling of being insufficiently supported during the postpartum period. What is currently offered is wholly inadequate.
In contrast, in the UK, all new parents receive a midwife visit within 36 hours of birth. Necessary follow-up is provided until care is handed off to a clinician about two weeks after birth for continued support to the infant and the mother.
No Infrastructure Support Before Kindergarten
There is extensive research documenting how early childhood education (ECE) is associated with improved cognitive, psychological, and medical outcomes years later. ECE teachers are experts in child development and a resource for parents. ECE supports parental employment, and provides protected time so parents can address their own medical needs.
For the majority of families, preschool is a huge expense. Like postpartum care, there are some state- or city-funded preschool programs, but these are outliers.
A general pattern emerges. If you have a lot of resources, you can pay for what you need. Low-income families will struggle with day-to-day expenses, but the child will be eligible for Headstart, a funded federal preschool option that the current administration is trying to deregulate. The group in the middle is left to fend for themselves. There is no federal program supporting all young families.
In contrast, several European countries provide heavily subsidized or free preschool. In a 2021 UNICEF report assessing rich nations' investment in childcare, the U.S. ranked second to last.
Americans don’t even notice the assistance is missing because we never had it in the first place.
No Infrastructure for College, Housing, and Healthcare.
On to education, housing, and healthcare: The costs of all three have exploded over the last several years without governmental programs to address the gap between costs and wages. The enhanced federal tax credits for the Affordable Care Act have expired. There are some federal safety nets, Medicare and Social Security being most well-known. While these programs are critically important, they leave most Americans without assistance during much of their life.
The American Ideal Is Hurtful
Somehow, this approach has become a story of American resilience. We are a tough people, and if you can’t make it, if you can’t afford childcare, or health care or housing, well, that’s on you. Wanting help somehow makes you a taker, a dead weight, or a potential parasite on the system.
This theory works well for politicians funded by billionaires and corporations. The “trickle down” economic theory, that taking care of businesses and the wealthy will allow wealth to trickle down to those less fortunate, has been promoted ad nauseam my entire adult life — and evidence shows it doesn’t work.
The system has been weighted against the average American for years. Why is it especially impacting mental health now? Decades ago, rent was cheaper and a mortgage was attainable. Wages could keep up with living expenses. The Affordable Care Act provided a safety net before it was systematically diminished. It was easier to dream.
Now, it feels harder because it is. What is it like to enter your 20s and be unable to find a job that will cover rent? What desperation causes a person to start a GoFundMe for necessary medical care?
It’s no surprise that anxiety and depression are up.
What If We Prioritized Taking Care of One Another?
I hope, before I retire, that I see an American economy and federal government that redefines patriotism as unabashedly, unashamedly, investing in all people at all ages. Imagine a government that would prioritize policies for student and family aid, that would protect and subsidize health care, and ease the cost of housing. Care for all stages of the life cycle would be considered. Just because we haven’t seen it happen, doesn’t mean that it couldn’t. I believe our individual psychological health would improve if our values and votes focused on meeting the needs of all Americans, from sea to shining sea.