ISSUE BRIEF NO.

06 | AUGUST 2020

POLICY BRIEF By Nick Murray, Policy Analyst & Julia Bentley, Policy Intern

A HUMANE APPROACH TO WORK FOR WELFARE:

An Assessment of the Mental Health Effects of Employment, Unemployment and Solutions for
Improving the Well-being of Welfare Beneficiaries

Introduction Individuals and organizations on the

KEY findings Fewer topics are more controversial

left have historically opposed work for
welfare programs because they add un-
and politically polarizing than the topic necessary stress to individuals who are
of “work for welfare” programs, which already struggling to get by, or because
> Public health concerns regarding
require welfare recipients to work in the idea that work for welfare programs
mental health have only increased
order to qualify for benefits. It should are “fair” does not ring true.4
in the U.S., particularly for young
be noted that this divide exists between
adults. the left and the right because of funda- Opponents of work for welfare have at
mentally different policy objectives and various points focused on the relation-
> Prior to the pandemic, roughly emphases. ship between sick populations and work
1/3 of those who committed sui- requirements. For the most part, they
Those on the right side of the aisle often have expressed concerns that people
cide were unemployed. The data
voice their support of work for welfare are forced to work when they are sick,
also indicate that the likelihood of
programs on the basis of fairness, a and requiring people to enter the work-
suicide increases the longer unem- force only exacerbates poor health.
pragmatic desire to lessen taxation
ployment lasts. burdens for citizens, and an interest in
promoting the personal independence The Center on Budget and Policy
> Unemploymnent, social isolation of welfare recipients. Priorities (CBPP), for instance, oppos-
and poverty create a cycle that is es President Trump’s decision to allow
difficult to escape. The Heritage Foundation, for instance, states to mandate work requirements for
has long supported the implementa- those who cannot prove that they have
tion of work requirements. Their policy a mental health condition due to con-
> Meaningful employment increas-
analysts argue that work requirements cerns that many mentally-ill individuals
es self-efficacy.
are important because they are fair; were being classified as able-bodied.5 In
those who receive benefits from soci- 2018, they also opposed adding feder-
> Research has found that de- ety should also contribute to society in ally-mandated work requirements for
pression is linked to lower socio- some able-bodied adults who were not
some way.1 The group also proposes
economic status while increases serving as a caretaker, citing concerns
that work requirements promote the
in earnings are a key reason for about the mental health of beneficiaries.
personal independence of beneficia-
decreased levels of depression. ries.2
Another progressive organization, the
> Reinstituting Medicaid work Another prominent think tank, the Foun- Center for American Progress, has
requirements is both compassion- dation for Government Accountability, expressed concerns that work require-
ate and the best means of ensuring argues that welfare beneficiaries are ments are “draconian” and that many
its recipients remain self-sufficient better off after entering the workforce who have been deemed ineligible for as-
and escape poverty and its related because those who move from unem- sistance are in fact suffering from mental
adverse mental health effects. ployment to employment experience illness or other forms of illness.6
dramatic increases in income.3

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POLICY BRIEF ISSUE BRIEF NO. 06 | AUGUST 2020

This report will acount for the characteristically compas- a lifetime.10 It is also the case that middle-aged individu-
sionate concerns of those on the left and consider how als have poorer mental health when they do not work.11
the traditional solution of work requirements actually Furthermore, years of research indicate that social
promotes the ideal of compassion that is typically priori- engagement is necessary for robust mental health, and
tized by left-leaning groups. work is a major source of social engagement for most
people, especially in a rural state like Maine where there
Unemployment has a detrimental effect on men- are fewer opportunities for community engagement.12
tal health; thus we should not promote nor strive to
maintain a system that incentivizes people to remain Research also indicates that engaging in the workforce
unemployed. A broad body of research indicates that has notable mental health benefits for those who have
employment actually improves mental health, which only previously been unemployed, indicating that those who
reinforces the idea that work requirements for the vast are mentally ill tend to benefit from employment.13
majority of beneficiaries does not threaten the well-be-
ing of these individuals—in fact, enforcing work require- Relationship Between Unemployment,
ments is a compassionate measure.
Depression and Suicide
This brief will outline the relationship between unem-
Prior to the coronavirus (when a significant portion of
ployment and mental health as well as some of the
the population became unemployed), roughly one-third
mental health benefits associated with employment. It
of those who committed suicide were unemployed.
will also highlight common concerns raised by organi-
This alone is not enough to indicate that unemployment
zations and individuals who oppose work for welfare
drives suicide; however, the data also indicate that the
policies, and address two of Maine’s primary entitlement
likelihood of suicide increases the longer unemployment
programs—Medicaid and the Earned Income Tax Credit
lasts.14 Research indicates that unemployment increas-
(EITC)—to consider how they can be adjusted to support
es risk of depression, and the prevalence of research
those who need assistance while also encouraging indi-
supports the claim that, in addition to increasing the risk
viduals to move in the direction of self-sufficiency.
of suicide, prolonged unemployment worsens depres-
sion.15 Not only does unemployment lead to depression,
Background research shows that employment lowers levels of de-
pression.16
The Center for Disease Control and Prevention acknowl-
edges that “The high rate of unemployment among
Relationship Between Unemployment and
emerging adults (aged 18 to 25 years) is a public health
concern.”7 Various studies, both within the US and
Anxiety
elsewhere, have concluded that mental health in par-
Anxiety is elevated for those who are unemployed. In
ticular suffers as a result of unemployment; those who
one key study, two groups were compared—one group
are unemployed are more likely to experience elevated
was employed and the other became unemployed after
levels of depression, anxiety, and mental deterioration.8
entering the research study. The results indicated that
Public health concerns regarding mental health have
those who had become unemployed had increased
only increased for young adults in particular—in the last
levels of anxiety.17 Other studies support the claim that
10 years, we have seen an uptick in suicide rates, de-
unemployed individuals are more likely to experience
pression, and anxiety.9
anxiety than employed individuals.18 Furthermore, over
the long-term (more than one year), unemployment
The negative mental health effects that arise from unem-
leads to increases in self-reported anxiety.19
ployment in young adulthood can last for decades, if not

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POLICY BRIEF ISSUE BRIEF NO. 06 | AUGUST 2020

Relationship Between Unemployment and to social isolation. Social isolation is known to increase
the likelihood of several mental illnesses, including
Substance Abuse
depression and anxiety. Especially among young demo-
graphics, unemployment increases the likelihood of iso-
A large and diverse array of studies from around the
lation.26 Unfortunately, unemployment, social isolation,
globe indicate that unemployment is associated with an
and poverty create a cycle that is difficult to escape.27
increase in drug use.20 Unemployment is associated with
Furthermore, individuals unemployed for longer periods
not only an increase in drug use, but is also associated
of time are more likely to report less support from their
with increased experimentation of novel, often more
social networks.28 As joblessness stretches out over time,
hazardous substances, in addition to more convention-
the unemployed are increasingly alienated from their
al drugs like marijuana.21 Furthermore, individuals who
communities.
have struggled with substance abuse in the past and re-
ceived treatment are more likely to relapse if they are un-
employed.22 It is also the case that individuals struggling
Meaningful Employment Increases Self-
with substance abuse are more likely to remain sober if efficacy
their addiction treatment is paired with employment.23
Self-efficacy is defined by Merriam-Webster as, “a
person’s belief that they can be successful when car-
Relationship Between Unemployment and
rying out a particular task.”29 An individual’s sense of
Cognitive Decline competency and purpose in life declines with loss of
employment and is restored for individuals who are able
Unemployment is also associated with cognitive decline. to procure a job.30 For young adults in particular, unem-
This makes sense—when we work, our brains are stimu- ployment is associated with lower self-efficacy.31
lated, but when we face no demanding tasks, our brains
start to atrophy from the lack of stimulation. The fact that Even those who are experiencing or have experienced
unemployment leads to cognitive decline corresponds mental illness in the past feel more capable when
with the well-established fact that brain functioning employed. Those with common mental health illnesses,
declines with underuse.24 Accounting for factors such as such as depression and anxiety, gain a better sense of
socioeconomic status, educational achievement, and ad- self-efficacy and mastery as a result of employment.32
verse events occurring early in life, studies indicate that And though there are certainly some forms of chronic
those with gaps in their employment are more likely to mental illness that are debilitating, research indicates
experience cognitive decline earlier than those without that for individuals with more chronic, severe forms of
gaps in employment.25 mental illness such as bipolar and schizophreniform
illnesses, employment improves self-efficacy and levels
It is also worth noting that increased drug use results of self-reported happiness.33
in cognitive decline, which increases the likelihood that
younger populations, who experience unemployment
and engage in drug use more frequently than their em-
Employment as a Preventative Factor for
ployed counterparts, are more susceptible to cognitive Vulnerable Populations: Employment Helps
decline. Reintegration for Formerly Incarcerated
People
Relationship Between Unemployment and
Social Isolation For individuals who are exiting incarceration, finding a
job is often a priority. This is an important step in the
right direction; those who become employed after
It almost goes without saying that unemployment leads

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POLICY BRIEF ISSUE BRIEF NO. 06 | AUGUST 2020

incarceration are less likely to become incarcerated mental well-being, some who oppose welfare programs
again.34 It is also the case that those who find employ- have posed thoughtful critiques of this research. Several
ment after incarceration stay out of jail for longer periods of these views are worth careful consideration. The CBPP
of time than their counterparts who are not employed speculates that a significant number of the unemployed
after incarceration.35 are already struggling with mental illnesses and that men-
tal illness is likely the cause of unemployment for many.41
The personal testimonies of formerly incarcerated indi-
viduals speak to the importance of work for this demo- While mental illness probably does increase the like-
graphic: James, a former inmate at Maine State Prison, lihood of unemployment, the inverse is also true. Re-
says that his employer “helped change my life,” and he searchers have taken measures to factor out the possi-
feels that he is “on the right track” after gaining em- bility that mental illness causes unemployment in their
ployment.36 Matt Pelletier, also a former inmate at Maine studies. One such research group, who published their
State Prison, is quoted as saying, “The thing about hiring article with the American Psychological Association, used
people who are getting a restart is the appreciation. You a sample consisting of individuals who self-reported that
don’t have an appreciation for things until you’ve gone they had never been diagnosed with or experienced
without.”37 Clearly, individuals working to overcome mental health problems within the 52 weeks. The group
counterproductive behavioral patterns benefit when our was then divided into those who were employed, unem-
social system prioritizes helping them find work. ployed, or partially employed for the past 52 weeks. The
study found that, while short-term unemployment does
Increased Income Directly Relates to not significantly harm mental health, long-term unem-
ployment does.42
Quality of Life
Another study used longitudinal data to determine if in-
It is clear that having more financial resources can
dividuals who had no prior history of mental illness were
improve mental well-being. Some who find a job after re-
at a greater risk of depression after becoming unem-
maining on welfare programs enter into low-income jobs,
ployed. The results support the conclusion that even for
but on the whole, research has found that depression is
those who have no previously documented mental illness
linked to lower socioeconomic status and increases in
prior to unemployment, the likelihood of depression in-
income are a key reason for decreased levels of depres-
creases for these individuals.43 These carefully developed
sion.38
studies are part of a broader body of literature indicat-
ing unemployment causes depression and is not merely
One national study conducted by the Department of
indicative of an underlying mental illness.44
Health and Human Services (DHHS) examined 20 “work
for welfare” programs and found that all groups who par-
In response to welfare reforms proposed in 2018, The
ticipated had increased earnings three years after joining
Commonwealth Fund noted that it might be impossible
the program.39 In our own state, we have seen that those
for states to determine whether some people are men-
who exit welfare programs and find a job experience
tally ill or not, which means that some who are mentally
increases in income. When former Governor Paul LePage
ill will be pushed into the workforce when they are not
required Mainers receiving certain forms of benefits to
healthy enough to work.45
meet work requirements, participants in the program saw
a 114 percent increase in wages after one year.40
Mental health exists on a spectrum, like all other aspects
of health. As mentioned earlier, for individuals who are
What Critics Say About Work for Welfare suffering from mental illnesses that affect personal func-
tioning less, like mild to moderate forms of Substance
Despite the extensive body of research indicating that
Abuse Disorder and mild to moderate forms of Major
unemployment harms individuals and work enhances

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POLICY BRIEF ISSUE BRIEF NO. 06 | AUGUST 2020

Depressive Disorder, work requirements will likely help, move into high-wage work.53 It should be noted that 95
rather than hinder, these individuals.46 percent of Maine’s population is white, and the average
age in Maine is 39.54 Upward mobility is an issue in our
Of course there are people who are not healthy enough society, but it is not as significant of a problem as some
to participate in the workforce. Proposed welfare re- might assume.
forms have historically exempted those suffering from
debilitating forms of mental illness from work.47 These Joe Grogan, director of the Domestic Policy Council,
are individuals who qualify for social security disability or contended in an article published by the Washington
supplemental security income. In Maine, the eligibility Post that forcing unemployed people to fulfill work
criteria and application process are generally uncompli- requirements puts these individuals’ health at risk—in-
cated and reasonable: it is possible to apply for both so- cluding mental health—because they are often unable to
cial security disability and supplemental security income meet these requirements.55
over the phone—applicants do not even need to visit an
office. Maine Disability Determination Services usually In the state of Maine, under Governor LePage’s admin-
requires medical records, a doctor’s note, and a personal istration, work for welfare requirements were not terribly
statement from the applicant explaining why disability stringent—young-to-middle-aged people without dis-
income is needed to determine eligibility.48 abilities who weren’t taking care of anyone were expect-
ed to work, engage in job training, or volunteer for 20
Gerard Vitti, a long-time healthcare expert who has hours per week (half the average work week), to receive
been an outspoken supporter of Medicare enrollment benefits. In addition, a five-year lifelong limit was placed
for years, has voiced his opinion that work for welfare on cash assistance, to name a few of the controversial
programs only push people into low-wage jobs that are requirements.56
likely to negatively affect emotional well-being.49 This
policy view has also been presented in The Atlantic. Solutions
Olga Khazan, in an article entitled “Is Any Job Really
Better than No Job?” promotes the view that working We should not feel squeamish or uncompassionate about
low-wage jobs might cause more mental health issues setting limits on welfare and discouraging welfare depen-
than unemployment.50 dency. There are several steps we can take to address the
unemployment of those who are reliant on entitlement
There is some evidence that entering into low-wage programs.
positions may actually worsen mental health (at least
for a short period of time). However, as one researcher
Reinstitute Medicaid Work Requirements
points out, this fact shouldn’t deter individuals from con-
tinuing to work—these individuals should negotiate with
Beneficiaries of MaineCare (Maine’s Medicaid program)
employers and coworkers to develop a better working
who are capable of working and not caring for family
environment.51
members should be expected to either work or apply
for jobs in order to receive benefits. In January 2019,
Federal research produced by the DHHS, for instance,
Governor Janet Mills withdrew the state’s request for a
indicates that five years after moving from unemploy-
federal waiver in order to establish work requirements
ment to employment, three-fourths of those who partic-
for MaineCare recipients. These requirements should be
ipate in work for welfare programs had found employ-
reinstated.57
ment and increased their earnings.52

The Urban Institute found after two years, 40 percent

of white, middle-aged, low-wage workers were able to

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POLICY BRIEF ISSUE BRIEF NO. 06 | AUGUST 2020

Mandate Work Requirements for Select program by increasing the tax credit offered to recipients
who do not have children by a relatively small margin.
Case Management Beneficiaries
Maine currently offers recipients without children 25 per-
cent of the federal amount of EITC offered. This means
Behavioral health services, including case management
that our state’s maximum EITC tax credit for these benefi-
services, are covered by MaineCare. To qualify, individu-
ciaries can total to roughly $135.62 While the federal-level
als need a primary mental health diagnosis, which could
EITC program offers a tax credit that is significant enough
be anything from a mild, single-episode mood disorder
to encourage individuals to move into the workforce, our
to severe, chronic forms of mental illness. For individ-
state could be doing more.
uals who have a substance abuse disorder or milder
forms of mental illness, having a job might very well be
Expanding EITC would not have to cost taxpayers more
a step toward wellness rather than an impediment. The
money—money saved from reinstituting Medicaid re-
most successful workforce development programs have
quirements (using funds that are made available when re-
focused on individual support and have emphasized con-
cipients drop from the program once work requirements
sistent follow-through on behalf of case workers.58 Case
are mandated) could be reallocated to expand the EITC
management services should be mandated to emphasize
program. Data from Maine’s DHHS indicate that when
entry into the workforce for eligible MaineCare recipi-
Maine instituted work requirements for work-capable
ents, and case workers should be held accountable for
Supplemental Nutrition Assistance Program (SNAP) recip-
assisting these beneficiaries in finding work or applying
ients, 80 percent of these individuals left the program.63
for jobs.
It is impossible to say with certainty that applying work
requirements to MaineCare would result in a comparable
Workforce development programs that emphasize
decrease in caseload, but when Arkansas, a rural peer
entering the workforce rather than meeting educational
state of Maine, instituted work requirements for Medicaid
requirements tend to produce larger earnings. Since
benefits, 18,000 individuals left the program.64 Expand-
increased earnings tend to result in greater life satisfac-
ing the EITC program would be a cost-effective way to
tion, in the majority of circumstances, it would be best
encourage Mainers to participate in the workforce.
to emphasize direct entry into the workforce rather than
prioritizing educational programs for unemployed indi-
viduals.59
Conclusion

Those who purport to look after the interests of the most

Expand EITC Payments vulnerable are remiss if they fail to consider the impor-
tance of work. Unfortunately, in 2019, Governor Mills
The Earned Income Tax Credit (EITC) is an extremely needlessly rolled back Governor LePage’s work require-
popular policy solution that is supported by policy institu- ments for MaineCare that were designed to help healthy,
tions on both the left and right side of the aisle.60 EITC work-aged individuals find employment.65 Despite the
incentivizes people to work because it offers a tax credit myriad evidence indicating that unemployment harms
to low-income individuals who engage in the workforce. individuals and employment is beneficial for the majority
This tax credit has shown to decrease unemployment, of healthy, young to middle-aged people, legislators and
thereby increasing financial self-sufficiency, which over the governor seem to have concluded that work require-
time decreases the total amount of tax funds allocated ments are harmful for those who need to meet them.
for entitlement programs. The National Bureau of Eco- Maine DHHS, the department responsible for determin-
nomic Research found that increasing EITC by $1,000 ing MaineCare requirements, and The Office for Family
resulted in more than a 7 percent increase in employ- Independence, the branch within DHHS that is respon-
ment nationally.61 It may seem counterintuitive, but our sible for implementing programs such as EITC, should
state should consider expanding Maine’s state-level EITC restructure their programs to prioritize helping welfare
beneficiaries gain independence through employment.

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38 https://academic.oup.com/aje/article/157/2/98/90059; https://www.sciencedirect.com/science/article/pii/S0277953617306160
39 https://aspe.hhs.gov/execsum/what-works-best-whom-impacts-20-welfare-work-programs-subgroup#I
40 https://www.forbes.com/sites/theapothecary/2016/05/19/new-report-proves-maines-welfare-reforms-are-working/#741a81293f6a
41 https://www.cbpp.org/research/health/taking-away-medicaid-for-not-meeting-work-requirements-harms-people-with-mental
42 https://www.apa.org/pi/ses/resources/indicator/2012/04/unemployment
43 https://academic.oup.com/ije/article/28/1/95/777542
44 https://www.cambridge.org/core/journals/psychological-medicine/article/cause-and-effect-in-studies-on-unemployment-mental-health-and-sui-
cide-a-metaanalytic-and-conceptual-review/00395C057A327A6AE1ACC4D85D570ED7
45 https://www.commonwealthfund.org/publications/journal-article/2018/may/work-requirements-and-medicaid-what-will-happen-beneficiaries
46 https://oem.bmj.com/content/71/10/730.short; and https://etd.ohiolink.edu/pg_10?0::NO:10:P10_ACCESSION_NUM:ucin1573570966154273
47 https://www.whitehouse.gov/wp-content/uploads/2018/07/Expanding-Work-Requirements-in-Non-Cash-Welfare-Programs.pdf
48 https://www.maine.gov/dhhs/ofi/programs-services/disability-determination
49 https://morningconsult.com/opinions/five-reasons-medicaid-work-requirements-dont-work/
50 https://www.theatlantic.com/health/archive/2017/08/is-any-job-really-better-than-no-job/537969/
51 https://academic.oup.com/ije/article/47/1/47/4079898
52 https://www.mdrc.org/sites/default/files/full_453.pdf
53 https://aspe.hhs.gov/system/files/pdf/75996/index.pdf
54 https://worldpopulationreview.com/states/maine-population; and https://www.infoplease.com/us/census/maine/demographic-statistics
55 https://www.washingtonpost.com/opinions/2020/02/09/americans-have-failed-people-with-mental-illness-trumps-new-budget-will-change-that/
56 https://www.maine.gov/governor/lepage/priorities-accomplishments/reforming-maines-welfare-system.html
57 https://www.maine.gov/governor/mills/news/lieu-medicaid-restrictions-governor-mills-directs-dhhs-labor-promote-work-opportunities-2019
58 https://aspe.hhs.gov/execsum/what-works-best-whom-impacts-20-welfare-work-programs-subgroup#I
59 Ibid.
60 https://www.cbpp.org/research/federal-tax/eitc-and-child-tax-credit-promote-work-reduce-poverty-and-support-childrens#:~:text=The%20
EITC%20expansions%20of%20the%201990s%20induced%20more%20than%20a,assistance%20to%20work%2C%20research%20shows.&text=More-
over%2C%20by%20boosting%20the%20employment,on%20a%20person’s%20work%20history; and https://www.aei.org/economics/us-labor-market/
earned-income-tax-credit-encourages-work-reduces-inequality-raises-family-incomes-and-move-families-out-of-poverty-new-study/
61 https://www.nber.org/papers/w21340?utm_campaign=ntw&utm_medium=email&utm_source=ntw
62 https://www.irs.gov/credits-deductions/individuals/earned-income-tax-credit/earned-income-tax-credit-income-limits-and-maximum-cred-
it-amounts#:~:text=The%20maximum%20amount%20of%20credit%20for%20Tax%20Year%202019%20is,%243%2C526%20with%20one%20qualify-
ing%20child
63 https://www.heritage.org/welfare/report/maine-food-stamp-work-requirement-cuts-non-parent-caseload-80-percent#_ftnref5
64 https://www.kff.org/medicaid/issue-brief/state-data-for-medicaid-work-requirements-in-arkansas/
65 https://www.pressherald.com/2019/01/22/mills-rejects-work-requirements-lepage-sought-for-medicaid-beneficiaries/

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