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Interviewing leaders in mental health

The failure to pass President Biden’s ‘Build Back Better’ program, whilst a massive blow to the middle class and the environment, the consequences are especially dire for poor families and their children.

Stephen SeligmanClinical Professor of Psychiatry at the University of California, San Francisco

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Written Thought Piece by Stephen Seligman

The Biden Administration has proposed sweeping legislation under the name, ‘Build Back Better.’ It includes $2 trillion for climate programs, broad social spending and a variety of programs targeted to improve the welfare of children and families. Child tax credits, free pre-Kindergarten, subsidies for early childhood daycare, and paid family leave were planned. The United States lags behind almost all developed countries in public programs for children and families, and this massive legislation has been an effort to begin to change this.

But the Democrats have only a one-vote margin in the Senate, the upper house of Congress, whose approval is necessary for passage, and no Republicans will support the bill.  Recently, West Virginia Senator Joe Manchin–whose vote is essential for passage–announced that he would vote no.  With no Republicans willing to break party lines, Manchin’s stance makes it all but impossible for “BBB” to pass.

Whilst this is a massive blow to the middle class and the environment, the consequences are especially dire for poor families and their children.  Here are the some details that offer a bit of a window into the American situation:

Even though paid family leave is associated with a 13% reduction in infant mortality, the U.S. does not guarantee it, one of just seven countries not to. Although federal government workers receive 12 weeks paid leave, only 16% of private sector workers get it. Many workers do not receive any amount of paid leave, especially hourly workers and those in lower-wage industries.

As a mental health clinician, I have seen the toll of not being able to take off from work to care for a newborn can have on infants, children and their families. For lower income parents, paid leave is generally not option, nor is licensed childcare, which costs on average $16,000 per year for infants. This leaves low-income parents with limited options, fueling exhaustion, depression, domestic violence and worse. Even the best-intentioned parents can’t help but pass their stress and trauma onto their children, sowing the seeds of personality and behavior patterns that last generations.

Take the story of one of my patients (with some details altered for anonymity). Like one in seven new mothers, she was exhibiting signs of postpartum depression after the birth of her son and could barely get out of bed. Although she needed to work to support her baby, her depression and deep fear that something awful would happen to her son if she left him with a neighbor almost got her fired. Through psychotherapy, she realized her deep-seated anxiety was rooted in her past. When she was 6 years old, she had been molested by a neighbor’s relative when her single mother had no choice but to leave her and her infant brother with the neighbor to go back to work. The realization of how her current situation mirrored her past improved her depression. Although she could have become depressed without these experiences, the added trauma of her past would only have compounded it, threatening her ability to provide for the next generation, as it actually did. Paid family leave could have prevented, or at least eased her situation, as well as that of her mother’s before her.

But the demise of the Build Back Better plan doesn’t just prevent many parents from staying home to take care of their children. The plan also carried within it the extension of the enhanced child tax credit. That, too, along with improved access to childcare and universal pre-kindergarten for kids 3 and 4 years old, which were also in the plan, is now gone.

Children are the poorest age demographic in the country. In 2019, over 10 million American children lived in poverty, 71% of whom are children of color. Almost half of America’s poor children live in extreme poverty, in families with an annual income below $25,000. In California (where I live) the situation is similar. Data from 2018 found that 18.8% of California children live in poverty, and in the San Francisco Bay Area over 75% of single parents reported that they couldn’t “make ends meet” while almost 50% of parents with partners responded in kind. And all of this was before COVID.

This is why in March, Congress passed the American Rescue Act, which increased the previous child tax credit benefit from $2,000 to $3,000 with a $600 bonus for children younger than 6 for the 2021 tax year. It also established monthly payments of $300 per child under the age of 6 and $250 for those 6 to 17 years old. Without an extension, these enhancements will expire in early 2022, even though their impact has already been significant. Contrary to Sen. Manchin’s concerns that parents would use their child tax credits on drugs, 78% of parents in a recent survey reported using their payments to help with housing, utilities, food costs and activities for kids. Moreover, according to an August survey by the Census Bureau, the tax credit allowed 3.3 million more households to feed their children, and a September report found that 94% of parents are doing the same amount of work or more due to the tax credit. If the Build Back Better plan had passed, the current credit would have been extended until 2025, reducing child poverty by 40% in a typical year.

According to the Columbia University Center on Poverty and Social Policy, improving children’s lives now would save American taxpayers hundreds of billions every year — reducing infant mortality and other health care costs for both children and parents, lowering crime rates and improving public safety, and cutting expenditures on protective services for abused and neglected children. Future generations will benefit as these savings grow every year, when today’s children become tomorrow’s workforce, contributing to everyone’s well-being and expanding the tax base.

Helping children and their families is an investment, not welfare. It improves short- and long-term health, shrinks health care costs, reduces crime, and raises kids’ school performance and adult pay. Infants and young children are the most vulnerable of all age groups, so infants can’t wait. There’s no reason that they should.

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Stephen Seligman

A father and mother helping an infant walk

Stephen is the author of Relationships in Development: Infancy, Intersubjectivity, Attachment (Routledge, 2018) and co-editor of the American Psychiatric Press’ Infant and Early Childhood Mental Health: Core Concepts and Clinical Practice.  He is also associate editor of Studies in Gender and Sexuality, and was a member of the founding executive board of the Journal of Infant, Child and Adolescent Psychotherapy.  He has authored over 75 papers, chapters, reviews, and other publications; his most recent, Psychoanalytic scholarship: Constructive and integrative curiosity in analytic scholarship, practice and theory-building. (tentative title)  Psychoanalytic Dialogues: International Journal of Relational Perspectives. 30, 6.

In the infant clinical area, Dr. Seligman’s recent work has focused on translating psychodynamic concepts to the broader arenas of work with infants, both in infant-parent psychotherapy and in work with special populations, such as abused and neglected infants and infants with developmental disabilities.  He practices, teaches and writes about infant intervention from the perspective of the continuing evolution of the original model of designed by Selma Fraiberg and her colleagues, in which he was directly involved for over three decades.


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