Every semester, Indiana University Northwest visiting professor Jean Olson gives her students an experiment.
"Take your phone and put talk radio on the headphones," she tells them.
She has them turn it up just loud enough to hear and go about their day. That's what life can be like for an actively psychotic person, she said.
Left untreated, whether out of stigma, cost or lack of access, mental illness can be dangerous.
There is a correlation between poverty and poor mental health, said Danita Johnson Hughes, president and chief executive officer of Edgewater Behavioral Health Services.
"There's been a number of studies done over the past 20 years that indicate a close association between mental illness and poverty," she said. "Some suggest the relationship is cyclical."
Health care providers and community leaders need to make an effort to reach those most in need.
"If you're wondering where your next meal is going to come from or how to care for your kids, it can take a toll on your physical and mental health," she said. "There is definitely a link."
Stress is often to blame.
"When you talk about poverty and mental illness, it's important to recognize that people living in poverty situations or those who are exposed to social inequalities are dealing with a number of stressors," she said.
People who live below federal poverty guidelines often lack basic resources. Many are living in adverse conditions and are less able," she said.
Resources are limited. There are only four community mental health centers in Northwest Indiana, between the Illinois state line and Michigan City, Johnson Hughes said.
"The mental health budget has been cut nationally for a number of years," she said. "When the budget is cut, it really increases the likelihood that people with mental illness will end up on the street."
They cycle through emergency rooms and hospitals, she said, and then are deposited back on the street.
Johnson Hughes touted Edgewater's South Shore Commons, 1201 W. 20th Ave., in Gary, as a beacon of hope and help.
The 60-unit, two-story complex serves homeless people who have disabilities, homeless families, those who earn a very low income, families at risk for homelessness and small families with specific needs.
Edgewater also offers on-site services.
It follows the "housing first" concept.
"That concept says, but for a stable place to live, a person is not going to be able to go out and seek the treatment and support they need," she said. "How do you apply for a job if you have no address?"
On a positive note, language in the Affordable Care Act, also known as Obamacare, has requirements that open the door for those seeking treatment to receive better care, Johnson Hughes said.
"Now, they have to cover mental health services," she said.
With mental health, stigma is a top barrier preventing care.
"Mental health is not always taken seriously," she said. "A lot of people think, 'I can deal with this.' "
But lowering mental health in priority can lead to self-medication through drugs and alcohol, which can result in addiction.
"The addiction myth is that it's a lack of will power or poor character," Johnson Hughes said. "That's not always true."
Research points to a number of factors, including genes, the possibility of existing mental illness and environmental factors, she said.
Addiction and mental illness are considered behavioral health problems.
"It's not just a matter of will power," she said. "One of the myths is that people may not recover or that they will never get better. For the most part, people can recover."
Olson, who teaches psychiatric mental health nursing and is a psychiatric mental health clinical nurse, said job loss created by the recession brought new stress into people's lives, leaving them without insurance coverage to pay for treatment they need, she said.
"People who would've had benefits and access to care have lost those benefits," she said.
Those who are newly poor because of a job loss might not be sharing that information with a lot of people or revealing the depression that often follows, Olson said.
There are cultural obstacles, too.
"Some people don't want to be talking to others about their problems," she said. "For many people, I'd say the stigma is still there."
People who have jobs and resources may have a support system or family doctor to notice a mental illness, but that is not necessarily the case for the poor.
"When you're homeless, who are the people you see every day who would notice there's a change (in behavior)?" Olson said. "They don't have the social support that might help propel them into treatment, much less help them follow-up after discharge."
Follow-up is key, she said.
People who rely on regular dosages of psychiatric medicine are under the watchful eye of health care professionals, she said.
Access to mental health care is a huge problem, she said. "We have a shortage of psychiatrists," Olson said.
"It doesn't have the income and glamour of a cardiac surgeon. We do feel that, right here in Northwest Indiana, our hospitals cannot get enough psychiatrists.
"There are places with good crisis programs, but then it becomes: Where does the patient go from there?" she said.
A burgeoning national physician shortage extends into psychiatry, leaving some of the most vulnerable with limited access to mental health care.
“We are one of those federally designated mental health professional shortage areas,” Johnson Hughes said.
It is a challenge attracting people to the field, because of the red tape associated with strict regulations.
“Paperwork is so stringent for regulatory purposes," she said. "The pay isn't great. It's very difficult now to find a good cadre.”
The psychiatrist shortage has patients turning to others in the health care field for help, said Patrick Bankston, associate dean at Indiana University School of Medicine Northwest and dean of the College of Health and Human Services at IUN.
“There are a lot of professionals who can pick up that slack,” he said. “One of them is social workers.”
Figures from 2010 show adults living below the poverty line were three times more likely to have serious psychological distress, compared to adults over twice the poverty level, according to the U.S. Department of Health and Human Services.
“When you have limited resources, it makes their condition deteriorate,” Johnson Hughes said. “In the end, it may cost more.”
A person with mental illness and lack of resources may end up in an emergency room or jail cell, she said.