Bridge of Hope: Pushing for Low Cost Anxiety Awareness in Urban Environments

By Ryan Rivera

Reviewed by Alejandro Adrian LeMon, Ph.D. on July 7, 2012

One of the problems I have as an advocate for the widespread treatment of anxiety disorders is that the Internet only has so much reach. Yes, there are hundreds of millions of people online, but most of them consistent of men and women that can afford or have access to online tools. In addition, the ability to connect with them is precipitated by the idea that they can find me. I do the majority of my advocacy online because that’s where I can have the largest impact, and yet there are groups excluded from that impact, either because they have no access to the Internet or not enough awareness of the issue to seek out advice or treatment.

This is a serious problem, because numerous studies have shown that those of low socioeconomic status, particularly men and women of color, are highly unlikely to seek mental health treatment, and when they do receive treatment their treatment tends to be shorter than the rest of the population. There is a stigma in many low income communities (and many cultural communities as well) that those that seek out mental health treatment are “crazy, “weak,” or potentially even dangerous.

None of this even mentions the prohibitive cost of mental health care, especially for those with problematic but not necessarily life altering mental health issues (such as anxiety and mild depression) where institutionalization is not an option.

Yet in my opinion, some type of mental health care treatment, particularly for more manageable but otherwise still life changing disorders like anxiety, is extremely important.

Potential Links Between Anxiety and Struggles in Urban Environments

There are so many examples of how such basic mental health disorders – indeed, mental health disorders that should have easily affordable treatments available – play a role in creating an unequal environment. Just a few include:

  • Social Support – Those with a strong social support system often find themselves with more confidence and emotional wellbeing. So it stands to reason that young men and women that have some level of anxiety would seek out some type of social support in order to feel more comfortable with themselves or suffer without it. Those that do seek social support in others may become more likely to join gangs, where not only will they feel supported but they may feel protected from the crime around them. Those that do not may have greater troubles dealing with the anxieties and stresses present in dangerous urban communities.
  • Panic/Agoraphobia – Panic attacks are also a frightening anxiety disorder that can lead to agoraphobia and hospitalization. For those of a low socioeconomic status, agoraphobia can be immensely troublesome, because many were not trained/equipped with skills or access to technology necessary to earn money from the home. In addition, many with panic attacks require hospitalization, because the panic attacks give them the impression that they’re dying. Those that cannot afford health insurance become likely to end up further into debt, solidifying their current economic troubles.
  • Drug Abuse – Finally drug and alcohol abuse are extremely common ways to self medicate for anxiety and other mental health disorders. In areas with little access to affordable medical care, turning to drugs or alcohol becomes a much easier route, and without long term mental health treatment options it can be easily expected for someone to relapse as a result of their next anxiety attack.

These are all brief but clear examples of ways that low income communities are affected by the lack of treatment options and awareness of anxiety disorders and other mental health problems. With all of the discussions about how to improve racial and socioeconomic equality, one of the clearest ways to improve the long term outcome of these communities seems to be providing them with greater access to mental health care, and educating those in the community about the value of mental health treatment.

How this can be done remains unclear, as government budgets for low income community outreach are lacking. However, some potential solutions include:

  • Organizing Religious Organizations – Churches, and other religious institutions, often have a great deal of sway in those of low socioeconomic status. If churches can be convinced to motivate their congregations to seek out mental healthcare, it could have a tremendous influence.
  • Providing Free Mental Healthcare – Mental health volunteers that actively go into low income communities to provide their support may help change the way that mental healthcare is viewed by the rest of the population.
  • Targeting Schools/Parents Separately – Teaching kids the value of mental health while in school (perhaps with psychology classes in low income schools) while simultaneously organizing parent events that advocate for mental health treatment may also reduce some of the stigma.

None of these are perfect solutions, but they would go a long way towards changing the landscape of mental health treatment. Regardless, it’s clear that some type of community outreach is necessary, and if we can organize these communities towards living with better mental health, their lives – and society in general – could benefit greatly.



Nall-Evans, Sharleen. Are drugs of abuse used to self-medicate for psychiatric disorders? Retrieved 7/3/2012 from:

Roy-Byrne P, Joesch  JM, Wang PS, Kessler RC. Low Socioeconomic Status and Mental Health Care Use Among Respondents With Anxiety and Depression in the NCS-R. Psychiatry Online, (2009), 60, 9. Retrieved  7/3/2012 from:

Videau Y, Saliba SS, Paraponaris A, Ventelou B. Why patients of low socioeconomic status with mental problems have shorter consultations with general practitioners. Journal of Health Services Research & Policy, (2010); 15, 2, 76-81. Retrieved 7/3/2012 from:

Vikram P. Mental health in low and income countries. Oxford Journals, (2007); 81-82, 2, 81-96. Retrieved 7/3/2012 from:


Author: Ryan Rivera

Ryan Rivera is the founder and president of Calm Ryan suffered from intense anxiety attacks for most of his life, and now he tries to help others understand the effects of anxiety.

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