The mental health effects of a Universal Basic Income: A synthesis of the evidence from previous pilots

In recent years the debate surrounding Universal Basic Income (UBI), has resurfaced and risen to prominence within global policy discussions (Downes and Lansley, 2018). Amongst its advocates it has been hailed as one of the most innovative, powerful and straightforward solutions to rising levels of poverty, decreasing job security, stigmatised benefit systems and the predicted automation of many routine jobs (Torry, 2019). Such arguments have been based on the prophesised benefits of UBI's five defining features: cash payments, made periodically, on an individual, universal and unconditional basis (Box 1) (Basic Income Earth Network [BIEN], 2019). However, the concept remains controversial (Downes and Lansley, 2018), with opponents questioning its affordability (Hoynes and Rothstein, 2019) and casting doubt on its potential to redistribute wealth amongst the population (Goulden, 2018).

Wealth has long been considered the most important social determinant of health (SDH), as it interacts with, and influences a number of other SDH pathways (Mikkonen and Raphael, 2010). In particular, there is now ample evidence to demonstrate that poverty is undeniably entwined with mental health and wellbeing, and acts as a key driver of mental health inequities (World Health Organization, 2008; Silva et al., 2016). Poverty and lower socio-economic status increase the likelihood of experiencing mental health problems, and this conversely increases the risk of poverty (Anakwenze and Zuberi, 2013). Therefore, for some of its proponents, UBI possesses not only the potential to improve the economic situation of individuals and their families, but through doing so to improve population mental health (Ruckert et al., 2018).

Yet, the proposed mental health benefits of UBI extend beyond any poverty alleviating potential it may possess and are also based on its unique principles of individuality, unconditionality and universality (Torry, 2019). It is argued that payments made on an individual, as opposed to household basis, could be potentially freedom enhancing for many, allowing them social and financial independence from partners, family members, caregivers and, in some cases, perpetrators of violence (Bueskens, 2017, Mays, 2019). Universal payments are similarly proposed to provide the unique ability to forge increased social justice, through reducing poverty stigma, because of the absence of targeting of particular groups (Mays, 2019). Finally, it is proposed that the unconditional nature of a UBI may have stress-reducing benefits for recipients (Torry, 2019). Recent studies exploring the mental health impacts of accessing social security have consistently identified significant psychological distress amongst claimants as a result of exposure to the benefit claim process (Craig and Katikireddi, 2020). Several mechanisms might explain this, however stress associated with sanctions and strict conditions applied to eligibility are considered to be significant (Craig and Katikireddi, 2020). It has therefore been argued that reducing the conditionality associated with benefit systems, may both protect the mental health of recipients and allow the associated cumbersome bureaucracy to be drastically slimmed down (Painter and Thoung, 2015).

However, while previous authors have variously examined the effects of UBI on income (Conner and Taggart, 2013; Berman, 2018), employment (Jones and Marinescu, 2018; De Paz-Báñez et al., 2020), labour market demand and consumption (Reed and Lansley, 2016; Gibson et al., 2018; Calnitsky, 2020), the direct mental health consequences of UBI pilots have been less frequently examined (Ruckert et al., 2018). Indeed, if included at all, to date, the mental health consequences of empirical UBI studies have largely been measured as a secondary, less well investigated outcome. In addition, to our knowledge, only two past reviews of UBI interventions in high-income countries have examined the health impacts of previous pilots at all (Marinescu, 2018; Gibson et al., 2020); and in both of these reviews mental health was considered only briefly, with the main focus centring on UBI's economic impacts. Therefore, while the potential for UBI to reduce health inequalities through alleviating poverty is often cited as one of its primary advantages (Painter, 2018), our actual understanding of how the mental health of a population may respond to such a form of economic support is limited. More recent research has highlighted that the correlation between income inequality and mental health may not be as straightforward as has previously been assumed (Ribeiro et al., 2017). Such findings cast doubt on the potential for UBI to improve population mental health and highlight the need for the mental health effects of previous pilots to be independently and thoroughly considered. Failure to rigorously investigate this would represent a missed opportunity to accurately inform policymakers on the best ways to invest in the mental health of an increasingly insecure and unequal society (Painter, 2018). Moreover, robust analysis is warranted in order to determine which, if any of UBI's defining features (i.e., individuality, universality and unconditionality) are most beneficial for population wellbeing, so that these principles can be prioritised. It is therefore essential that the question of whether UBI schemes can directly contribute to reducing mental health inequities is systematically addressed, and our understanding of how any mental health benefits might be mediated is furthered.

In addition, although some existing studies have indicated the health effects of small UBI schemes, previous pilots have not been designed to promote health specifically. As such, it remains unclear how future UBI pilots should be designed and delivered, in order to gain the most reliable estimation of the effect larger UBI schemes could be expected to have on population wellbeing. Without such an evaluation, it is likely that evaluations of UBI pilots will fail to accurately infer its mental health effects. A robust examination of the methodologies used in previous UBI pilots is therefore essential in order to inform the design of future studies.

The purpose of this paper is therefore to conduct a review of the literature on UBI and to re-examine the existing research with a mental health focus. In particular, we aim to (a) assess the mental health outcomes associated with previous UBI pilots; (b) to examine the relative influence of its individual, unconditional and universal principles on these outcomes; and (c) to provide an indication of how future pilots should be designed and conducted in order to produce the most reliable estimation of its mental health effects.