Unconditional basic income and mental health. Reports from Spain and the UN

Whether an unconditional basic income is suitable as an instrument of transformation towards a solidary and care-centred society is the subject of controversial debate in the Care Revolution network. Elfriede Harth argues for this UBI in a lecture she gave in autumn 2025. We are also documenting this because it vehemently takes up the basic ideas of the Care Revolution network, which already played a major role at the founding conference in 2014: The physical and mental strain on people, even in the highly productive economies of the Global North, is caused by society. They cannot be blamed on those who suffer from overwork, but we are called upon to change these societies so that the needs of all are catered for. Care Revolution now!

The first publication on the website of the Initiativgruppe Bedingungsloses Grundeinkommen Rhein-Main can be found here: https://bge-rheinmain.org/bedingungsloses-grundeinkommen-und-psychische-gesundheit

An input by Elfriede Harth as part of the Frankfurt Psychiatry Week on 10 September 2025

People's mental health is deteriorating worldwide. Corona also acted as a magnifying glass in this area. This phenomenon had already been observed before the COVID pandemic, for example in connection with the economic crisis of 2008. A study by the Harvard School of Public Health from September 2011, just under a decade before the pandemic, estimated that the direct and indirect costs of mental illness would rise from 2.5 billion to 6 billion dollars by 2030. In other words, it would more than double. This would make it the biggest driver of healthcare costs.

Young people are particularly affected. And among adults, women are particularly affected. According to the Shell Youth Study from early 2024, 4 out of 5 12 to 25-year-olds in Germany are afraid of war in Europe. Two thirds worry about the economic situation, are afraid of climate change and fear increasing polarisation and hostility among people.

Mental illness often begins in childhood. In an international study, the University of Padua found that 1/3 of mentally ill people already had symptoms before the age of 14. By the age of 18, this figure had risen to just under half and by the age of 25 to almost 2/3.

In 2024, the Lancet Commission on Mental Health reported in a study that this is a global problem that has a variety of causes. One particularly well-documented reason for the rise in mental illness is poverty. Children who grow up in a household with a low socio-economic status are twice as likely to develop mental disorders as those who grow up in a household with a high socio-economic status. Unemployment of the parents and the associated precariousness, lack of money and time, which cause existential fears, hopelessness and even depression in the parents, have a negative impact on the children.

Mental illness is not an infectious disease that can be transmitted via viruses or bacteria. However, they have almost become a pandemic, as they are spreading more and more. In addition to poverty, growing pressure to perform, increasing social inequality, generally growing insecurity, poor housing conditions, fear of the future, fear of climate change and climate change itself, worsening working conditions, social polarisation and the accompanying isolation, etc. seem to cause or exacerbate mental suffering.

These are all problems that go hand in hand with social development - not just in our country, but worldwide. Social and economic developments therefore have an impact on mental health. But health developments also have an impact on the economy, and in this case just as negatively. The result is a kind of vicious circle that needs to be broken.

Mental health problems are now the main reason for absenteeism in the workplace. In 2024, mental illness caused 17.4 % of the sick leave of DAK-insured employees, as reported by DAK in April 2025. The main causes of depression cited by 95% of those affected were stress at work, conflicts at work and/or with colleagues by 93% and permanent availability by 83%. (Barometer Depression 2021)

It is therefore becoming increasingly urgent to do something to put a stop to this development. Not only for purely human reasons, but also for tangible social and economic reasons.

The need for socio-ecological transformation, which has been championed by various spectrums since the 1970s - ecofeminism, anti-colonialism, the degrowth movement and the care movement, to name but a few - is now becoming visible and recognised in all its urgency.

In Spain in particular, those affected have been organising and proposing solutions for years. One of these is the introduction of an unconditional basic income.

What is the UBI?

In Germany, it is defined as follows:

The unconditional basic income is an income for all people,

• that secures their livelihood and enables them to participate in society,

• to which there is an individual legal entitlement,

• which is paid without a means test and

• guaranteed without compulsion to work or other

guaranteed.

In Spain, a somewhat less precise definition is used, namely: "A basic income is an unconditional cash grant from the state to the entire population". However, this definition is repeatedly supplemented with the remark that this cash grant must be at least high enough to be above the poverty line or to secure a livelihood.

What is the aim of the UBI?

To lay the foundations for democracy. Democracy can only become a reality if freedom, equality and solidarity prevail in a society.

In order to be free, people need a livelihood that enables self-determination and participation.

Equality means that no one is discriminated against on the basis of gender, ethnicity, age, etc., but also on the basis of health.

Solidarity means that everyone contributes to the common good according to their means and that everyone's basic needs are met.

The UBI would fight poverty, it would reduce social inequality, it would redistribute. As everyone would receive it, it would destigmatise. It would relieve people mentally and enable them to develop in a self-determined way.

What is happening in Spain?

In Spain, a manifesto was published in September 2020 by people undergoing psychiatric treatment, i.e. those affected, calling for the introduction of a BGE.

The manifesto denounces the fact that mental illness is defined in a neoliberal manner as an individual biological problem of those affected, instead of understanding and addressing it as a psychosocial fact. The sick individual must change and adapt so that the illness-causing system can continue to exist. Pharmaceuticals are therefore administered to sedate people. The person's biology is "corrected" and the system is protected and allowed to develop further.

This system is based on people securing their existence through gainful employment. But sick people are sorted out and stigmatised as useless workers. 7 out of 10 mentally ill people are excluded from the labour market. This causes existential fear and has a negative impact on health. The consumption of psychotropic drugs is rising alarmingly. This puts Spain in second place worldwide. As is the case worldwide, the younger population is particularly affected. A growing burden for the future of society.

The introduction of the BGE would guarantee a livelihood independent of employment and thus reduce existential fears. As everyone would receive it, the stigmatisation as a recipient of handouts would also disappear. People could take time to get through times of personal crisis. They could avoid jobs or working conditions that make them ill and take their time to integrate into meaningful work.

The social redistribution of jointly produced wealth, which the welfare state has so far provided in the area of social reproduction, is working less and less well. The state is increasingly withdrawing from the infrastructure of public services of general interest and leaving large areas of this to the "free market". Just think of outpatient and inpatient care facilities in - partly international - corporate hands, the lobbying of the pharmaceutical industry, especially in the pricing of medicines, the privatisation of hospitals or the introduction of profit maximisation criteria in the administration of the rest. The ever-increasing privatisation and profit orientation of the housing market, the neglect of educational institutions and public mobility infrastructures (railways, public transport), etc.... As a result, earned income, i.e. the part of the income of the majority of the population that pays for the costs of social reproduction that are not socialised (i.e. borne by the general public), is becoming increasingly important, but increasingly inadequate and increasingly insecure. In Spain, the younger generation in particular suffers from high unemployment (over 25% in some regions) and precarious employment, which is one of the reasons why birth rates there are among the lowest in the world: 1.12 children per woman of childbearing age, with immigrant women accounting for a good 20% of births. It is becoming increasingly difficult to start a family.

To underpin the introduction of the BGE as an effective solution, the manifesto refers to the WHO. I quote: "As the WHO points out, the suffering caused by poverty, precarious living conditions, economic insecurity and unemployment are among the main causes of experiences diagnosed as mental disorders, addictive behaviour and suicide." And the manifesto also puts a finger in the wound of our welfare state concept. In principle, it is financed by non-wage labour costs. All formal wage labour is compensated with a wage that is paid to the worker. The net wage. But as a percentage of the wage, an additional payment is made to the social security funds. In Germany, these are the health insurance fund, the nursing care fund, the pension fund and the unemployment fund. This is an amount of over 40% of the net wage, at least for wages that are below the cap. Employed people who earn above this cap pay lower social security contributions as a percentage, which is one of the legal regulations that produce growing inequality. And then there are people who do not pay into the social security system because they have other forms of cover, e.g. assets or private insurance, or because the state pays the corresponding costs for them as civil servants. Or simply because they are not (formally) gainfully employed.

But that's not all. Another feature of this problematic conception of the welfare state is the type of entitlement to social benefits. Only those who pay into the social security system are entitled to social benefits. Only those who have paid into the pension fund are entitled to a pension. And the amount of the pension depends on the amount paid in. Anyone who does not pay into the pension fund because, for example, he or she mainly performs unpaid but socially absolutely necessary care work is not entitled to a pension. With health insurance, it is a little fairer: everyone who pays health insurance contributions has the same right to treatment, regardless of how high their contribution was. And from the time of the "family wage", when wages were supposed to be high enough for a whole family to live on, comes the right that spouses (if available and not also employed) and children (up to a certain age) also have a right to treatment because they are then also insured.

The welfare state - beyond the social security funds - must not allow someone to starve to death because he or she has no income. For these people, there is social legislation that stipulates that they are entitled to a minimum income. This is financed on a non-contributory basis. In other words, through taxes. In order to receive it, people have to prove their poverty or their neediness (in this case their "sufficiently serious" illness). And that is stigmatising. Especially in a society that believes that everyone is the architect of their own fortune and that those who are poor have only themselves to blame. Just as someone who is rich deserves it. They were particularly hard-working or intelligent or had exceptional abilities, etc... However, anyone who is poor is either lazy, stupid or ill and lives at the expense of the hard-working, intelligent and healthy.

However, if everyone receives a UBI, this stigma disappears. The stigma of being ill and the stigma of being poor.

According to the manifesto, a UBI would also be a "fundamental means of promoting recovery and empowerment processes...." It would expand the range of life opportunities for mentally ill people - desired part-time jobs, jobs in sheltered environments, volunteering, studying, vocational retraining, etc. - by covering basic needs without social pressure or stigmatisation."

In another article from 2024, the Catalan social psychologist Hernán Maria Sampietro, also argues for the introduction of the BGE as an important measure toendthe spiral of - as he calls it: "psychopathologisation, medicalisation and chronification of psychological complaints". He says: "In our country, the psychiatrisation of psychosocial disorders works like a perfect dismissal machine, so that seven out of ten people with psychiatric disorders are not on the labour market and are unlikely to be." - This formulation indicates that the UBI enables people to play an active and productive (and I, as a Care Revolution activist, would add "especially reproductive") role in social life.

The current economic system is characterised by the fact that it is completely indifferent to people. It views them simply as a resource for profit maximisation. Either as labour power that can be exploited or as consumers who, through their consumption, i.e. the purchase of products and services thrown onto the market, make the realisation of profit possible in the first place. The sick and the elderly, i.e. people who are not or no longer available to the labour market, are still "worth something" or "useful" as long as they consume. This could be rent that is paid in a retirement home or pharmaceutical products that are taken for all sorts of things.

I quote again from the article: "Instead of assuming an epidemic of defective brains, perhaps we should begin to consider that the neoliberal project is incompatible with the emotional well-being of the population, at least the working class. If young people in particular suffer the consequences of this situation, it is due both to the material difficulties they face and to their progressive displacement from a life project." And he points out that "It is precisely to promote a paradigm shift and move beyond the biomedical model that the World Health Organisation has been promoting its QualityRights initiative since 2013, which proposes a community-based, recovery-oriented, person-centred and rights-based approach (Funk and Drew, 2020)." And he quotes Eduardo Costas, Professor of Pharmacy at the Complutense University of Madrid, who stated in 2024: "Instead of fighting inequality, we are anaesthetising the most disadvantaged with psychotropic drugs".

Moreandmore studies are showing that precarious living conditions and social exclusion are factors in the development of mental health problems. And that, on the other hand, people who have been diagnosed with a mental disorder are confronted with greater material insecurity in life and greater social marginalisation. Poverty and social inequality therefore urgently need to be combated. And a UBI is the perfect way to start this necessary paradigm shift.

How much suffering and how much cost would its introduction save! With a UBI, the problems arising from precarious living conditions and social exclusion would not be individualised, medicalised and chronified and thus depoliticised, but their causes would be tackled. It would drastically reduce expenditure on medicines, emergency room visits and psychiatric admissions, non-contributory transfer payments and all the costs associated with the current cycles of dependency in which psychiatrised and impoverished people end up. This would reduce the financial burden on the welfare state.

And as a care activist, I would also add that a lot of sometimes very stressful, mostly unpaid care work would become unnecessary, which the neoliberal state would massively shift back to private households and therefore primarily onto women. It's no wonder that women in particular are experiencing increased psychological suffering and stress.

A statement from the UN

Finally, I would like to draw your attention to a report from 2024 by Olivier de Schutter, the UN's Special Rapporteur on extreme poverty and human rights. In it, he comes to the same observations, conclusions and solutions as the Spaniards. Poverty, material insecurity, fear of the future, growing pressure to perform, climate change - everything caused by the current profit-orientated economic system has a fatal effect on mental health, especially for the younger generation, who are facing a significantly longer future than someone like me, for example, who can already look back on more than 70 years. He also emphasises the need for a paradigm shift and sees the introduction of the UBI as an important measure to prevent the worst and pave the way for a socio-ecological transformation.

Our Unconditional Basic Income Rhine-Main initiative group has published and linked to these inspiring resources from Spain and the UN on our website. I warmly recommend everyone to read them and to forward them to others. We must all realise that it is 5 minutes to 12, but that in the midst of these polycrises, there are approaches and measures that point the way out. That there is a horizon where the sun rises. That we should move towards it and invite as many people as possible to join us. We would be delighted to hear from anyone who is still interested in the UBI and perhaps wants to actively campaign for it with us.

The resources cited or mentioned in this article can be found here:

Unconditional Basic Income: A solution to the vicious circle of psychopathologisation, medicalisation and chronification of ailments by Hernán María Sampietro

Recovering dignity and well-being in mental health by Iñaki García Maza and Sergi Raventós

Mental health through basic income? (on the report of the UN Special Rapporteur on extreme poverty and human rights) by Marina Martin

Manifesto of psychiatrically treated people for an unconditional basic income from Catalonia from 18 September 2020