Economy's problems may be causing people's mental health needs to rise

From The Denver Post:

They come in for counseling related to a DUI, but it turns out the alcohol was meant to kill the depression of a lost job, a lost house, a lost spouse — or maybe all three.

They ask for help with gas money or car repairs so they can make their therapy appointment. They struggle to make co-payments.

They rush to take advantage of employee assistance programs — sometimes fearful they might lose their job, sometimes trying to grapple with their job loss before employee benefits expire.

Layoffs, corporate cutbacks, a tumbling stock market and the credit crunch have ratcheted stress to new levels, prompting many experts to connect the economic downturn to a recent uptick in requests for mental health services — even as some patients can hardly afford them.

Although most say it's too early to pinpoint the precise cause of the jump, anecdotal evidence from both caregivers and consumers suggests the failing economy has pushed more people toward therapeutic relief.

Variations on the theme have emerged all across the country — muted only slightly in Colorado, said George DelGrosso, executive director of the Colorado Behavioral Healthcare Council, a statewide association of community mental health centers.

"We're at the beginning stages of it," DelGrosso said. "As people are losing their jobs and health-insurance coverage is going away, they're experiencing depression or frustration at not making ends meet. You reach back to get the help you need, but often you find that your health-insurance coverage is not comprehensive enough."

Tucked away in a maze of hallways at The Rainbow Center, a mental health drop-in facility in Thornton, the food bank and Santa Shop, where clients can find free gifts for their kids, do a brisker-than-usual business.

Group discussions veer into a tangle of troubling what-ifs about jobs, housing and Medicaid. Calls to the crisis team have spiked — including a couple of suicide threats.

Program director Gloria Anderson has taken at least eight calls this month from people who've never before asked for help.

"They're at the end of their rope — they don't know what to do," said the 62-year-old Anderson, whose own diagnosis of depression, post-traumatic stress and personality disorder helps her empathize with the callers' plight.

Effects of long-term economic trouble could reach deep into family life, said Mitchell Berdie, psychologist and product director of Anthem EAP, which handles employee assistance programs for 3 million members nationwide, including many in Colorado.

"If this is the early stage, what happens next year, if it drags on?" Berdie said. "The longer stress goes on within a family, the more likely it is to impact all members of that family."

Mental health experts often point to the aftermath of the Sept. 11, 2001, terrorist attacks as the definitive spike in demand for services. But some, like Berdie, see the unfolding economic meltdown having a more direct affect on people as jobs, retirements and relationships come under strain.

"This is more pervasive than other things we've seen," he explained. "Certainly 9/11 had its own characteristics, but it didn't pervade into as many domains as this crisis. I don't know that in our generation we've seen anything that quite has this portent."

On the Western Slope, chief executive Sharon Raggio of Colorado West Regional Mental Health in Grand Junction hears two different stories.

Colleagues in private practice tell Raggio that mental health referrals are "drying up" as potential clients put off treatment and tend to more immediate financial concerns.

But she hears something else at mental health centers like the nonprofit Colorado West.

"Folks already are engaged with expressing anxiety over the financial state of their personal lives and the country," she said. "They may come in because of a DUI, but they're drinking because of anxiety they're experiencing over financial concerns."

Beth Lonergan, clinical operations director for The Mental Health Center Serving Boulder and Broomfield Counties, notes an increased volume of both crisis and routine services, including some recent acute cases that seemed to come out of nowhere.

"We ended up hospitalizing a couple of people who didn't have any kind of psychiatric history," she said, "but real-life circumstances had mounted to where they had become suicidal — loss of job, sort of a domino effect, loss of place to live, loss of family, basically going to a pretty dark place. "

Demand for mental health services generally increases during the fall, particularly as the holidays approach. But while a broad statistical picture won't come into focus for months, individual service providers have reported some numbers that eclipse the usual rise.

The Arapahoe/Douglas Mental Health Network notes a "significant spike" in requests for service — from 170 in August to 195 in September to 240 in October.

After meeting with officials from five other mental health centers, executive director and CEO Scott Thoemke said those numbers are reflected across the metro area.

The network's Medicaid-eligible clients — one indicator of financial struggles — has surpassed 100,000 for just the second time in about a decade. The number averages in the low 90,000s. The Arapahoe/Douglas network has seen a 17 percent increase from August's 9,950 "units of service" — that can be anything from a 15-minute consult to an hour of therapy — to 11,642 in October.

"Without looking at the narrative of each of those requests, it's hard to say, but all of our general impressions were that this reflects the tough times we're going through," Thoemke said. "People are higher-strung, mental illness is exacerbated and there's more stress to bear on a daily basis. "

For individuals already diagnosed with mental illness, the stress of tough economic times can deliver a double wallop. Not only does it tend to magnify symptoms, but it also demands difficult choices.

Already on a tight budget, Kim and Peter Fanelli of Lakewood find themselves juggling $17 therapy co-pays with necessities like food and gas. Both have been diagnosed as bipolar, and the flagging economy has touched them in ways that can easily send either spiraling into depression.

"We sit there, and Peter and I look at the budget for this month and decide how many appointments we can afford," said Kim, 53, who receives some Social Security income and works part time as a tutor.

Peter, who works as a limousine driver, has felt the financial sting of cutbacks in corporate travel, even to the point of less generous tips. And tighter money means tension at home.

When he used some of his tip money to buy Kim some perfume, she thought the gesture was sweet. But in the back of her mind, she couldn't help thinking: This could've been food. This could've been a co-pay.

"So much is beyond my control," said Kim, lamenting the national scope of the hard times. "I have no idea if a stimulus package will work. Hope is a huge part of the mental health world. If you don't have hope, you start to ask why you're here."

The Fanellis access services through the Jefferson Center for Mental Health, a nonprofit that serves Jefferson, Gilpin and Clear Creek counties. The center saw record program admissions in October — 20 percent more than the previous month and nearly double the number from October 2007.

Employee assistance programs also have been hearing more accounts of finances impacting lives.

"Staff are hearing people saying their marriage is suffering, or a relationship is suffering because of financial stress," said Anthem EAP's Berdie. "It's not just that they're losing their job or that they've had a foreclosure, but there are all these more subtle impacts that really do have an impact on mental health and relationships."

Anthem has beefed up its legal and financial counseling programs, modified its stress-management training specifically to address how money impacts relationships, and created brown-bag seminars that touch on similar aspects of conflict resolution.

Berdie says the company's researchers have talked about collecting data during the downturn and then running it against external measures, like the Dow Jones index.

But from a mental health standpoint, the market's individual fluctuations loom less significant than its overall unpredictability.

"There's an adage in psychology that predictability is a good substitute for control," Berdie said. "If you can predict what's going to happen, your sense of competence is enhanced. If look at what's happening on the markets now, it's as unpredictable as it is out of control."