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August 3, 2009

Feeling Stressed? | As recession anxiety builds, more seek therapy

Hard times are hard on more than one’s wallet. Financial trouble can take a real toll on emotions, relationships and overall mental health, as well.

In a recent report, Ross Gittell, a professor of management at the University of New Hampshire and vice president of the New England Economic Partnership, argued that the recession is sending more people in search of mental health services, so many more that the state’s health care system could be unequipped to bear the burden.

Mental health professionals say Gittell’s argument was sound, and the scenario Gittell described may be worse than he could calculate in purely economic terms.

Anecdotal Evidence

According to Theo Manschreck, president of the Massachusetts Psychiatric Society, no formal data supporting Gittell has been gathered in Massachusetts. But, he said, “the perception is there is an increased level of calling for appointments across the board. Insurers are trying to locate therapists with a little more effort than they have in the past.”

Manschreck said calls for therapy “seem to have been building gradually over the last three months,” and those calls aren’t necessarily from the recently laid-off or those whose home loans have been foreclosed. The calls are from people on the edge of situations like that and the prevalent feelings among them are anxiety, stress and frustration.

Manschreck has treated people who’ve lost their jobs. He said the fear of being laid off is perhaps more damaging psychologically than actually being laid off.

That rings true for James Carbone, president of the Shrewsbury-based Wellness Corp.

“Pressure has increased in every socio-economic group…a lot of people are worried about getting laid off,” he said. Since the recession started in late 2007 and early 2008, Carbone said the Wellness Corp. has seen its call volume increase by about 20 percent.

Wellness Corp. offers free, confidential phone service to people in need of psychological service. The company was founded by Carbone, a nurse, in 1984 and he said some of the same social stigmas related to mental health then are still at work today.

“That kind of anxiety, the lack of sleep, irritability; they bring that to work and the supervisor notices,” Carbone said. “They’re looking for some help, but there’s still a stigma attached to mental health. When they call, they’re usually close to a breaking point. People usually suffer with this stuff by themselves.”

Insurance plans typically require patients to seek mental health services through referral by their primary care physician, Carbone said, and many simply do not want to do that. “If it’s an easy access program, they’ll make the call.”

That trend has taken firms like Wellness Corp. from being “an afterthought,” to being full-time providers, Carbone said.

“People have managed care and HMOs and closed networks, they jump through hoops,” he said. “This is easy access. We have become a first triage for a lot of people and that’s a huge change. We were an afterthought before.”

But according to the Massachusetts Nurses Association, the tide of people seeking mental health services may soon rise too high for even the free, easy access agencies to handle.

David Schildmeier, an association spokesman, said the state is making the same mistakes during the current recession that it did during the recession of the 1980s. The results, homelessness and crime, will be the same, too, he said.

In June, the association argued against a state Department of Mental Health plan to close 100 beds in the state mental health hospital system.

“That is a dramatic shortage, especially for poor people,” Schildmeier said. And as Carbone noted, “getting laid off when you’re making $25,000 a year is a lot different than getting laid off when you make $80,000 a year.”

“Nurses are reporting seeing greater demand for utilization” as people lose their homes and their jobs, Schildmeier said. “We’re heading for a major crisis and this is a system in shambles.”

Karen Coughlin, an association vice president, painted a grim picture during testimony before the DMH inpatient study committee.

“Right now, we have psychiatric patients clogging our emergency rooms across the state...” she said. “We also know that in tough economic times and times of recession, the incidence of mental illness, depression, suicide and substance abuse increase, necessitating a greater need for all levels of psychiatric care.”

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