January 1st, 2010

Jobless have increased mental health woes

A national study shows Americans affected by the economic downturn displaying symptoms of severe mental illness at a much greater rate than those who haven’t been affected.

Unemployed Americans are four times as likely as those with jobs to report symptoms consistent with severe mental illness and twice as likely to report concern with their mental health, according to a September survey conducted for Mental Health America and the National Alliance on Mental Illness in collaboration with the Depression is Real Coalition.

Additionally – workers who are employed full-time but faced involuntary changes in their employment status – such as pay cuts or reduced hours – were twice as likely to report such symptoms.

In the survey, 13 percent of unemployed persons reported thoughts of harming themselves (four times more than full-time workers) and half reported difficulty in obtaining healthcare.

While economic difficulties typically cause increased anxiety, the magnitude of the effect reported was alarming, says David Shern, Ph.D., president and CEO of Mental Health America.

Although historically there’s a rise in suicide during economic downturns, Shern says he was struck by the “fourfold increase” of people with suicidal ideations. He was also concerned by the severity of the reported symptoms.

Compounding problems for the unemployed is what Shern calls an “upside-down system” – unemployed people who need mental health care no longer have the health insurance that might help them get it.

Of those surveyed who have not spoken to a health professional about concerns, 42 percent said cost or lack of insurance coverage was the primary reason.

Michael J. Fitzpatrick, MSW, executive director of the National Alliance on Mental Illness, is trying to get a message out to the uninsured – help is available. “Community mental health centers are available and will work out the financial end of it. The best case down the road is that everybody will have health benefits. But even today there are alternatives if you need help.”

Fitzpatrick says he’s never seen an economic downturn this difficult. “There’s a real human impact,” he says. “We haven’t seen anything this bad and this protracted since the Great Depression. People need support. They need to know there are places to go to get help.”

Shern says his organization is trying to raise public awareness and encourages people to visit its Web site, (liveyourlifewell.org), which features evidence-based strategies for managing stress.

Of the nearly 20 percent of respondents reporting involuntary job changes in the past year (such as pay cut or reduced hours), twice as many were likely to report symptoms consistent with severe mental illness and five times more likely to report feeling hopeless, even though they remained employed.

“The major operational variable has to do with unpredictability,” Shern says. “When we talk about people experiencing toxic stress or chronic stress, typically what you mean are people living in an environment where they don’t feel like they can accurately predict what’s going to happen. They have a tendency to live in a constant state of activation. It’s a sense of being sort of off-kilter, off-balance, unable to predict what is going to happen.”

Elaine Ducharme Ph.D, a licensed psychologist in Glastonbury, Conn., says many people who weren’t affected at the start of the economic downturn are now feeling its long-term effects.

She is seeing patients face foreclosures, downsizing, the depletion of unemployment benefits and some couples who both lost their jobs. In addition to observing concrete financial effects, she’s also helping patients cope with changing roles within the family – such as women becoming the primary breadwinners while their husbands stay home with the children.

“It’s a change in identity for people,” she says. Ducharme says she has treated some patients pro bono or at a low fee. “I think therapists are doing those kinds of things and trying to work with people so that their lives aren’t disrupted.”

She says many affected families have never had to worry about finances before.

Fitzpatrick notes that many Americans who are experiencing job loss or downsizing have never been in the mental health system. “So you have the stigma and anxiety about going to see a mental health professional,” he says. “I think the concern we had is people recognize what they are experiencing and that they access treatment. The message we tried to give out with this survey is that depression is really treatable.”

Ducharme says other factors – like political divide and even swine flu – are adding to the stress. “People can take a certain amount and they are okay and they can cope and be resilient. But after three or four things hit, you just can’t be so resilient anymore and you start to fall apart.

“And when you start to fall apart, we often don’t use our better coping mechanisms,” she says, leading people to drink or smoke more, stop exercising or isolate themselves.

The survey showed that unemployed people were twice as likely to report concern with their use of alcohol or drugs during the last six months.

By Pamela Berard

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