Thursday, April 09, 2009

Does the Failing Economy Lead to Psychiatric Disorder?

In yesterday's New York Times, Pam Belluck writes "Recession Anxiety Seeps into Everyday Life." She talks about people who've needed psychiatric care, including medications, because of the poor economy. Some are people who are not actually having financial problems, but are very symptomatic, nonetheless.

So what have I seen? I work in two different outpatient settings, but I can summarize what I've seen pretty easily.

---In the private practice setting, every patient has at least mentioned the troubled economy and concerns about money, if not in passing, then as a cause of significant worry and personal concern. Some people have decided to come less often. Referrals are down. No one new has presented with their only complaint being anxiety because of money worries, but in the realm of things causing stress, it's pretty much on everyone's list. Many people are worried about losing their health insurance.

--In clinic settings, many of the patients I see receive disability or some other source of fixed income. Money is always a stress, there's simply not enough of it. Or, they live in a setting where their needs are met, their money is managed with no room for luxuries or savings, and it's not something they mention to me. There are no jobs to be lost, no cars to be repossessed, no luxury vacations to be longed for. Here, few mention the economy or money worries in a way that relates to economic changes: they have no credit, mortgages, or portfolios, and paying the bills is the same struggle it's always been.

Anyone else notice anything interesting?


Mr Ian said...

It is better to have spent money and lost than to never have had money at all.

Alas - this is the new mantra of the capitalist world.

Retriever said...

The failing economy simply adds to the stress about money that all patients and their families have. Where I live, the shrinks are having a temporary bonanza because it is a very rich suburb and people can still pay retail to get help for their depression/anxiety and substance abuse.

However, the middle class working people I know are basically stockpiling meds, begging their shrinks to prescribe lots while they still have insurance, and anticipating no more therapy for anyone in the family once the job and health insurance are lost. The psychiatrists' free samples are asked for shamelessly now.

One thing that occurs to me is that shrinks are going to have to research the prices of the meds they recommend to their patients and talk with them about them, as well as side effects. For example: all mood stabilizers and antipsychotics will make you plump at first, fat later, obese eventually. This one costs 30 dollars a month, this one 500. This one will give you a 30 percent chance of tardive dyskinesia, that one slim to none. How lucky do you feel?

I am not being flippant. But even people who still have health insurance are being forced to pay an ever higher percentage of the prescription costs, and when you consider that many people are on three or four medications, and sometimes three people in a family are being treated, cost becomes a huge issue.

Unknown said...

Agree with you as I often do Dinah.

People with jobs paying out of pocket to see me are coming less frequently, making payment plans or asking for fee reductions (which I always do). These people call to reschedule and postpone their appointments 24 - 48 hours in advance.

People on fixed incomes or whose care is paid for by outside sources are concerned about the economy, but the details of their everyday lives are not changing at all. They have their dependable, for now, fixed income. They do not miss their appointments.

Anonymous said...

from a patient:

It's affected me a lot. My photography business had already been affected by the advent of widespread digital camera use and influx of unemployed dot-com-ers into the business. Add in the recession and the photoo business is belly up. Meanwhile I was retooling myself to teach. In Oct. 2007 when I started thinking about it, there were front page headlines about a teacher shortage. Most recently in CA 29,000 teachers just got layoff notices. I am 8 weeks from finishing my credential and now there are NO jobs. Everyone in my credential program is distraught. Many if not most of the teachers where I am student teaching are distraught. When I talk to my photographer buddies they are beyond distraught. They are desperate, anxiety ridden, grief-stricken. It all seeps into my reality because there's not a bright spot anywhere. One of my best friends is a photo retoucher who got laid off in January, managed to get another job and due to lack of work at the lab who hired her, she was just laid off again on Wednesday of last week. Another very close friend is one of those 29,000 teachers. She is 62 years old, not married, pays $2,000 a month for a tiny 800 sq. ft bungalow and has 2 dogs ... and not job after another month or so. She's a special ed teacher who has been teaching 17 years. it's sad and it is maddening. I can tell you that it all works at making my personal mental status worse than normal.

If you are wondering.. I have not cut back on sessions or missed sessions with my psychiatrist. In fact, I feel that I need him more than ever and can stil afford it.

Anonymous said...

Did not know that anxiety and other symptoms in response to real life stressors were considered psych disorders.

Perhaps someone wants to look at psych disorders as a cause of the failing economy. Grandiosity, greed, delusions of all sorts, played some part, no? The entire society is disordered, symptomatic, and needs to be on meds. Specifically, the economy needed an anti-depressant, a very expensive multi trillion dollar one.....! One that had not passed clinical trials (no big surprise there).

Reese Rivera said...

Although I'm not a doctor, I was thinking about this exact subject very recently. I see alot of the same people you treat. I hear many of the same stories that you hear. The economy is a growing concern for many. Many of my clients are now on medication to cope. What do I have to do with your profession? Well, I'll tell you. I've lead many of my clients to seek psychiatric help due to stories they've shared with me. Women in my profession are probably your biggest source of referrals and you don't even realize it.

Reese Rivera

Midwife with a Knife said...

I should write a post about this. Although I'm not affected by the downturn in the economy directly (new job intact, income will increase dramatically in July, etc)., my patient load as a fellow has perhaps doubled (all uninsured pts).

Roy said...

As a hospital-based psychiatrist, I am certainly seeing a greater proportion of patients coming to the ER or admitted medically (eg, for heart failure, chest pain, pneumonia, stroke, withdrawal, etc) who cite financial/housing/job-related problems that compound their medical or psychiatric illness.

I wouldn't say that these economy-related problems "cause" psych illness, but for many people they do exacerbate their problems. Folks are skimping on meds to save money and stretching out their appointments or not keeping them. And some are resorting to drugs or alcohol or even suicide attempts due to pending foreclosure, bankruptcy, overwhelming bills, losing insurance and unemployment.

We try to help connect them with social services, housing assistance (like the Hope Fund), switching to affordable $4 meds if possible, and applying for assistance. We also encourage them to reach out to family and friends rather than trying to hold it all in and not ask for help.

Roy said...

Oh, I also wanted to thank Reese for her different vantage point as an, um, what, I guess an "escort" or a prostitute. I can imagine how this sort of business might fall off with a bad economy, but on the other hand, I could see how the stress could increase the use of this service. I am glad to hear that if one of your clients is clearly in need of mental health treatment, that you refer them for help. That being said, I have to admit that I've never had to call a prostitute to get collateral history about a patient. I guess it's not the sort of thing one offers to their doctor, and I don't routinely ask if my patients purchase such services.

Anonymous said...

This topic brought up some conflicting feelings in me. I've been struggling how to define it.

I feel that the failing economy affects not just paying patients, but the clinic patients as well.

I used to feel a lot of fustration at the poverty-level living that fixed income provides me... so i immediatly tuned out and expressed angry at the financial advisors on tv.

Cut your income in half for savings? How exactly am I supposed to do that on $1k a month? What about the $14 in foodstamps I have been alotted, that soo makes a difference... same with reduced bus passes...

but... with openmindedness and awareness... I spent that $14 purchasing something extrabagant - crab meat, or ribs or something... just to feel like i have that 'extra treat' and i be sure to thank the food stamps for it.

Then I travel to a meat market to purchase meat, a fruit market for vegatables, even if it means a long hike. I be sure to hit the food pantries - and instead of being resentful at the fact that a single person gets 1lb of frozen hamburger meet a month... i am greatful that i have one meal i don't have to pay for. Then i hit an off-brand store for boxed stuff.

I figure, the stamps and pantry, contribute $35 or so to my food budget, depending on the pantry. The meat market provides good meat at lower prices, and the same with the fruit market. I recently was able to purchase, apple, mango, bananna/strawbary, guava, and orange juice 2 pint boxes for $0.37 cents each.

These food changes - moving from aldi's to the markets, plus the stamps, means that my $60 cash budget for food, not only feeds me, but keeps me feeling satisfied.

My apartment - i'm not eligible for housing, so following some tips, i recently was able to move from one apartment to another in a different but almost safer neighborhood - dropping close to $300 in rent - not to mention reducing my utilites by over 2/3rds...
and i still have gas, electric, and internet.

I made a few other changes as well, dropping my phone by $10 a month, my insurance by $20, my copays by $1.25... which nets me another $40 or so a month...

My point is not the changes i made, nor financial recovery... because while, I have dropped my expensesby $550... i have simply gone from 'in the hole' to 'just making it'...

My point, however, really, is that, as a clinic patient, i have felt helpless over the limited/fixed income and maintained/remained in the learned helplessness place...

truth is... it effects everyone & cuts can be made, which strangely has approved my quality of life...

anyone and everyone... and if my supports (pdoc/therapist/friends)didn't have these experiences and suggestions... i would still be paying more, getting in debt, and feeling deprived

instead of happy & safe... because my fixed income, limited as it is, my fixed income gives ME some saftey that others are not experiencing.