A Time to Invest in Psychiatric Care

Aside from the incredible antics of my state governor, which I addressed in my column in the January 16 issue, most questions I receive from the media these days are about the psychiatric impact of the world economic cataclysm. Reporters want to know whether the incidence of mental illnesses has increased; are we seeing more patients? They want to understand how the threat and reality of job and financial loss work to affect our patients. They want to pass on to their readers and listeners any expert advice we can offer to help them weather these abrupt and unanticipated changes in their finances.

Since we don't have any organized central oversight of the health of our population, I don't have data to indicate an increase in psychopathology. I have been told that the number of prescriptions for antidepressants has increased. We have some studies from areas differentially affected by economic hardships in the past. The suicide rate increases. There is evidence that people tolerate hard times better when everybody is in the same boat than when others are doing better than they are.

Tragically, I expect that there is increased need for, but decreased access to, psychiatric services under current circumstances. Employees, whose mental health coverage was often inadequate to begin with, lose their health insurance when they lose their jobs. People who lose their homes and have to move their families in with relatives or to shelters hardly rank mental health care as a top priority. As state and local budgets are stretched, public psychiatric services are overwhelmed or disappear—the city of Chicago is about to close three mental health clinics in an already disadvantaged area. So I tell reporters that I am concerned that we are having a silent epidemic of anxiety and depression and that those symptoms will make it all the more difficult for those affected to face moves, find new jobs, and adapt to new lifestyles.

We have all read about the positive and negative reactions to President Obama's $500,000 ceiling on salaries at companies receiving“ bailout” funds. Reporters want to know why some people are profoundly distressed despite the fact that, even with the economic downturn, they should have ample remaining resources to house, feed, and educate their families. People can lose their senses of identity, status, and purpose along with their incomes. Recently regarded as geniuses and heroes, they have suddenly become dupes, villains, or losers. They may have failed a great many other people, who were depending on their advice, and made investments intended to fund their children's college educations, provide a comfortable retirement, or just keep roofs over their heads. In America, people are closely identified with their jobs.

Here is the advice I give reporters to pass on to their readers. This is a time to renew basic values of family, friends, and faith. People have to support their loved ones rather than blaming them for financial decisions that turned out to be unwise. They need to reassure their children. They need to take care of themselves. Healthy meals and regular exercise may seem like indulgences, but they are more important now than ever. People need to keep themselves strong to find new resources and adapt to new circumstances. So this is a time for investments in psychiatric care even when money is tight. When anxiety and depression persistently interfere with sleep, appetite, energy, and concentration and are left untreated, a person enters a downward spiral. It takes more energy, more creativity to think up new ways to earn a living and survive economic loss than just to go to work each day. Sad faces and agitated body movements are not positive attributes in job interviews. People with persistent symptoms need professional consultation.

We don't know where our economy is going or for how long. We are all worried about our own security and about our coworkers, employees, and loved ones. We may have to eliminate the jobs of people we care about and depend on to run our offices and care for our children and elderly parents. APA is making serious cuts in staff and governance to protect the resources we need to serve us and our patients. This is a time for us to pull together and invest in ourselves. Encourage your colleagues to become or remain members of APA. Come to the annual meeting in San Francisco: to refresh, learn, network, enjoy old friends, and be inspired by our brilliant fellow researchers, teachers, and clinicians. ▪