The financial tsunami that has hit the United States and most of the rest of the globe is causing unparalleled misery for hundreds of millions. In America, millions of jobs have been lost, and it appears that millions more will be lost. In a nation where home ownership is a cherished expectation and goal, millions are losing their homes. The GNP is shrinking, the value of nearly all investments has plummeted, and the retirement plans of millions have been decimated.
The psychological impact of this economic catastrophe is incalculable. With shocking speed, a job lost can lead to a home lost, a family fractured, the dream of college abandoned, health care insurance lost, savings drained . . . the list goes on and on. Paralyzing fear, depression, loss of self-esteem, and physical illnesses for which there is no apparent cause are frequent. For members of the comfortable middle class who have never experienced such trouble, the assault may be especially damaging psychologically. Just consider the well-dressed, middle-class men and women we see on the evening news visiting food pantries or using food stamps at the supermarket. Many, stunned and bemused, say, “I never dreamed I would be doing this.” Equally vulnerable are the not-long-ago poor, who, having struggled to get out of poverty, suddenly find themselves plunged back into it—usually through no fault of their own.
Severe stress breeds mental health problems in vulnerable individuals, and psychiatrists and other health professionals are seeing the onslaught of such problems arising from the financial crisis.
“The economic crisis is dominating people’s psychological landscape,” says Richard Rubin, MD, who practices psychiatry in Guilford, Conn. “It’s causing nearly everyone to worry and to develop a chronic sense of unease and apprehension that’s permeating our society and country.”
Although there is little quantitative data that indicate a rise in need or demand for mental health services as a result of the financial crisis, there is growing anecdotal evidence attesting to this. Manual Mota-Castillo, MD, who has a private practice in Orange City, Fla, and is a psychiatric consultant to a local community hospital, reports that the number of calls to his office from people seeking help has doubled in recent months. But with an already full patient load, he is able to see very few of them.
According to Mota-Castillo, people with generalized anxiety disorder or obsessive-compulsive disorder are particularly vulnerable to the ubiquitous barrage of bad economic news. “These are people who suffer from anticipatory anxiety: they spend much of their lives playing “What if this or that bad thing happens to me? Now, it’s what if I lose my job or lose my house?” says Mota-Castillo. “Unfortunately, such fears may be justified, which only heightens anxiety and may undercut years of relative stability.”
Both Andres Pumariega, MD, chairman of the department of psychiatry at Reading Hospital and Medical Center in Pennsylvania and professor of psychiatry at Temple University Medical School, and Rubin are concerned that the loss of patients’ financial security, combined with cuts in public funding for mental health services, could result in a significant decline in the number of patients who receive psychiatric treatment at a time when the need for it is growing.
In times of economic crisis, public services—including health services—are very likely to be reduced. Many psychiatrists worry about possible cuts in Medicaid mental health programs and in school-based counseling programs for children. Indeed, in financially ravaged families, visits by children to mental health professionals may be suspended. Although the Obama administration’s stimulus package provides additional Medicaid money to the states, it is probable that publicly funded mental health services as well as those provided by nonprofit hospitals will be constricted.