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Mental Health in a Time of Financial Cholera: Page 2 of 3

Mental Health in a Time of Financial Cholera: Page 2 of 3

Pumariega has seen a rise in decompensation and in inpatient care and emergency department use among the severely mentally ill population because of financially driven curtailments in the community-based services that support this population. He believes that because of the severe financial stresses experienced by psychologically vulnerable individuals—especially those without adequate support systems—more patients with a history of serious mental illness will experience a re­lapse. Pumariega believes that rates of clinically significant depression, anxiety disorders and, especially, sub­stance abuse disorders will rise. He also anticipates increasing comorbidity of mental health and substance abuse problems.

Men have been disproportionately affected by job loss in the current economic crisis, and this may have psychological complications for the male “breadwinner,” according to Mota-Castillo. Many unemployed men feel diminished, guilty, and emasculated because they are unable to fulfill the traditional role of supporting the family. The humiliation is intensified when, as is likely, the wife is then obliged to work or take a second job. This situation can give rise to other problems, such as depression, lethargy, rage, and alcohol abuse. Mounting tensions within the family may lead to spousal abuse and domestic violence. In addition, unemployment can inhibit a man’s ability to move on, accept the changes that have occurred, and search for another job or contemplate a new career.

Given the far-reaching nature of the financial crisis, patients with anxiety disorder are in a particularly difficult position. Events may impose drastic changes in their lives, yet the hallmarks of anxiety disorder—rigidity of thinking, difficulty in problem solving, and difficulty in planning for the future—can prevent them from adapting.

The drastic loss of income and savings is not just an accounting ab­straction. It is reflected in real deprivation in many things recently taken for granted—no shopping, no restaurant meals, curtailed vacations, and so forth. These things may not in themselves be very important, but their loss is certainly stressful and a constant reminder of what has happened. Pumariega is concerned that substance abuse (especially alcoholism), depression, and even suicide may occur in elderly patients who have lost much of their income and the status that goes along with a financially comfortable lifestyle. The elderly are generally less likely to seek psychiatric help. Indeed, for any age group, substance abuse can prompt suicidal ideation.

A possible increase in the incidence of suicide as a consequence of the financial crisis is also of major concern. There is a disturbing statistic from the National Suicide Pre­vention Lifeline: between 2007 and 2008, the number of hotline calls rose 38%, from slightly over 400,000 to slightly more than 550,000. Apart from reflecting heightened anxiety in the population, it is difficult to know what these numbers mean. Although they may foreshadow a significant rise in the number of serious suicide attempts and “successful” suicides, this may not be the case. A hotline call usually reflects uncertainty about a resolve to commit suicide; in some cases, the call is not even about suicide.

The psychiatrists with whom Psychiatric Times spoke anticipate that the number of suicides will increase as a result of layering the tensions and anxiety of the economic situation onto whatever underlying problems these individuals are experiencing. Nevertheless, suicide by mentally healthy persons who have been damaged financially and who may never fully recover what they have lost is unlikely.

For psychiatrists and other mental health professionals, the financial health of their patients is a big concern, because it may mean that patients can no longer afford treatment or are no longer insured for it. For these patients, there is virtually no alternative: free mental health clinics are already stretched to the limit.

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