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

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

As is doubtlessly true of most psychiatrists, those consulted by Psychiatric Times do what they can to relieve the financial burden of treatment for beleaguered patients. This includes reduced fees, extended payment schedules, forgiven copays, less frequent visits, brief therapy sessions conducted by phone, and placement (when possible) in free clinics. But such measures are often not enough, and the choices are limited. As one practitioner bluntly put it, “Although I may want to do so, I simply can’t afford to treat my patients for nothing.”

The very nature of the financial crisis—a huge, malignant, external force over which the people affected have little, if any, control—also presents mental health professionals with the enormous challenge of providing comfort and hope to pa­tients in an environment that seems to offer none. Medications and other treatments can help, but clinicians cannot undo the reality of lives turned upside down.

Mota-Castillo tries to get patients to put their situation, no matter how bad, into perspective. He tells them that they can’t give up. I say that “as long as you have energy, you have to keep swimming or you will drown.” He also reminds patients that they aren’t totally without help and that there are practical things they can do.

Pumariega says that clinicians must make patients aware of the practical options that are now available—consulting a credit counseling agency, negotiating new mortgage terms, using food banks and other community safety nets, etc—while emphasizing that there is no shame in using these resources.

For people who have never been in such a situation and never imagined that they could be, shame is a huge obstacle to dealing with this trauma and, indeed, makes it worse. Simply reminding people that they are not alone can be helpful: when bad things happen, there is strength in numbers. For some patients, meeting the challenge of job retraining and changing careers can become a component of psychotherapy.

Rubin agrees but admits that as a therapist, given the present situation, he often has a sense of impotence. “It’s hard to know what to tell people and how to support them when, for example, their incomes have shriveled,” he says. “Saying, in effect, ‘this too will pass,’ which may be comforting in other circumstances, isn’t appropriate here. There’s no end in sight, and no guarantee that their finances will ever rebound. The reality of what’s happening is so difficult that sometimes there is nothing I can say. The only comfort I can offer is empathy.”

On a slightly more hopeful grace note, Pumariega notes that he was struck by the fact that President Obama had said that responding to this crisis will require sacrifice from all Americans. “If Americans can come together in a spirit of common purpose and are willing to make sacrifices for the common good, I think this will be an important factor in reducing mental health problems,” says Pumariega.


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