The recession's psychological toll

At the height of the recession last year, Deanna Ross was busy training the newly unemployed and others how to form support groups to cope with mental illness in these stressful times.

Then Ross lost her own job as a regional field worker at the National Alliance on Mental Illness in December. Since then, the 42-year-old Columbia mother with bipolar disorder has been struggling against the reflex to withdraw from society and with fears of becoming homeless.

For Ross and other workers — both on the unemployment rolls and in the workplace — the Great Recession is taking a steep psychological toll.

Laid-off workers are having trouble adjusting to the displacement, emotionally and financially, while those who survived layoffs are left to cope with survivor's guilt, more work, lack of motivation and job insecurity, according to mental health workers and workplace consultants. That, in turn, has had implications for health care providers and employers.

Hospitals and counselors are straining under an increasing caseload as people suffering from job-related stresses seek help and often can't cover costs because they have lost jobs, income or health insurance. Employers are seeing a rising volume of requests to assistance programs that offer help resolving personal issues, including financial stress, as part of health benefits.

"For many American workers, this financial stress, uncertainty and anxiety can be significant, and it's important that they have places to turn for guidance and support," said Dan McCarthy, chief clinical officer at Magellan Health Services, which specializes in managing mental health benefits.

Magellan found that the use of services through its employee assistance programs, or EAPs, increased 10 percent nationally last year through the first quarter of this year. The company found that more people were calling with legal and money troubles, with concerns related to debt management, mortgage refinancing, foreclosure and job loss.

For Ross, the anxiety can be crushing. The mother of five has consistently worked during her lifetime, while managing the bipolar disorder that left her feeling very high or very low and sometimes hearing voices. She was diagnosed at 27.

"I am concerned about being on the street — that's my gut feeling," she said. "I'm concerned that my family won't have what we need. We're just barely hanging on."

After she was laid off late last year, Ross knew that she needed to continue weekly therapy sessions while tapping into disability insurance. She also is volunteer teaching a peer-to-peer support group through NAMI.

She hopes to turn her public speaking talent into a small business, Power Seminars & Coaching LLC, which she recently launched. Her goal is to use her experience with her own mental illness and her marketing background to speak to organizations about mental health issues.

"The best thing that's happened for me is to stay connected with my peers, those folks who have mental illness, those who know what it's like, those who can sit down with me for hours," said Ross. "They can laugh and cry with me. Those moments are priceless."

A survey last fall of more than 1,000 adults for two advocacy groups, Mental Health America and the National Alliance on Mental Illness, found that unemployed individuals were four times as likely to be coping with severe mental illness as those who had jobs.

And people who experienced a forced change in their work, such as a pay cut or reduced hours, were twice as likely to have symptoms of severe mental illness, the survey showed.

When such drastic changes occur in the workplace, "people are just dumbstruck," said Nancy Grunnet, a consultant for First Sun Solutions, an employee assistance provider in South Carolina. "They don't know what to think, what they're going to do."

Several large EAP providers, which also offer counseling for alcohol abuse, legal tangles and other problems that could hurt a worker's well-being and job performance, report that use of their services has steadily climbed during the past two years. This comes just as companies are under mounting pressure to limit expenses tied to rising employee health care costs.

The sharp jump in EAP use appears to be closely tied to the recession and to difficulties people are having with employment and stresses at home.

In a review requested by The Baltimore Sun, ValueOptions, a large national provider of EAPs to private organizations and government, found that the number of people reporting moderate or severe anxiety jumped 10 percentage points, to 53 percent, from September 2009 to February 2010. In general, anxiety rates had been rising since May 2008, the company found.

The timing of the increase corresponded closely to a steady rise in the national unemployment rate and the real estate loan delinquency rate, ValueOptions found. The company also said employees reported more difficulty coping with legal and financial problems, as well as personal relationships.

"We're seeing employers who are very much concerned about their workers," said Rich Paul, a ValueOptions vice president. "Because they're doing more with less, the concern is that many employees may be at the breaking point. There's some fear they'll be left with a traumatized workforce that's hostile and eager to leave at the first opportunity."

But some companies are cutting back on the EAP benefits in contracts that are typically negotiated annually, industry experts said. That can compound pressures on employees, said Jodi Jacobson, chair of the EAP academic program at the University of Maryland Baltimore.

"EAPS are being asked to reduce services and are losing contracts with companies who don't have anything else to cut," Jacobson said. "You end up with stressed-out employees."

Meanwhile, experts warn that employees in disrupted workplaces could experience a lack of motivation or severe anxiety over their own job security — thus affecting company productivity.

MHN, the behavioral health subsidiary of insurer Health Net Inc., has seen the number of its employer training programs for how to help workers cope with on-the-job change and stress grow 45 percent from 2007 through last year. MHN also doubled the number of financial consultations it provides employees under company plans as the economy worsened between 2006 and 2009.

"If I'm on the job, and I'm worried I'm going to lose my position, then my productivity goes down," said Ian Shaffer, MHN's chief medical officer.

In the Baltimore area, there are signs that those without work or health insurance are increasingly tapping into mental health services.

Towson-based Sheppard Pratt Health Systems, which specializes in mental health care and substance abuse treatment, has seen the rate of patients who don't have insurance double from 5 percent to 10 percent over the past year.

Dr. Steven Sharfstein, the system's chief executive, blames the increase partly on people who've lost their jobs and lack insurance.

"It has increased fairly dramatically," Sharfstein said. "We've seen a very big jump in uncompensated care."

Dr. Brian Hepburn, executive director of the state's Mental Hygiene Administration, which oversees the state's publicly funded mental hospitals, said the number of people tapping Medicaid for mental health care grew 13 percent from mid-2009 through March.

"For us, that's a fairly dramatic spike in our mental health services," Hepburn said. He attributed at least part of the increase to the poor economy and a lack of work and health insurance for single mothers, who seek hospitalization for psychiatric issues.

Many of the clients who walk into the North Baltimore office of clinical social worker Rita Preller increasingly have one thing in common: high stress related to the poor economy and their job — or the lack of one.

Preller now gives discounts to about one-third of her patients because they're out of work and have trouble paying. Over the past year, she has seen economic-related stress build up for them and their families.

"This economy has forced them to deal with the fact they can't pay their bills," Preller said. "They feel like they can't do anything. They isolate. They withdraw. And the problem becomes worse."

At the Greater Baltimore Counseling Center in Glen Burnie, psychologist Deepan Chatterjee said he's helping more people suffering from severe anxiety and panic attacks.

"About 50 percent of my cases are related to job loss," Chatterjee said. "I'm definitely seeing a lot of anxious people who have lost jobs, who don't know what's going to happen tomorrow."

For assistance, contact:

National Alliance on Mental Illness, Metro Baltimore office

(410) 435-2600