Anxiety over jobs, for example, drives demand for mental healthcare services at a time when funding is dwindling.
At the same time, those with chronic mental health issues are finding that fewer Medicaid funds are being allocated to services thanks to government belt tightening.
A recent report by the National Alliance on Mental Illness (NAMI) documents a total of $1.6 billion in direct cuts to state mental health agencies by individual states over the last three years. According to the National Association of State Mental Health Program Directors, which includes a variety of non-direct funding cuts related to mental healthcare in its numbers, states have cut back by $3.4 billion over the last three years.
"We're seeing a tremendous increase in referrals, requests for services on stress disorders, anxiety and depression," he says. "A lot of what we're seeing is work stress. That's coming from a number of sources. Some of it comes from increased pressure from superiors to do more with less, some comes from co-workers who are somewhat dysfunctional and not pulling their share of the load-often because of their own stress and anxiety. Many have fears of job loss. Finally, more people are coming to us because they're now unemployed."
Solly says the clinic has also seen a rise in alcohol and substance abuse, some of which he attributes to people trying to self medicate their mental illnesses.
At the federal level, cuts to Medicaid funding have been the subject of ongoing Congressional debate. Proposals for cuts in Medicaid have ranged from $75 billion to almost $200 billion.
"Medicaid is the biggest source of funding for serious, chronic mental illnesses," says Ron Honberg, NAMI's director of Policy and Legal Affairs. "The reason for that is, among the population of people with serious chronic mental illnesses, only 30% are employed."
He says those high unemployment rates are due to a number of factors, including the disabling effects of the illness, trouble getting jobs, and disincentives to work that are built into public benefit programs. For example, private insurance at a workplace may not cover mental healthcare the way public benefit plans do.
"Private insurance is particularly important for the broader mental health category [such as mild depression or intermittent anxiety], as well as in the early onset of more severe mental illnesses," Honberg says. "Often when people are initially diagnosed with severe, chronic mental illness, they are already employed and have insurance, or are younger people who are still covered under their parents' private insurance. Historically, private insurance has not adequately covered mental healthcare."
Details of The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, which was enacted on Oct. 3, 2008, are still being hammered out. However, Honberg says the federal law is a first step toward equalizing health insurance benefits.
"It's one of those cases where people look at what's simplest to cut on the surface," says Solly. "Mental health services are not used as much as a lot of the physical health services. People are in the habit of going to physician when they're not feeling well, or going to dentist for check up. Very few are in the habit of going to a psychologist or mental healthcare provider regularly."
But that doesn't necessarily mean mental health services are less needed. Part of the parity problem between physical and mental healthcare services stems from the stigma still attached to mental health issues.
"That stigma is a big, big factor," Honberg says. "I've met lots of people who have said, 'When I needed counseling or psychiatric treatment, I paid out of pocket.' People are afraid of losing their insurance or losing their jobs."
He compares it to the way "cancer" was once a "dirty word," but now is openly discussed and money is raised to research it.
"Although the prevalence rates of serious mental illnesses are quite high-6% to 7%-families tend not to talk about it, or discuss it in negative terms," he says.