Unfortunately, therapists find business booming

Back in the early 1980s, Minneapolis psychologist Gary Schoener and colleagues wondered if the recession was affecting the mental health of people living in Hennepin County. "We were convinced there was a problem," said Schoener, then chairman of the Council on Mental Health Programs.

How right he was. The study revealed "personal adjustment problems showing up in all kinds of places. It was fairly clear that we were going to be seeing more of those things," he said.

Schoener is, again, seeing more of those things. "We're busier than ever, and we haven't had any recent publicity or visibility," said Schoener, executive director of the Walk-In Counseling Center in Minneapolis. "It's quite striking."

He estimates that the number of clients is 20 percent higher than just three years ago. Calls are coming from stressed-out couples who can't stop fighting, from people worried about losing their jobs, from parents whose adult children have been forced to move home. "And we haven't seen the full bore of the housing crisis," he said.

Amy Gold is seeing an increase, too. "You can really see how full your schedule is getting," said Gold, a licensed marriage and family therapist with Loring Family Clinic in Minneapolis. She said she's getting one or two new calls weekly, expressing a now familiar laundry list of worries.

"Financial stress, job layoffs, housing problems, transportation, all of which can complicate and heighten an already existing diagnosis of depression or anxiety," said Gold. She noted a similar uptick in calls after Sept. 11.

The increase is being noted nationally. Richard Chaifetz, chairman and CEO of ComPsych, a huge employee-assistance mental health program based in Chicago, told USA Today that requests for therapists increased 15 to 20 percent over the past three months.

The rub, say many mental health professionals, is that the more people need services, the harder such services are to get.

Financially challenged companies are cutting back on health insurance coverage, or cutting out coverage completely. Deductibles and copayments are growing, too. "The standard percentage paid by the insurance company used to be 80/20," said licensed social worker Suzanne Harman. "Now it's 70/30 or 60/40."

Those who cannot pay higher out-of-pocket costs are turning to clinics that serve clients without health insurance, creating exploding demand and an increase in the number of people turned away. Harman had one young female client, "whose family is under such financial stress that she can't come anymore, which is horrible. I'll reduce my fee, but it's the gas to get here. They're going down to one car, and they can't spare the car."

And it's not just lower-income families who are affected, she said. "Families where the main breadwinner is in the mortgage and housing industry are just being killed by this. Therapy is a luxury for every family."

Troubling immobility

"People, when they're struggling, get more and more immobilized," she said. "It's harder to pick up the phone, especially for those who have never been seen in the mental health system. There's still a stigma. Add economic barriers, and that takes it to another level entirely."

But Kramer and other mental health professionals say the strategy is not to hide, but to get creative. If you can't afford to see a therapist, make an appointment with your pediatrician or primary care doctor. Each can offer a thorough evaluation and coping tools.

School and guidance counselors also can be good resources, as are a trusted spiritual leader. Or consider making an appointment with a financial planner, a group that, not surprisingly, is also seeing a slight increase in clients.

At a recent meeting of the Financial Planning Association of Minnesota, a nonprofit organization with about 700 members, spokesman Lucas Bucl said several members noted that they were "definitely seeing more prospects coming in, specifically looking for additional help." The inquiries go broader than smart investing, Bucl said, to "mortgage refinances, budgeting and career transfers." People are asking, he said, "If I'm laid off, how do I manage my money for a few months?"

"In tough economic times, people are looking for advice," added Dave Rustad, a spokesman for Thrivent Financial for Lutherans, "someone who could come alongside them and give them guidance and emotional confidence."

"We don't have a whole lot of control over this [economy]," she said. "But I want to help clients see what they do have control over."