Angst Is Rising, but Many Must Forgo Therapy

Tag : Medical Pocket Scales

Ankur Saraiya, a psychiatrist in Manhattan, says some of hispatients are too embarrassed to talk about money, "so they willtalk about the fact that they don't want to come in as often." He'soffered to renegotiate his fee for people who no longer can affordit. "Many therapists have a dedication to their patients'well-being," he says.
April Jones, who lost her job as a paralegal last year, recentlynegotiated with both her therapist and her psychiatrist to continuetreatment for her bipolar disorder at a rate she could afford. Ms.Jones, a single mother in Plattsmouth, Neb., had paid a $10co-payment per session until her insurance ran out. After that, herout-of-pocket expenses jumped to $105 for her therapy appointmentsand $180 for her psychiatrist. She also had to pay for hermedications out of pocket.
At first, Ms. Jones, 37, stopped seeing both medical professionalsand even cut back on her medication, but her health quicklydeteriorated. "I got depressed and lonely," she says. "I couldn'treally do anything: The dishes and laundry piled up. I didn't havethe energy to give attention to my kids." Sliding Scale
She discussed her situation with her psychologist, who suggestedshe pay on a sliding scale, based on what she can afford. Herpsychiatrist agreed to do the same. Now, she sees both hertherapists less frequently, and pays just $5 for each session. Shealso applied to the patient assistance program at AstraZeneca PLC, and the pharmaceutical company now gives her her medication.
"It's degrading and embarrassing to have to ask for help," says Ms.Jones. But "it's definitely life or death," she says.
Experts say people with the most severe mental disorders will bethe hardest hit if they encounter problems paying for treatment."The 'worried well,' who do therapy for personal growth, willgenerally be OK," says Iona College's Dr. Greene. "The people whoconcern me are those for whom that therapy helps them to functionand earn a living and be good parents." Suicide and Recession
Research shows that suicides and psychiatric hospitalizations tendto peak at the lowest point of a recession, when unemployment is atits height. A smaller peak also occurs just prior to the economyfalling into recession, when there is widespread uncertainty. "Ifyou were to look at suicide graphically, it wouldn't be difficultto imagine that you would be seeing another economic indicator,"says M. Harvey Brenner, a professor of public health at theUniversity of North Texas, in Denton, Texas, who has studied therelationship between recessions and mental health, primarily atJohns Hopkins University's Bloomberg School of Public Health.
Other research, most notably a Rand Corp. health-insurance studyfrom the 1970s, has shown that when costs increase people aresomewhat more likely to defer their mental-health care than theirgeneral medical care because they may see it as more discretionary."You are more likely to forgo your therapy compared to your surgeryor chemo," says Harold Pincus, vice chairman of the department ofpsychiatry at Columbia University and a senior scientist at Rand.
A big reason is insurance. If people lose their jobs, they losetheir health insurance. But even people with insurance may havetrouble affording mental-health treatment, since therapy can beexpensive and is not often adequately covered by insurancecompanies. Meanwhile, government and nonprofit resources formental-health treatment are strained, with more cuts likely on theway as the economy slows.
Legislation meant to address at least some of these problemsfinally made it into law -- more than a decade after it wasintroduced in Congress -- when it was tucked into the Bushadministration's $700 billion financial rescue package and signedby the president last week. The law, known as the Paul Wellstoneand Pete Domenici Mental Health Parity and Addiction Equity Act of2008, requires most employers and insurers to cover mentalillnesses just like other medical conditions covered by theirplans. But experts say it's too early to know how the legislationwill actually affect individual consumers.
Mental-health experts have advice for people who are struggling toafford treatment. First off, people who are thinking of hurtingthemselves should not curtail or stop therapy. Psychiatrists alsoadvise people not to cut back on their medication without thesupervision of a doctor.
"If you are in treatment, the first thing to do is to have a veryfrank talk with your doctor and with yourself," says Nada Stotland,a psychiatrist with a private practice in Chicago who is presidentof the American Psychiatric Association. "For example, are youbuying a $5 coffee every day?"
If you really cannot afford your treatment, Dr. Stotland suggestsasking your doctor if you can renegotiate the fee. Many therapistswill agree to do that. "Doctors have a right to earn a living, butthey don't have a right to abandon someone if they are in thethroes of a disease," she says. Experts say some people can reducetheir therapy appointments safely, under the supervision of theirdoctor.
If your therapist cannot reduce your payments, he or she may beable to refer you to someone who has a sliding-scale fee structure.Local and national crisis hotlines, such as the National SuicidePrevention Lifeline (1-800-273-TALK) can provide referrals totherapists who accept reduced fees, and to local communityresources.
Write to Elizabeth Bernstein at elizabeth.bernstein@wsj.com