Angst is rising, but many must forgo therapy

In the latest sign of the deepening economic crisis, more people are considering cutting back on their mental-health therapy, even as they become more stressed.

Across the country, psychiatrists and psychologists say they are seeing an increasing number of patients who are worried about paying for treatment. Some are reducing the amount of time they spend in therapy. Others are trying to negotiate a reduced fee. And, despite doctors' warnings that it can be detrimental, some patients are using tactics to make their medication last longer, such as taking half their dose.

"People are in a quandary," says Jaine Darwin, a psychologist who teaches at Harvard Medical School and has a private practice in Cambridge, Mass. "The economy is forcing them to decide, 'Do I give up my lifeline?"'

The developments come as Americans begin cutting back on a broad range of health care, ranging from preventive tests to prescription drugs. But studies show that in times of economic crisis, when people lose their jobs and insurance, they tend to reduce their mental-health care more readily than their general medical care, with consequences that can be dangerous. When the economy slides, suicides and psychiatric hospitalizations tend to go up, as people neglect to get treatment until it's too late.

More people are showing signs of psychological distress. In New York, some therapists are reporting an influx of clients from the beleaguered financial-services industry. And many doctors nationwide say that patients are talking more often of their concerns about losing jobs, homes and savings.

Lynne Brunello of Verona, N.J., has been struggling to keep paying for her daughter's eating-disorder treatments. Kristen, a 21-year-old college student, has been hospitalized twice in the past two years. She sees a psychologist twice a week and a psychiatrist and nutritionist once a month - care that costs about $400 a week.

Brunello, a bookkeeper for a title company, estimates she and her husband have spent $80,000 on their daughter's care over the past couple of years. She says they have taken out a second mortgage on their home and have given up all luxuries, including vacations and evenings out.

Now, Kristen is worried about the future as the price of necessities such as gasoline and food have risen. "I have been thinking about sacrificing care, how it's going to have to happen if things keep going the way they are, because we can't keep paying $400 a week," she says.

Psychiatrists and psychologists are seeing patients of all types struggling to afford their care. At Massachusetts General Hospital in Boston, Mark Goldstein, chief of the division of adolescent and young adult medicine, says he's noticed some patients with eating disorders who may be trying to save money by calling to discuss their illnesses with him on the phone, rather than coming in for appointments.

In New Rochelle, N.Y., Paul Greene, a psychologist who is a professor at Iona College and has a private practice, says he's seeing patients asking to cut back on the frequency of their visits. In Belmont, Mass., Carol Kauffman, a staff psychologist at Harvard-affiliated McLean Hospital, has allowed patients to schedule shorter therapy visits - a half hour instead of an hour - so they can pay half as much.

Ankur Saraiya, a psychiatrist in Manhattan, says some of his patients are too embarrassed to talk about money, "so they will talk about the fact that they don't want to come in as often." He's offered to renegotiate his fee for people who no longer can afford it. "Many therapists have a dedication to their patients' well-being," he says.

April Jones, who lost her job as a paralegal last year, recently negotiated with both her therapist and her psychiatrist to continue treatment for her bipolar disorder at a rate she could afford. Ms. Jones, a single mother in Plattsmouth, Neb., had paid a $10 co-payment per session until her insurance ran out. After that, her out-of-pocket expenses jumped to $105 for her therapy appointments and $180 for her psychiatrist. She also had to pay for her medications out of pocket.

At first, Ms. Jones, 37, stopped seeing both medical professionals and even cut back on her medication, but her health quickly deteriorated. "I got depressed and lonely," she says. "I couldn't really do anything: The dishes and laundry piled up. I didn't have the energy to give attention to my kids."

She discussed her situation with her psychologist, who suggested she pay on a sliding scale, based on what she can afford. Her psychiatrist agreed to do the same. Now, she sees both her therapists less frequently, and pays just $5 for each session. She also 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 Jones. But "it's definitely life or death," she says.