Emotional Fallout from a Foundering Economy

Chris Sereno got a call at his Naples restaurant from an employee who’d gotten drunk and in trouble. He needed Sereno to get him out of jail. For the fourth time.

Roger Mann’s pool-service company lost an account when a normally reliable employee failed to show up. The tech leveled with Mann when confronted. "He was embarrassed to tell me he was depressed. He thought it would affect his job," says Mann.

Plenty of employers in those situations would have fired the offending workers, but Sereno and Mann thought their troubled employees were worth helping. Sereno gave his a choice: Go to rehab and get straight, or you’re on your own. The employee went through a 28-day program at David Lawrence Center. In the two years since, "He’s turned his life around," says Sereno. He faithfully attends AA meetings, has his own home, is engaged to be married—and holds a position of responsibility in Sereno’s business, with about 30 people reporting to him.

The pool tech "just made a judgment error and went off his [medication]," Mann says. "I made a deal that if he didn’t go off his meds again that I wouldn’t fire him." They both have kept the deal, and the tech is a "great" employee, says Mann.

According to the National Institute of Mental Health, an estimated 26 percent or more of Americans have some kind of diagnosable mental disorder—ranging from dementia to bulimia to schizophrenia—in any given year. More than 20 percent of American adults suffer each year from major depression, bipolar or another "mood disorder." Substance abuse is a common problem, and often goes hand-in-hand with other diagnoses. When the economy goes south and stresses rise, such behavioral healthcare issues often rear their heads at work.

Beth Adelman, a Naples realtor and member of the David Lawrence Center board of directors, sees firsthand the financial crunch of the downturn in the real estate market and the mental toll it can exact. "Fewer home sales mean less income for me and for everybody whose professions are aligned with the housing industry," she says. "Does it translate into higher stress? Of course it does."

For many of the region’s employers, especially in the service and construction industries, the economic downturn has made for some tough decisions. Suspended or scrapped development projects spelled layoffs of regular employees and less work for subcontractors. Resort and restaurant employees like Sereno’s also feel the pinch, as the nationwide economic malaise means fewer vacationers and less discretionary spending.

"If I lose my job," explains Kevin Lewis, CEO of Southwest Florida Addiction Services, a Lee County provider of addiction and mental health counseling, "that will affect a lot more than just me and my family. It will impact my banker, my telephone vendor, my dry cleaner. We have a tendency not to appreciate the ripple effect that’s felt throughout the community when one person loses a job."

It’s not just businesses that suffer the effects of an economic slump, and the pain isn’t just in consumers’ pockets. The stress that accompanies a smaller weekly paycheck, fears of a layoff and the looming specter of foreclosure can lead to serious mental health issues within the broader community, including depression, drug and alcohol abuse and even suicide.

"As the economy slowly weakens, people still anticipate a comeback," explains Molly Barrow, Ph.D., a Naples-based psychologist and self-help author. "They allow their savings to be depleted; they don’t cut back on their spending. As making ends meet becomes more difficult, we see people increasingly turning to alcohol, street drugs and prescription medicines."

"It’s hard to capture why people come in for treatment," says Michael McNally, vice president of community relations at Lee Mental Health Inc., a nonprofit community behavioral healthcare provider in Fort Myers. "But we’re seeing an ongoing increase in people accessing our services. It’s safe to guess that the economy has some bearing."

"Anytime you see a weak economy—even though Southwest Florida is better off than a lot of places—you see an increase in requests for emergency mental health services and substance treatment," says David Schimmel, CEO of the David Lawrence Center. "With the diminished resale value of homes and the region not being an employee’s marketplace like it was, people start to use substances as coping mechanisms."

Although the David Lawrence Center treats a lot of uninsured clients, many are insured and, as Schimmel puts it, "come from good backgrounds. A psychological crisis or substance abuse can strike someone from any background. It’s not limited to the disenfranchised."

Even employees in relatively stable industries can be affected. Lewis cites a corporate client whose employees must interact on a daily basis with clients facing foreclosure. The stress of their clients’ hardships has taken a toll on the company’s employees. "Fortunately," says Lewis, "our client has been very proactive in trying to help its employees manage stress, and asked us to do a staff training to help them cope."

Mental health and the bottom line
n the workplace, depression leads to absenteeism and reduced productivity. The obvious pitfalls of substance abuse include missed days of work, poor job performance and the volatile potential of substance use at the workplace.

The Partnership for Workplace Mental Health, an advocacy arm of the American Psychiatric Association, provides at its Web site (www.workplacementalhealth.org) tools for calculating the cost to businesses from alcohol abuse and depression in employees. For example, a 300-employee hotel is likely to employ 30 problem drinkers. That 10 percent of the workforce will account for 31 lost days of work and almost $120,000 per year in healthcare costs, including emergency-room visits.

Twenty employees will see their work performance and absenteeism affected by depression. The model estimates that, between absenteeism and low productivity on the job, those employees will miss up to 635 days per year due to depression. The cost for substitute employees ranges up to $45,000 per year, and healthcare costs are another $40,000.

Statistics provided by the National Institute of Mental Health indicate that 80 percent of individuals with depressive disorders improve with mental health counseling. However, the U.S. Surgeon General reports that fewer than one-third of individuals with depressive disorders seek care each year. Because of lingering stigmas to mental health disorders, says Schimmel, "it takes longer for mental health services to be sought out."

Those statistics are especially discouraging in Florida, which, according to the National Alliance for Mental Illness, ranks 48th in the nation for per capita mental health spending. The shortage of available mental-health and substance-abuse treatment services has a two-fold effect. When individuals do seek care prior to a full-blown crisis, they might run into a shortage of providers that accept their insurance. Options for the uninsured—and many self-employed subcontractors are among them—are even more scarce, since nonprofit mental health centers are dealing with their own budget crises in the face of a statewide budget squeeze.

The biggest crisis occurs when emergency care is needed. Schimmel explains that because so many people fail to seek mental health or addiction-prevention services before things get out of control, many end up needing crisis-intervention care. "These are not people who seek treatment voluntarily," says Schimmel.

Law enforcement is usually called, and often, officers attempt to bring patients to emergency mental health centers such as David Lawrence Center. But when the center’s beds are full? "Seventy percent of them will end up in jail." In fact, Schimmel says, the Florida Department of Corrections is the largest mental-health provider in the state. And, he adds,
"Prisons cost a lot more taxpayer money than upfront mental health care."

The possible silver lining to law enforcement intervention is that it can force people—at least those not facing long-term incarceration—to confront their mental health or addiction issues. Still, lack of health insurance is a barrier to many seeking care.

Those hit hardest by the economic slump are also the least likely to have health coverage. A 2006 report from the Center for Labor Research and Studies at Florida International University indicates that of the 3 million uninsured people in Florida—that’s almost 19 percent of the population—42 percent are employed in the construction industry, which the report claims "likely has the worst health insurance coverage rate of any industry in the state." Leisure and hospitality is also near the top of the list, with 35 percent of workers uninsured. Statewide, that’s 2.3 million uninsured workers in two of the largest and hardest-hit employment sectors.

As a result, the David Lawrence Center and other nonprofit mental health centers are faced with the prospect of turning people away when there are no beds and dwindling resources to help them. "The situation has been bad for years, but it’s gotten worse recently," says Schimmel. "With population growth coupled with the downturn in the economy, we have a bad situation that’s now becoming a crisis situation. Yet we’re not in an economy that will allow for an expansion of services."

McNally adds that not everyone who goes to Lee Mental Health needs mental health services. "A person may not need counseling," he says. "He may need to know where to go to look for a job.