Recession victims crying out for help


As the Great Recession grinds on and unemployment rates hover near double digits, calls to hospitals, clinics and hot lines for mental health problems have soared, as has the number of people admitted to psychiatric wards.

A volunteer taking a call at CONTACT We Care, a statewide crisis hot line.

CARMINE GALASSO / STAFF PHOTOGRAPHER

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A volunteer taking a call at CONTACT We Care, a statewide crisis hot line.

Inpatient hospitalizations are up by 20 percent from last year at Hackensack University Medical Center. At St. Clare’s Hospital in Denville, steady 2010 rates follow a 25 percent jump in 2009. St. Joseph’s Regional Medical Center in Paterson treated nearly 50 percent more outpatients in 2009 than in 2007. And, in some counties, suicides are up.

The same trend is echoed nationally, and a chorus of experts pins the blame on the economy.

“More people are calling about losing their job,” said David Owens, executive director of the Westfield-based Contact We Care hot line. “If they haven’t lost it, they’re afraid they will, and if they lose their job, they’ll lose their house, and if they lose their house, their family will leave. This chain of events, even before it happens, has people paralyzed with fear.”

Suicides

Total per year

Year State Bergen Passaic Hudson Morris
2000 593 60 26 34 22
2001 623 68 34 30 31
2002 585 58 28 38 22
2003 587 44 38 23 22
2004 628 66 36 33 22
2005 549 50 20 33 32
2006 629 64 24 30 35
2007 646 71 25 30 39
2008 668 67 31 38 35
2009 674 51 38 41 22

Source: New Jersey Medical Examiner’s Office

Spotting suicide risk

Most people who attempt suicide show warning signs beforehand. These may include:

* Persistent low mood, pessimism or desperation

* Anxiety or unexpected rage

* Withdrawal or loss of interest in usual pleasures

* Difficulty sleeping or sleeping too much

* Increased alcohol or drug use

* Increased impulsiveness and risk-taking

* Threatening suicide or expressing a strong wish to die

* Giving away possessions

* Sudden purchase of a firearm or other means of killing oneself

Take such warning signs seriously:

* Express concern, giving specific examples of warning signs they have shown, and ask them directly if they are considering suicide.

* Ask if they have seen a therapist; if not, encourage them to do so. Help them get to a mental health professional.

* Don’t try to argue someone out of suicide. Instead, let them know you care, that suicidal feelings are temporary and that depression can be treated.

* If someone is threatening or planning suicide, it is an acute crisis. Do not leave them alone. Make sure they don’t have access to firearms, drugs or other dangerous implements, and take them to an emergency room or walk-in mental health clinic.

* If a clinic or emergency room is not available, call 911 or the National Suicide Prevention Lifeline (1-800-273-TALK).

Source: American Foundation for Suicide Prevention

To get help

Help is available 24/7 for someone with thoughts of suicide. Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), and your call will be routed to a crisis hotline. You also can visit http://www.suicidepreventionlifeline.org, or call one of the county-based centers below:

Psychiatric emergency hotlines

* Bergen: Bergen Regional Medical Center, 201-262-4357

* Passaic: St. Joseph’s Regional Medical Center, 973-684-7792

* Morris: St. Clare’s Hospital, 973-625-0280

* Hudson: Palisades Medical Center, 201-854-6300

* Essex: East Orange General Hospital, 973-266-4478

Long-term mental health services

* Bergen: 201-634-2753

* Passaic: 973-225-3188

* Morris: 973-285-6852

* Hudson: 201-369-5280, ext. 4250

* Essex: 973-571-2821

Source: New Jersey Department of Human Services

What they’re saying

Providers across the region — from hospitals to local clinics to hotlines — weigh in on the growing mental health crisis.

Gary Rosenberg, medical director of behavioral health services at Bergen Regional Medical Center: “Suicide is the end result of a long process. It’s not just an impulsive event for most people. Clearly, when someone completes suicide, 90 to 95 percent of the time it’s related to some diagnosable psychiatric disorder. Why does someone have a psychiatric problem? That’s multi-determined, too. All these things come together, and one can look back … and find all sorts of issues that weren’t really addressed.”

Phyllis Hancock, outpatient coordinator for behavioral health services at St. Mary’s Hospital: “With the benefits being cut as well, it’s kind of like everything’s being cut at once. When someone comes in with those kinds of problems, social problems … you as a therapist get involved in also doing a lot of other things — calling food banks or shelters, trying to get resources for your clients.”

David Owens, executive director of Contact We Care: “What you [as a hotline volunteer] find out is, you could be talking to your neighbor or your sibling. One of the things that new volunteers find as they approach the phones with some anxiety is that it’s just a regular conversation with another human being. … We get a lot of calls from people in absolute despair. We had a call from someone a few months ago who was on his way to kill himself when he saw our sign. We don’t know what’s become of him, but we can say we saved him for the moment, for that time.”

Demand high, funds low

Health providers are struggling to meet spiking demand with stagnant funding. Many hospitals have wait lists of up to three months for outpatient and voluntary inpatient services, and patients in crisis are flooding emergency rooms.

Trenton funds two short-term programs to keep people out of the ER — one at St. Clare’s and one in Atlantic County — but money is an obstacle to more.

In the meantime, both tragedies and success stories abound.

In one well-publicized incident in February, 33-year-old Sean Cassidy of Wayne killed himself even after being placed in a supervised apartment by the Trenton-based SERV Behavioral Health System.

But for hundreds of others, treatment saved their lives.

Ben, of Ridgefield Park, who asked that his last name be withheld, admitted himself to Bergen Regional Medical Center last September for depression related to Oxycontin and cocaine addiction. He was suicidal then but now is planning to attend Bergen Community College.

For Bayonne resident John, three failed back surgeries sent him into a depression. “I didn’t want to get out of bed — I just wanted to lay there and die,” he said.

The Community Advocates program, which is run by the Mental Health Association of New Jersey, treated him and helped him file for Social Security disability pay and other services. Now he’s better and volunteering for the program.

Of eight hospitals and six other programs in the region, all but one reported greater demand for mental health treatment since 2007.

Suicide rates are less clear-cut. The state medical examiner’s statistics show an increase since 2007 in Passaic, Hudson and Essex counties but a decrease in Bergen and Morris. Numbers have varied greatly from year to year since 2000.

This disparity may relate to economic distress, as counties with higher unemployment had more suicides. Paula Clayton, medical director for the American Foundation for Suicide Prevention, and a statement from the American Association of Suicidology both noted that unemployment historically correlates with higher suicide rates.

And while suicides are down among the typically at-risk teens and elderly, they’re up for those ages 46 to 64, the hardest hit by long-term unemployment.

“A good proportion of our patients are really poor, and the poor are severely impacted,” said Phyllis Hancock, outpatient coordinator for behavioral health services at St. Mary’s Hospital in Passaic. She added that she’s seen people with preexisting mental illnesses recover with medication but relapse because they’re unable to afford it.

Not just the economy

The economy is not the only factor in play, but it is connected to others.

For example, alcohol and drug abuse increase with unemployment, as does domestic violence, said Deborah Hartel, administrative director for behavioral health services at St. Joseph’s.

It affects not only unemployed individuals, but their families as well: Marriages are strained and children begin to pick up on the tension, said Michael Tozzoli, CEO of West Bergen Mental Healthcare in Ridgewood.

“Add on top of that [unemployment] issues of health insurance and retirement and all those things we worry about in the middle of the night, and now you have people worrying about it 23 out of 24 hours,” Tozzoli said.

Still, more than 90 percent of people who commit suicide have a diagnosable mental illness, said Diego Coira, chairman of psychiatry and behavioral medicine at Hackensack University Medical Center. “Financial stress is added to other things going on in their lives,” he explained.

Whatever the cause, people in need should not be ashamed to seek help, experts say. Mental illness is treatable but must be taken seriously. “Depression can be fatal. It’s like cancer — it can kill you,” said Clayton, the American Foundation for Suicide Prevention doctor.

Help is available. Every county has a 24-hour screening center that can hospitalize people who threaten themselves or others, and patients waiting months for a psychiatrist — or who can’t afford one — are relying on them more.

“It very much parallels the medical health system: If people don’t have primary care physicians and access to health care, you see them winding up in emergency rooms,” said Jim Romer, president of the state Mental Health Emergency Services Association, which oversees screening centers.

Emergency rooms are feeling the strain. St. Joseph’s runs the only inpatient psychiatric unit for Passaic County. St. Mary’s treats outpatients only; inpatients are sent to Clara Maass Medical Center in Belleville and emergency patients to St. Joseph’s, said spokesman Erik Ramos. Chilton Memorial Hospital in Pequannock cut its unit last year.

The number treated via the St. Joseph’s emergency screening center rose more than 40 percent from 2007 to 2009. That’s mostly due to the influx of

St. Mary’s patients; the county total has actually decreased, according to the state Department of Human Services, thanks to new programs designed to funnel patients to non-emergency services. But outpatient volume, a separate measure, also rose by nearly 50 percent at St. Joseph’s from 2007 to 2009, and that unit is nearly at its 2,000-patient capacity.

Other options for care

Since 2005, DHS has allocated more than $80 million to local screening centers. Deputy Commissioner Kevin Martone said the state is trying to divert as many patients as possible to non-emergency programs such as the Wellness and Recovery Center at St. Clare’s.

The WRC treats patients who would otherwise use emergency services, said Kathleen Gronet, administrative director of outpatient behavioral health centers at St. Clare’s.

They receive various services for up to 30 days, from individual counseling to support groups to medication, and then are referred elsewhere if needed.

This has allowed St. Clare’s to treat more patients, but the state only has two such programs, with the second in Atlantic County. Newark Beth Israel Medical Center launched a similar but separate effort this spring that aims to keep patients stable from their initial emergency room visit to a subsequent outpatient appointment.

Martone said 25 percent of New Jerseyans have a diagnosable mental illness, with 5 to 7 percent — about 400,000 — experiencing a “serious and persistent” illness. The current DHS mental health budget of $761.4 million is only enough to treat about 275,000 a year, he said.

And while a few providers have managed to add staff, most make do with less. They have maintained services, thanks to staffers taking on more work.

In Bergen County, the Department of Health Services runs four mental health agencies, which lost $1 million in state funding and $500,000 in county money this year, said Vicki Sidrow, president and CEO of Vantage Health System, one of the four.

This year, Newark Beth Israel had to return $7 million the state had granted for charity care. With more patients and less money, everyone is overworked. Said William Annitto, chairman of the behavioral health unit there:

“You suck it up and do what you’ve got to do.”

Drop in N.J. calls to hot line raises questions

Alongside data from local psychiatric emergency screening centers, call volume to the National Suicide Prevention Lifeline (800-273-TALK) gives a glimpse of mental health needs nationwide, and it is sharply up: Yearly calls have risen by over 100,000 since 2007.

Three New Jersey centers — Contact We Care in Westfield, Contact of Mercer County and Contact of Burlington County — answer Lifeline calls, but they are overburdened.

Only a third of the 42,177 calls made from New Jersey area codes from 2007 to June 2010 were answered in-state; the rest were routed out of state, meaning longer waits for callers and less familiarity with local resources.

The number of New Jersey calls taken has decreased since 2007 — “perplexing,” said John Draper, director of the National Suicide Prevention Lifeline, given the upward national trend. He said the poor in-state rate and resulting wait times may be responsible.

Scott Fritz, director of the New Jersey Society for the Prevention of Teen Suicide, said the decrease in calls did not reflect a decrease in need among New Jerseyans.

“We lose between 60 and 70 kids 24 years old and younger every year,” Fritz said. “If you’re in crisis and you have to wait that long [for an answer on the Lifeline], you’re going to hang up.”

The federal Substance Abuse & Mental Health Services Administration, which runs the Lifeline, put $1 million in its 2009 budget for local call centers. NSPL gave 20 centers awards from $26,000 to $50,000. New Jersey’s centers didn’t get awards because they only cover certain counties, and the funding would have been only for a year.

“These three centers, no matter what funding they receive from us, simply cannot cover most of New Jersey,” Draper said. “The SAMHSA funds were intended to address the current economic climate … but only for the short term.”

He and Fritz lobbied state officials for money, but budget constraints prevailed. In 2006 and 2007, the state Department of Human Services gave hospital screening centers a total of $11.5 million, but officials say they can’t afford more funding for the Lifeline.

“Other states may not have as well developed an emergency care infrastructure, so the national line plays a greater role,” said DHS Deputy Commissioner Kevin Martone. “We measure our state’s responsiveness to psychiatric emergencies based on how well [county] screening centers are doing.”

Martone said the state is looking into potential federal funding from SAMHSA or the Centers for Medicare and Medicaid Services, but when it comes to the Lifeline, “We’re not in a position to increase funding in particular areas where we just don’t have it.”

Hot line raising awareness

As hospitals and clinics struggle to meet rising demand, hotlines are working overtime to help, with many tailoring themselves to repeat callers, not just people in acute crisis.

“They may get past that initial impulse to suicide, but they’re still overwrought with lots of other emotional issues,” said David Owens, executive director of the Contact We Care line in Westfield. “What comes out is they are having mental health problems that they may be getting professional help for, but that’s not enough.”

Said Peter Cooper, coordinator of the Peer Recovery Warmline, a daytime line run by mental health consumers and sponsored by the Mental Health Association of New Jersey, “We build a relationship with callers. Most other hotlines are run by professionals, but everyone who handles the Warmline are mental health consumers themselves.”

At the statewide New Jersey Mental Health Cares, where calls have doubled since 2008, “We try to be creative in suggesting alternative services — self-help groups, primary care physicians for some bridge medication, places where they can get job assistance,” coordinator Stephanie Mulfinger said. “We’re often involved with people over a couple of months.”

While need is clearly high, publicizing resources also plays a role in increasing calls. The National Suicide Prevention Lifeline, for instance, advertises through Facebook and Twitter, and when people Google certain terms, such as “suicide” or “kill myself,” the first hit is the Lifeline number.

“It is okay to reach out so you can go back to having the quality of life you deserve,” said Donna Corrieri, a spokeswoman for Bergen Regional Medical Center. “What we’re starting to see is people making that first step.”

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