By H. Steven Moffic, MD
Psychiatric Times, November 3, 2011,
“Love and work are the cornerstones of our civilization.” This quote, rightly or wrongly attributed to Freud, simply and succinctly indicates the importance of the “Occupy Wall Street” movement.
Maslow, in his prioritization of our basic mental health needs, put security, safety, and adequate nourishment right at the top. Since it is clear that good work opportunities are diminishing in the USA and even more so in other parts of the world, our cornerstones are crumbling.
While it must be true that many occupiers around the world are there for other psychological and social reasons, and the tactics debatable at times, the crumbling of the mental health of our citizens and the mental healthcare that we can provide seems unmistakable. To wit:
• Loss of jobs is correlated with an increase in anxiety, depression, substance abuse, and suicide risk.
• Loss of good jobs or unsatisfying jobs often contributes to problems in relationships with loved ones.
• Obtaining jobs has traditionally been more difficult for the mentally ill.
• Obtaining jobs has even been more difficult for those large numbers of mentally ill being released from jails and prisons.
• Without such jobs, committing more crimes is more likely.
• Large numbers of returning veterans from the “war on terrorism”, and so many with health and mental health problems, will also be seeking jobs.
• The economic conditions influencing job loss has also resulted in Medicaid cuts and funding reductions in some of our “safety net” state mental healthcare programs
• There has been some job loss in some of our public community mental health systems in terms of clinicians and staff.
• Many private practices are not thriving.
• Where the so-called “millionaire’s tax” has been put in place in California, more outpatient services for the severely mentally ill resulted in less arrests and incarceration.
• There are ethical principles that support us advocating for jobs, including Sections 3 and 7 of the Principles of Medical Ethics of the American Medical and Psychiatric Associations (“A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient” and “A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health”, respectively).
• Although we can provide medication and psychotherapy to address some of the psychiatric effects of insufficient and inadequate jobs, correcting the core problem will be more effective.
Of course, psychiatrists can’t really prescribe a job, and other than the Clubhouse movement, obtaining jobs is not part of any treatment guidelines that I know of.
Nevertheless, for all the above reasons and more, we can advocate that more and better jobs will help the mental health of our citizens.
We can do that as citizens, as psychiatric professionals, or as part of a professional organization that is willing to speak out on this need.
Please join me in doing so in any way that you see fit. Thank you.