Milwaukeean Ellen Anders (not her real name), 59, a single mother, was earning a good living until she and her job became casualties of the economic downturn that began in 2008.
“In February of 2009, I had a full-time job, making over $56,000 a year,” Ellen said in a telephone interview Dec. 5, adding that her employer provided other benefits as well. She had been with the firm 18 years and had even won an award for her work.
Then, suddenly, there was no job, and the illness of both her parents at the time made her situation even more stressful.
Feeling very low — “like it was the end of the world” — Ellen did some research, and found that counseling would be available to her at Jewish Family Services in Milwaukee. She remains a JFS client today.
In a telephone interview Nov. 19, JFS President and CEO Sylvan Leabman confirmed that the stress Ellen has been experiencing because of the economic downturn of recent years is one of numerous factors that have led to a large increase in demand for mental health services at JFS.
According to Leabman, the number of sessions in all JFS clinical program activities increased by 36 percent from 2010 to 2014.
“The turndown in the economy has created tremendous stress for some families,” he said. “Without employment, they can’t maintain their standard of living, and they are also sometimes stressed by having responsibility for older adults in the family. The stress of the last four years has made them recognize that they need (outside) support.”
The counseling Ellen has been receiving at JFS has helped her, she said. “Many times things seem surreal, and I don’t feel grounded. When I’ve felt defeated, my therapist has given me validation — he says, ‘You are stronger than you think; I’ve seen you do it before, and you can do it again.’ He is helping me to look back into myself for the answers. And he shares information, like about other organizations that I can go to for help.”
JFS — a partner agency of the Milwaukee Jewish Federation — provides counseling services to many clients through its certified outpatient mental health clinic regardless of the client’s ability to pay.
About 70 percent of the clients seen in JFS programs have annual incomes of less than $15,000, Leabman said. Many are uninsured, and the amount they pay is determined by a sliding fee scale based upon income.
Some who do have insurance cannot afford the deductibles or co-pays. “These become write-offs for JFS,” he said.
However, he added, “Our allocations from the Milwaukee Jewish Federation and the United Way, along with support from generous individual donors, allow JFS to subsidize the cost of care.”
“We don’t turn anyone away — it’s part of our mission,” he said.
More seniors
In addition, there has been an increase in demand for services to the elderly, said Amy Biller Daniels, a psychotherapist on the JFS staff. She works with older adults through the Late Life Counseling program.
Leabman confirmed “a huge increase in demand,” noting that the counseling sessions in this program have increased from 400 to more than 1,200 per year.
Partial funding is provided by Milwaukee County, Leabman said, but JFS must raise at least $50,000 per year to cover the total cost.
The clients in this program are more than 60 years of age, are homebound, and receive counseling in the home, Daniels said in a telephone interview Nov. 20. Depending upon the circumstances, members of the client’s family may also be included in the sessions.
Asked what she thought caused the increased demand for these services, Daniels said there is heightened awareness in the community about problems affecting older adults, and of JFS’ ability to help.
As the lifespan increases, problems associated with advancing age increase, as well. “A lot of these clients are dealing with loss — not just of family members, but also loss of their own abilities,” she said.
For some in the program, Daniels said, financial resources are a concern. “We see older people affected by the economic downturn. Their children might be out of work; they might have a grandchild who’s now out of college but has no job.”
Less stigma
Mental health professionals understand that people in lower-income groups experience higher levels of depression. Their mental health is also often compromised by life experiences associated with poverty — divorce, domestic violence and exposure to crime in their neighborhoods.
(See, for example, the Nov. 2, 2011, article, “The Vicious Cycle of Poverty and Mental Health” by John M. Grohol, Psy.D., on the psychology/psychotherapy website PsychCentral.com; and the article in The Atlantic, Oct. 26, 2011, “Poverty and Mental Health” by Esther Entin.)
However, these negative effects of poverty do not, by themselves, account for the growth in demand for JFS services over the past several years. Leabman said demand has increased overall, across the many different types of cases JFS handles.
In a telephone interview Nov. 12, Beth Shapiro, JFS intake coordinator, said she takes calls from people with a wide variety of problems, and agreed that the increased demand for services was not limited to any one or two areas of need.
She said it appears that people are more comfortable than in the past with seeking help for mental health issues. “It used to be that mental illness was a family secret — there’s less of that now.”
P.E.A.C.E. (Processing Emotions and Communicating Effectively) is one program for which Shapiro said there is increasing demand.
Begun about four years ago, P.E.A.C.E. is a program for parents entrenched in a high level of conflict, and whose inability to communicate is detrimental to their children.
The courts refer such parents for therapy that is designed to enhance their chances for success in a co-parenting relationship. “The courts like this program,” Shapiro said.
George Saxton is a psychotherapist at JFS who specializes in these types of cases. He said in a telephone interview Nov. 20 that parents are usually referred by a judge or a guardian ad litem, or occasionally by an attorney.
Shapiro said that children whose parents are involved in the P.E.A.C.E. program frequently are referred to “Kids In The Middle.” This program offers counseling services to children whose parents are separated or going through divorce.
Demand for this program is high, Leabman said, reiterating the well-known statistic that 50 percent of marriages in this country end in divorce.
JFS became a licensee of this nation-wide program in 2006, and remains the exclusive provider of its services in Milwaukee, Ozaukee, Racine, Kenosha and Waukesha counties today.
Support for the disabled
JFS has a Disabilities Case Management program for individuals with developmental disabilities and severe and persistent mental illness.
Marybeth Murphy, the program manager, said in a telephone interview Nov. 20 that clients are often referred into this program by a friend or family member.
She said clients can have any one of “a range of (mental health) issues that run the gamut from schizophrenia to bipolar disorder to anxiety and depression,” and that they receive psychotherapy, along with support services that enable them to live as independently as possible.
Among the longest running support services is the more than 25-year-old Sandy Naimon Breakfast Club, which meets weekly.
In addition, the club offers monthly outings to such venues as the zoo or the theater, as well as special gatherings at Thanksgiving and Passover.
Murphy said JFS has, in recent times, seen an increase in the frequency with which clients come into this program as a way of “getting connected and put in the right direction,” adding that many such clients “don’t necessarily stay that long.”
She said that “when demand has gotten too heavy, I’ve had to close intake for a couple of months.” She acknowledged that caseloads have increased for all five full-time and one-part time case managers that JFS employs.
Increased accessibility
In recent years, JFS has increased its accessibility in the community by offering services at a variety of locations apart from its headquarters at 1300 N. Jackson St. in Milwaukee.
In an interview Nov. 25, Leabman said this broadened access to JFS may be viewed both as an impetus to the recent increase in demand for those services, and as part of the agency’s response to that increased demand.
“We opened offices at Bayshore [Town Center in Glendale] to make things more convenient for clients — parents could bring kids (for therapy sessions), leave them and shop,” he said.
“We found that people didn’t want to come during the day — daytime sessions interfered with their work. So, we began offering sessions at night.”
On June 1, 2013, the JFS mental health clinic opened a new office in Brown Deer, located at Bradley Crossing Supportive Housing Community, 4375 W. Bradley Rd. The new clinic office has proved to be convenient for local clients who live in the North Shore.
In an email Dec. 9, Tara Clark, JFS director of marketing and communications, said JFS envisions continuing to grow and serve more clients who reside to the north and to the west at the Brown Deer location.
In November, JFS opened licensed clinical offices to provide mental health services to residents and families at Chai Point, 1400 N. Prospect Ave., Milwaukee.
Leabman said JFS will also soon be seeing adults in a new clinic facility to be located at Sojourner Family Peace Center in Milwaukee.
Since 2009, JFS has offered on-site counseling to students in several Milwaukee charter schools and in the Village of Brown Deer school system, Leabman said. Shapiro said school psychologists and social workers also refer children to JFS programs outside of school, such as “Kids in the Middle.”
Affordable housing
Meg Kissinger, who covers public health issues for the Milwaukee Journal Sentinel, said in a telephone interview Nov. 17 that recent trends have placed more emphasis on moving the mentally ill out of institutional inpatient settings, and providing them high quality community-level support systems instead.
A major obstacle to achieving this transition from institutional to community-based care, however, “is a shortage of affordable, accessible housing for people with disabilities, including mental illness,” said Barbara Beckert, director of Disability Rights Wisconsin in Milwaukee, an organization that provides advocacy assistance to people with disabilities in southeastern Wisconsin, in a telephone interview Nov. 18.
In response, JFS has taken significant steps to meet an ever-increasing need for housing among lower or middle income households that cannot afford local fair-market rates for rental apartments.
About six years ago, the Wisconsin Housing and Economic Development Authority (WHEDA) granted JFS $10.4 million in tax credits, enabling the agency to acquire Deerwood Crossing, a 66-unit affordable housing apartment building located at 4195 W. Bradley Rd., designated a Residential Care Apartment Complex under Wisconsin law.
Deerwood is an “age in place” facility, allowing residents to move from independent to assisted living, changing the level of services required based on their changing needs.
A 30-unit expansion of Deerwood Crossing Senior Residences opened in June 2014, bringing the total number of apartments to 96 at this facility. Leabman said only seven of these apartments rent at market rate; the remaining 89 are leased at affordable rental rates.
In the process of acquiring Deerwood Crossing, JFS Housing Inc. was created. JFS Housing also sponsors Bradley Crossing Supportive Housing Community, acquired about four years ago with the help of tax credits from WHEDA. It initially provided 30 apartments to support adults who live independently, and 30 apartments for individuals with developmental, physical, or behavioral disabilities.
“Bradley Crossing is 100 percent affordable housing,” Leabman said. “Fifty-four units are being added,” with completion expected by the end of 2015.
Other factors
While more difficult to document at present, clearly the Affordable Care Act (ACA), also known as Obamacare, is affecting or will affect the demand for services.
Kissinger said that mental health service is one of the covered areas under ACA, and said she expected to see increases in demand for services, from treatment of mild depression through schizophrenia. “You’d hope that the greatest needs will be addressed first,” she said.
Rachel Nelson, acting clinic director at JFS, in a telephone interview Nov. 12, agreed that while it is too soon to make an overall statement about the effects of ACA, “we’ve seen a major increase in demand for mental health services among people newly covered.”
Leabman pointed out the extent of the problem nationwide. According to figures published by the National Alliance on Mental Illness (NAMI), 61.5 million Americans — one in four adults — experience mental illness in a given year.
One in 17 — about 13.6 million — live with a serious mental illness such as schizophrenia, major depression, or bipolar disorder. Approximately 20 percent of youth ages 13 to 18 experience severe mental disorders in a given year.
Summary: Multiple causes
The major finding of the research for this article is that there appear to be multiple causes for the significant increase in demand for JFS services over the past several years. These include:
• The economic downturn.
• The increasing use of court-mandated and associated programs to address the needs of parents and children.
• The increasing needs of older adults, coupled with heightened awareness in the community of those needs.
• The reduction in stigma associated with seeking mental health services.
• The increased accessibility of JFS services which is both a cause of and a response to increasing demand.
• The effect of expanded mental health coverage under the Affordable Care Act.
• The increase in need for affordable housing for those with disabilities, including mental illness.
• The increase in violence in the Milwaukee community.
• The reputation JFS has established for providing quality services.
Freelance writer Lynne Kleinman, Ph.D., is a retired teacher and journalist.
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