On a Thursday night the 22 cubicles at Family Service of Montgomery County in Gaithersburg are filled with the troubled, the anxious and the depressed.
These are busy times for the county's oldest social service agency. Night hours have been added, moonlighting psychologists have been hired to handle the load and there is a five-week waiting list, the first in the center's 75-year history. Most evenings there are so many people that snatches of troubled conversations in one room can be heard in the next.
"Frankly, three years ago we didn't have enough work," said Charles Brambilla, the clinic director.
"Now it's a constant barrage of people unaccustomed to doing without, many who have lost jobs for the first time. We're seeing more violence in the family: physical abuse, sexual abuse."
In the year ending last June, the center handled 3,924 visits--700 more than the previous 12 months. Anxiety about money, about unemployment or about an uncertain financial future were underlying causes of many of those visits, according to family service staff members, who received special instruction last fall from an official of the First Women's Bank of Maryland on how to counsel recession-battered clients.
The crowded Gaithersburg clinic is an indication of one of the least obvious but potentially most damaging effects of the recession: the severe psychological toll on those without work or under financial pressure.
Throughout the Washington area, help hotlines are experiencing significant increases in calls, shelters for battered women are seeing more first-time victims and the instances of child abuse, suicide and alcoholism have grown. According to interviews with social workers, ministers, psychiatrists, nurses and clinic directors, the recession is a major cause.
"This is not the way it was in the '70s when Washington was pretty much spared and it was observing what was happening across the country," said Dr. Louis Kopolow, a psychiatrist who practices in Potomac and Gaithersburg. "People are seeing a number of their clients and associates going under. We've had an earthquake here."
While recession's role in increasing mental health problems is hard to quantify, some barometers do exist. Social scientists point to increases in the following categories as evidence of a growing feeling of instability and anxiety among many residents of the Washington area:
The number of suicides. In the District, there were 90 last year, 29 more than in 1981. In Baltimore, 90 persons usually commit suicide in a year, according to John Switzer, a city biostatistician. In the year ending in September, there were 101 suicides.
Although neither city keeps records on whether a victim was working, officials in both cities say many of the suicide victims were jobless.
Reported incidents of child abuse and neglect. In Northern Virginia, there were 962 more abuse reports, or 6,653 incidents, in the year ending in June, while there was a 10 percent increase statewide.
"Our cases have become much more desperate," said Brenda Watson, a child protective service worker in Fairfax County. "The threat of a loss of a job is increasing the intensity of the violence," she said, noting that an average of 38 children were removed from homes each month since November, triple that of a year ago.
In Maryland, the most tragic increase was measured in burials: 23 children died of abuse last year, more than a 100 percent increase from 1981. Neglect complaints also rose in the District last year, with 2,909 complaints, almost 1,000 more than a year earlier.
The demand for alcoholism and drug abuse counseling and treatment. The county clinic in Arlington, for example, saw 1,127 new clients, 22 percent more, in the year ending in June and the trend is continuing, according to director Phyllis Kohlman. "There's a much larger percentage of clients who are unemployed. We're seeing it as those paying no fees have jumped to 40 percent from 25 percent in the last year and a half."
Even in areas with low unemployment, such as Prince William County, public alcoholism clinics are overloaded. "The people who use public clinics, a lot of construction workers, painters, are the ones hit," said Philip Haber, director of the county program, which has experienced a 20 percent increase in the last year, to 625 patients.
For the first time, nonemergency cases are put on a one-month waiting list and some people who still have insurance are being referred to private treatment centers. "I'm always hearing suicide now in counseling sessions; suicide is new to us," Haber said.
Case loads at mental health clinics. The five mental health clinics run by the Prince George's Health Department, for example, saw an average of 35,000 patients last year, 2,000 more than previous years. Counselors say that anxiety about work, particularly from those who have skidded to a lower job, is foremost.
"Our waiting list has grown to 26, the highest ever," said Eric Kafka, director of the Cheverly clinic. Patients who had been making progress have suffered setbacks when they have been unable to find work, Kafka said. "The economy has put therapy at a standstill."
Dealing with the often devastating psychological impact of joblessness presents mental health experts with some formidable challenges. A major goal, according to Kopolow, is rebuilding a person's sense of self-worth.
"People need to know that we can still respect you, regard you highly, laugh at your jokes," he said. "It's the people who can't realize they're worth more than their jobs who are lost." Tomorrow: Difficult choices