A Case Study

ARTHUR: RETIREMENT BLUES AND MONEY WORRIES

Retirement can be a happy time. Many people look forward to a good life after work, expecting a peaceful transition into golden years. Some people plan ahead, invest wisely, manage and provide for their financial well-being. Others are not so lucky. Health problems can complicate money worries.

McMan’s Depression and Bipolar Weekly October 10, 2001 e-mail newsletter (three free issues are available from jmcmanamy@snet.net) quoted from the World Health Organization’s report, Mental Health: New Understanding, New Hope, that "an estimated one in four families has at least one member suffering from a mental or behavioral disorder." Common conditions include depression, anxiety, attention deficit disorder, stroke, dementia and Alzheimer’s. Less common conditions are schizophrenia, autism and dyslexia. Many conditions involve symptoms of depression.

Consider this case from Finding Care For Depression, Mental Episodes and Brain Disorders by R. Sealey (SEAR Publications, Toronto, 2001).

Arthur, a 69-year-old retired professional, was worried, confused and upset. His cash position was tight after he withdrew $ 50,000 from his savings account, bought a new car and booked a six week cruise. He berated himself for overspending. Lately, he had trouble concentrating and difficulty sleeping. He was forgetful, lost his appetite, drove erratically and had blue moods. After his last episode of depression, Arthur stopped taking his antidepressant and sleeping medications. He was fed up with side effects. Now he was dispirited and anxious about getting sick. This time he felt a lot worse. His wife his adult children were concerned. They wondered what was wrong and whether they should do something to help Arthur.

"Do money problems cause depression?" Arthur asked Bob, his accountant. After a sigh, Arthur added, "Or, does depression cause money problems?" "Neither," said Bob. "But people worry about money when they feel blue." "Should we sell our home?" fretted Arthur "I don’t think my wife can manage with me sick and the house to look after." "Before we chat about making such a drastic change to your lifestyle, let’s discuss how you can get proper medical care," said Bob. "If you can stabilize and restore good health, you will feel more comfortable. Then we can update your financial plan and discuss your retirement."

Rather than anticipating the stigma of ‘mental’ illness, it helps to realize that some people are vulnerable to biochemical imbalances; from time to time their brain ‘fuels’ get low. According to Dr. Sydney Walker, who wrote A Dose of Sanity, here is no need to panic; competent health professionals can diagnose which of 50 medical conditions may mimic, cause or contribute to symptoms of depression and anxiety. There is usually a root cause.

When a retired client suffers with a brain disorder or has an episode of depression, he may worry about money. The combination of symptoms and anxieties can challenge family and financial advisors who are not familiar with mental illness. Should they ignore medical matters? When there are concerns about money and an illness, what can caregivers do? Without giving medical advice, even a financial advisor can suggest that the client see his doctor, ask for a mental status exam, prepare a list of symptoms, review past treatments and get medical testing. A competent doctor will make an accurate diagnosis and recommend effective treatments. After the client’s medical situation is clarified and resolved, then the patient, family and advisors can discuss money matters and update financial plans.

Sounds quick and easy, but the mysteries involved with common mental conditions may not be quick or easy to solve. These days when patients report symptoms of depression and anxiety to professionals who face healthcare cutbacks, doctors may cut corners, trying to cope with the overload. Medical Nightmares: The Human Face of Errors, by BC community coroner Susan McIver reports 30 cases of patients who were not diagnosed accurately or treated effectively. She explains how patients and family can learn to cooperate with health professionals and take timely action if symptoms do not resolve after a poor outcome of substandard medical care.

Finding Care For Depression, Mental Episodes and Brain Disorders has information for patients like Arthur, his family and caregivers.

Tips for Finding Effective Mental Healthcare

1.
If there are symptoms of depression and anxiety, there is a reason. These are brain signals. Consider underlying medical, neurological or biochemical conditions. Psychosocial factors, loss and transitions may also be involved.

2.
See the doctor. Check with the therapist. After medical and psychological testing, health professionals will make a differential or root cause diagnosis and recommend effective treatments.

3.
If the first treatments don’t work, be patient. Check with the doctor or ask for a referral to a specialist. Make daily notes of symptoms, problems and progress.

4.
There are standard of care procedures and guidelines for diagnosing and treating mental conditions. Patients can ask for an overview to learn the basics.

5.
After receiving a diagnosis from a competent health professional, ask for a short reading list. The goal is to find quality information that will reassure the patient and help the family understand how to cooperate with health professionals. There are many books for laymen. Consider doing an Internet search and checking out patient support groups. Health-related books usually fit into one of four categories: standard information, survivor stories, health professional survivors who know how to help and references about restorative treatments.

6.
If there is no progress, it is reasonable to ask for another opinion.

7.
If there are side effects from medications or problems with ongoing treatments, the patient can make notes, list the problems and ask health professionals to fine-tune the caregiving and update the counselling.

8.
Ask the doctor, pharmacist or drug company for information about medication effects, adjusting the timing and doses. Informing about the risks and benefits and getting the patient’s consent before treatments are normal routines for educating the patient and the family. Monitoring blood levels and kidney functions can help.

9.
Don’t lose hope before you go for help. There are a range of effective treatments for chronic episodes of depression including: medication, therapy, ECT, orthomolecular restoration, SAD light, transcranial magnetic or vagal nerve stimulation, EEG neurofeedback and combinations. Patients usually respond to effective treatments.

10.
If you have suicidal thoughts, don’t do anything drastic. Ask for help TODAY!

Tips for Coping with Money Worries During an Episode of Depression

1.
Before making any big or impulsive decisions during an episode of the blues, call for advice. You can think before spending; consider whether you need the item now. Even if you don’t feel well, you can pause to plan before spending.

2.
After splurging on a treat or overspending, don’t panic. Ask your financial advisors to review your situation and do a financial check-up.

3.
If you have a crisis or a health problem, tell your family. Let your friends be extra sympathetic. Caring people will respect that you are going through a difficult time.

4.
Tell your advisors what is happening. Your accountant, banker, broker, lawyer, insurance agent, financial planner and consultant are on your side. They will listen, offer suggestions, advise objectively and encourage your recovery.

Brain disorders like depression and anxiety have a number of possible causes and contributing factors. These chronic but treatable conditions can be diagnosed accurately and treated effectively. If there are uncharacteristic or irritable outbursts, helpless, hopeless attitudes or unusual behavior involving money, the patient and family can call their health professionals to schedule an in-depth check-up. After the client gets a diagnosis, the doctor will explain the prognosis and recommend treatments. Financial consultants can listen when the client explains ongoing mental health problems and treatments. It is appropriate for an advisor to encourage the client and his family to monitor the progress of healthcare, budget for ongoing costs, adjust financial goals and develop realistic retirement plans.

by R Sealey, BSc, CA

Robert Sealey, BSc, CA is an independent consultant in North York offering accounting, tax and planning services. His mental accounting and consulting services help people cope with depression, mental episodes or brain disorders or care for family members. Bob authors the SEAR series of layman’s guides.

1.	If there are symptoms of depression and anxiety, there is a reason. These are brain signals. Consider underlying medical, neurological or biochemical conditions. Psychosocial factors, loss and transitions may also be involved.
2.	See the doctor. Check with the therapist. After medical and psychological testing, health professionals will make a differential or root cause diagnosis and recommend effective treatments.
3.	If the first treatments don’t work, be patient. Check with the doctor or ask for a referral to a specialist. Make daily notes of symptoms, problems and progress.
4.	There are standard of care procedures and guidelines for diagnosing and treating mental conditions. Patients can ask for an overview to learn the basics.
5.	After receiving a diagnosis from a competent health professional, ask for a short reading list. The goal is to find quality information that will reassure the patient and help the family understand how to cooperate with health professionals. There are many books for laymen. Consider doing an Internet search and checking out patient support groups. Health-related books usually fit into one of four categories: standard information, survivor stories, health professional survivors who know how to help and references about restorative treatments.
6.	If there is no progress, it is reasonable to ask for another opinion.
7.	If there are side effects from medications or problems with ongoing treatments, the patient can make notes, list the problems and ask health professionals to fine-tune the caregiving and update the counselling.
8.	Ask the doctor, pharmacist or drug company for information about medication effects, adjusting the timing and doses. Informing about the risks and benefits and getting the patient’s consent before treatments are normal routines for educating the patient and the family. Monitoring blood levels and kidney functions can help.
9.	Don’t lose hope before you go for help. There are a range of effective treatments for chronic episodes of depression including: medication, therapy, ECT, orthomolecular restoration, SAD light, transcranial magnetic or vagal nerve stimulation, EEG neurofeedback and combinations. Patients usually respond to effective treatments.
10.	If you have suicidal thoughts, don’t do anything drastic. Ask for help TODAY!

1.	Before making any big or impulsive decisions during an episode of the blues, call for advice. You can think before spending; consider whether you need the item now. Even if you don’t feel well, you can pause to plan before spending.
2.	After splurging on a treat or overspending, don’t panic. Ask your financial advisors to review your situation and do a financial check-up.
3.	If you have a crisis or a health problem, tell your family. Let your friends be extra sympathetic. Caring people will respect that you are going through a difficult time.
4.	Tell your advisors what is happening. Your accountant, banker, broker, lawyer, insurance agent, financial planner and consultant are on your side. They will listen, offer suggestions, advise objectively and encourage your recovery.