The Future of Mental Health

The field of mental health encompasses many different professions. It is good for the public as well as teachers and psychologists in training to know the lay of the land, and to understand current practices in the field of psychiatry, because many referrals are made to this profession. The New York Times recently reported the story of one psychiatrist whose practice has changed from regular talk therapy to to short 15-minute medication adjustment sessions that occur much less frequently. This particular doctor explains in the article why he believes the kind of practice he conducts is now necessary because of the way psychiatrists are reimbursed for their services, and he refers patients who need more traditional talk therapy to psychologists, social workers, and mental health counselors:

DOYLESTOWN, Pa. — Alone with his psychiatrist, the patient confided that his newborn had serious health problems, his distraught wife was screaming at him and he had started drinking again. With his life and second marriage falling apart, the man said he needed help.

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But the psychiatrist, Dr. Donald Levin, stopped him and said: 'Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate.'

Like many of the nation’s 48,000 psychiatrists, Dr. Levin, in large part because of changes in how much insurance will pay, no longer provides talk therapy, the form of psychiatry popularized by Sigmund Freud that dominated the profession for decades. Instead, he prescribes medication, usually after a brief consultation with each patient. So Dr. Levin sent the man away with a referral to a less costly therapist and a personal crisis unexplored and unresolved.

Trained as a traditional psychiatrist at Michael Reese Hospital, a sprawling Chicago medical center that has since closed, Dr. Levin, 68, first established a private practice in 1972, when talk therapy was in its heyday.

Then, like many psychiatrists, he treated 50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each. Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart. Then, he knew his patients’ inner lives better than he knew his wife’s; now, he often cannot remember their names. Then, his goal was to help his patients become happy and fulfilled; now, it is just to keep them functional.

Dr. Levin has found the transition difficult. He now resists helping patients to manage their lives better. 'I had to train myself not to get too interested in their problems,' he said, 'and not to get sidetracked trying to be a semi-therapist.'

If you read the entire article, you will learn how this doctor has instituted different efficiency-based business techniques that are a virtual script to get patients in and out of the office itself in the shortest possible time. He explains that this is necessary for him to keep the kind of lifestyle he was accustomed to before the insurance industry made sweeping changes in the 1990s and 2000s in the manner in which physicians are reimbursed by insurance companies. These, he explained, forced him to change the manner in which he practices medicine. There are many thoughtful comments in the ensuing blog discussion. One may wonder if this doctor is making necessary changes to keep up with the times, or question, as Evander Lomke, Executive Director of the American Mental Health Foundation does, whether or not "money is in, and sadly help (not among all, but among too many in the field experiencing the inevitable pressures of time and money) is out."

And do church teachings and opinions on social justice—recently discussed back and forth on America as they apply to public sector workers such teachers, police, and fire fighters (who may earn in "rough figure" ranges, with benefits, between $60,000 and $130,000)—apply to specialists in a field such as psychiatry where salaries are commonly in the $150,000-200,000 range? Some doctors are even wondering if they should consider establishing labor unions for physicians, not only for salary protection, but to allow them professional freedom so they—instead of management by insurance companies—may continue to set and practice standards based on their professional training, competence and guidelines.

William Van Ornum

 

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Brandy Gang
6 years 7 months ago
      To me, this is matter of what is more important in this day in age. Obviously our economy is not as great as it use to be, but how we completely change the way we treat people who need help just because we are not getting the right funding anymore? I think this is completely wrong. Patients oftentimes come to their psychiatrists to talk because they have no other place to talk about how they feel. So, in a way, these patients need the talk therapies more then they need the medicine. Sometimes, it simply helps just to listen to someone.
      From reading the entire article, I’ve learned that Dr. Levin’s son also has gone to school to become a psychiatrist. One thing that appalled me of this idea is that he says “I’m concerned that I may be put in a position where I’d be forced to sacrifice patient care to make a living, and I’m hoping to avoid that”. This shows that even he is worried about the money involved with being a psychiatrist. Yes, money is important in today’s society, but if you do not love the job and feel the need to help people, then why would you ever get involved in this area of expertise?
Amna Mahmood
6 years 7 months ago
As soon as I started reading “The Future of Mental Health,” I remembered reading that same article on the New York Times website recently. It was shocking when I read it there and it is once again shocking reading it here. It is hard to imagine going from 50 patients to 1,200. It seems like there is a big problem in the insurance and medical fields with regards to how people are reimbursed.

Dr. Levin made a comment along the lines that he had to change the way he practiced medicine to keep up his lifestyle. Everyone understands the need for security in your job but the fact that doctors are being forced almost to treat patients this way goes against everything that doctors are generally taught. Instead of the psychiatrist being there to help and talk all that’s going on now is prescribing medicines. I am not denying that medicines do not help, but our society seems to be relying too heavily on medication to fix our problems. Doctors should be able to practice how they were taught and not coerced to practice in the way that insurance companies want them to. Insurance is supposed to be there to help us when we need it and keep us healthy. Instead, these companies seem to be forcing Doctors to just find a quick way out and not allowing people to get the help they actually need to recover from their mental health issues. I think we really need to look at where we are going with this, and realize that we are not helping ourselves and looking out for others as we should be.
Erin Graetzer
6 years 7 months ago
It is rather upsetting that the time has come that we only have time to treat people for 15 minutes at a time and can only give them prescriptions to solve their problems instead of talk thereapy to talk it out. Granted, some people do need prescriptions and at times they can work wonders but to what extent do they fully solve the problem? Just handing out prescriptions can be seen as almost a way of masking the problem and not actually solving it. I'm sure people who have been in mental health situations can agree that in order to "clear the air" you must talk it out and not hold anything in. in some cases a psychiatrist can be like a best friend the person you count on the most to help you in the most desperate times of need. They might be the person who knows everything about you and all the details of your life. A prescription medicine can't do that; it will never know the innermost core of your being.
     Today's world is so focused on efficency and getting everything done in a New York Minute that sometimes we might forget that there are more important things in life, like the people around us. The whole point of mental health is to listen to people and help solve their problems. If mental health keeps going in the direction it has been, then will it really be mental health or just medication?
Jaclyn Greiner
6 years 7 months ago
       After reading this blog I decided to do some more research on the topic. While researching I found this article about managed care and how it affected psychiatry. In this article the author talks about how managed care is all about reducing the cost of medical care. Although because of this a patient may no longer always get the best psychiatric care that is available. In my opinion this is completely unacceptable a person’s mental health should not be sacrificed in order to spend less money. In this article the author states that “this situation has perhaps affected psychiatry more than other specialties.” I believe this to be true because I feel like mental health problems are things that can be somewhat put off and therefore prices have rose. People who are under these managed care organizations “may not have access to new, effective, but expensive, drugs or information about them from their physicians.”(Slovenko, 2009, p.522) This is not fair and makes the physician face a difficult decision of whether to do his job to the fullest and lose money or earn more money by doing less for his patients.
       To put physicians in awkward unmoral positions like this is not just and is causing some physicians to want to form unions in order to protect their own interests. Managed care forces psychiatrists to decide between economic gains and moral standards. To me the only way this problem will be fixed is if physicians that have private practices find a way to form a union that can protect their rights to run things the way that they would like and that they find is medically appropriate. We cannot continue to have doctors being paid more for the less they do. It is unethical and going to put many patients’ mental and physical health at risk. Some physicians are actually told by their organization that “corners must be cut at every opportunity.”(Slovenko, 2009, p.522) This is just like Dr. Levin who refused to listen to his patients problems. Overall I am completely against this form of psychiatry and hope that something will be done.  
Slovenko, R. (2009). Psychiatry in law/law in psychiatry 2nd edition [2nd edition 522-523]. (Googlebooks), Retrieved from http://books.google.com/books?id=LJ7RxeaBGzQC&printsec=frontcover#v=onepage&q=managed%20care&f=false
 

6 years 8 months ago
The movement in this country  has been to make economic profitability a major ethical factor. Correlatively, there has been a diminishment of the common good. Professionalism tends to suffer in that environment and even to be denigrated.
While one should not minimize that psychotropic drugs have had beneficial effects,  the medical and psychiatric professions sem obviously to be under pressure to move patients in and out.
ed gleason
6 years 8 months ago
MSNBC had a piece today about the pressure to allow psychologists to be able to proscribe psychiatric drugs to patients along with talk therapy, the talk therapy that MD psychiatrists are abandoning. New Mexico and the military, for awhile, have allowed psychologists to prescribe without any problems.
we vnornm
6 years 8 months ago
Lia,

Thank you for your examples-they illustrate one of the problems in the system-as-it-exists today. bvo
we vnornm
6 years 8 months ago
Vanessa,

It is good for young people to know the lay of the land and how times change. Sometimes textbooks may be years behind actual practice. Thanks. bvo
Janice Feng
6 years 8 months ago
I could not find exactly how often this 15 minute session format is used among psychologists, but I did find an interesting link:

http://edynathan.com/psychology/sessions-personal-group

The above link directs you to a website which allows you to purchase individual psychoterhapy sessions that start from 15 minutes and go up to 45 minutes. There is also the chance to purchase group sessions. "The individual sessions with Edy enable you to address issues that create an obstacle in your life,  giving you tools to help you feel better in your everyday life." Edy allows people to have that "personal touch" but in the "privacy of one's home." I understand why a therapy session in one's home would seem appealing, but I do not believe a 15 minute session would accomplish anything besides introductions. I laughed when I read her business quote/catchphrase at the top of her page, "Intuitive psychotherapy and the evolution of you." I wonder what makes people who enter the field with a desire to make that difference through therapy end up where Edy Nathan or Dr. Levin are now.
Samantha Young
6 years 7 months ago
I completely agree that it is important for teachers to be updated on advancements in the field of psychiatry. I found it devastating that this poor PA man went to seek help from a qualified psychiatrist and instead he is being turned away because his problems are taking too much time. While it is true that psychologists are not able to prescribe medications and psychiatrists can, both are equally qualified to talk a person through their problems. In my eyes, regardless of funding, if an individual is turning people away simply because they do not need a medication adjustment they are neglecting to do their job sufficiently.
Being that Dr. Levin now does not know his patients well, the question arises is he qualified to be tampering with these drugs on the individual? This question is affecting the entire field as a whole. With all of the addictions and overdoses these days, how can one know if a patient isn't coming into the office and making up a quick ten minute convincing story just to get some more medications. It devastates me to think that the role of this profession has changed from helping people to reach their full potentials and live a happy and prosperous life to just making it by in less pain. It is almost as if these individuals are becoming walking zombies; hopped up on medications and numb to the world around them instead of embracing their initial problems and learning to deal with them. I am not sure how I feel about the suggestion of labor unions for this field, but it would certainly stir the pot a bit. Regardless of the times, t isn't right that insurance money is ruling the game. Changes must be made to get the field back to its roots.
Danielle Molins
6 years 7 months ago
Throughout my life, I have mainly heard about the positive effects of therapy to respond to and assist one through any issues or problems that they face. However, upon reading of these transformations of types of therapy, I developed a concern and became perplexed about the future and morality of this form a psychiatry. Patients being dismissed after a mere fifteen minutes session with a therapist and with a prescription for a psychotropic drug in hand, barely seems like a logical solution to any problem that the patient may face. I do believe that there are people who reap the benefits of psychotropic drugs, however, I feel that there are also people who could benefits of traditional talk therapy without unnecessary drugs intake and the repercussions that this can involve. 
Since fifteen minutes is an inadequate amount of time to understand one’s personality and problems and develop a sense of the derivatives of the issues of a patient, this type of therapy can be unethical. This can insinuate that a patient will be dispensed unneeded drugs, given the wrong dosage of drugs or given a drug that will not be of service to any of their problems and in the worst case scenario, lead to the development of supplementary predicaments. I hope that because of this modification to psychiatry that there will be no detrimental effects to anyone. People involved in this type of therapy should proceed with caution.
Vanessa Adamo
6 years 8 months ago
While reading this article I became very heart broken over the issue that is occuring in the field of psychiatry. As I am a psychology major it is dificult to see what some of the professionals in the field are resorting to in order to benefit themselves instead of their patients. I have always been taught and have always trusted that the goal of a psychiatrist was to help his patients become happy, to help them work through their current problems, not to just keep the individual functional. When I read that "it is just to keep them functional" it was difficult to swallow. Are we no longer human beings who possess feeling and emotions? As human beings we should not just be kept functional but we should be fulfilled. In addition, I understand that insurance has caused an immense issue for many doctors, however, I do not believe that due to insurance reasons a doctor should sacrafice the health and well being of his patients. I strongly believe that talk therapy is effective and is a healthy release of negative energy that cause some individuals pain. It is important that individuals feel that they have someone to talk to about their problems, however, if this talk therapy is taken away and replaced with medication we as a society will begin to find life to be a bit more difficult.
Kayna Pfeiffer
6 years 8 months ago
Dr. Van Ornum,

 I did some research on the subject and I found that the number of psychotherapy sessions have reduced over the last ten years. From the years 1996 to 2005 (10 year period), psychotherapy was provided to 5597 of 14108 visits (34% of all visits). The percentage declined from 44.4% in 96-97 to 28.9% in 04-05. Also, the number of psychiatrists who provided psychotherapy to all of their clients decreased from 19.1% in 96-97 to 10.8% in 04-05. These are alarming statistics that support that view that the majority of psychiatrists have shifted from psychotherapy to strictly prescribing sessions.


Mojtabai, R. and Olfson, M. (2008) National trends in psychotherapy by office- based psychiatrists. Arch Gen Psychiatry. 65(8):962-970. Retrieved from 
http://archpsyc.ama-assn.org/cgi/content/abstract/65/8/962 

To supplement this, I found another study that provided evidence for why this is occurring. In a study 2,323 psychiatrists were surveyed to find out the mean costs for a psychotherapy sessions (45-50 minutes) and medication management visits (15 minutes). The mean for psychotherapy was $155.59 (undiscounted) and $107.64 (discounted) while the mean for medication visits (3 visits=45 min) was 263.19 (undiscounted) and $182.16 (discounted) This data indicates that medication visits are substantially more lucrative than psychotherapy sessions. 

West, J.C., Wilk, J.E., Rae, D.S., Narrow, W.E., and Regier, D.A. (2003). Psychiatry Services.  54(12):1582-1588. Retrieved from 
http://www.psychservices.psychiatryonline.org/cgi/reprint/54/12/1582 
6 years 8 months ago
In response to the question: What percentage of psychiatrists still do therapy in addition to counseling?, I looked up numerous articles.  I found one article by Lori Wiviott Tishler, associated with Harvard Medical School.  According to this article, New York Times took a survey in 2005 and found that only 11% of psychiatrists provided talk therapy to all patients.  It continued to explain that although many psychiatrists don’t find this type of practice fulfilling, they continue to engage in it to maintain their incomes.  The link of the article follows: http://harvardpartnersinternational.staywellsolutionsonline.com/59,NP030811a.  In addition, I saw the question “How typical is his practice?” After reading the article above, and Dr. Donald Levin’s personal experience, it leads me to believe this practice is very typical.
6 years 8 months ago
Bill,  You have some great students!  They are making an important contribution to your blog.  I read the article referenced by Lia #39 and was interested in what the authors said about the training of psychiatrists in med school.  I think if we look at curriculums over the past years and see if and what changes have been made in the teaching of psychotherapy we'd get an idea of the direction the profession is moving in.  If the courses are fewer and being watered down, we get an indication that the profession is going to be more and more focused on medication management.

The authors said:  "Traditional model of psychiatric training with its emphasis on competency in delivering formal psychotherapy may become less relevant to future generations of psychiatrists who operate in managed care settings in which short-term medication visits are the norm and formal psychotherapy is delegated to non medical professionals."

That historical change in focus and the fact that there are only 1,000 board certified child psychiatrists in the country are very disturbing when considering the future of mental health care in the U.S.  I hope your students consider the various ways they can make contributions to the field, exploring the professions you listed.  They are our future and we are depending on them!!
CHRIS SINNAPPAN
6 years 8 months ago
As a board certified psychiatrist, in my experience, a patient is first seen for a comprehensive evaluation for 60 to 90 minutes, and working in conjunction with a team of therapists, the treatment is divided into psychotherapy and medication therapy. There are many times, I have recommended that a patient try psychotherapy first and psychiatric medication later or use both in combination. I am lucky to work with a team of therapists where each week we discuss the progress of patients that are in therapy and coming to see me for medications. My medication management sessions with patients are 20-30 minutes long. I was trained between 1993-1998. I received training to do psychotherapy and still use my skills but mostly when working with inpatients. 
Allyse Bamonte
6 years 8 months ago
Sorry if I'm straying a bit from the last few comments, but I thought this would be an interesting point to bring up.


This article & its comments are incredibly fitting for me at this time . I was shown a film last week called Generation Rx, in which I heard some remarkable statistics found in a study by Lisa Cosgrove and Sheldon Krimsky, who is professor that has researched many areas of ethical situations within psychology. Together, they found (1994) that:
     Of the 170 DSM panel members 95 (56%) had one or more fi -
     nancial associations with companies in the pharmaceutical
     industry. One hundred percent of the members of the
     panels on ‘Mood Disorders’ and ‘Schizophrenia and Other
     Psychotic Disorders’ had financial ties to drug companies. (Cosgrove, Krimsky, et.al)

This points out an alarming situation. Because DSM panel members have links within these drug companies, are they widening the range for diagnoses in order to increse prescriptions? There have been attemps made to reduce this conflict of interest in order to make sure patients are being evaluated fairly and truthfully. However, statistics show that there has been no decrease. Do these panel members work as phsyciatrists and prescribe the medications according to the companies they are associated with? Could this be a reason that phsychiatrists only need 15 minutes in order to diagnose and prescribe medication? I hope and believe that there are still some phsyciatrists who are moral people, doing their job to the best of their ability. Still, I fear that the United States is only going to become more and more reliant on drugs to solve problems, and less time will be spent really assessing and identifying where the problems truly lie and how they can be overcome with cognitive behavioral therapy or other non medicated means.

Lisa Cosgrove and Sheldon Krimsky's study: http://www.tufts.edu/~skrimsky/PDF/DSM%20COI.PDF

Recent stats and other facts: http://www.cchrint.org/2010/05/21/dsm-panel-members-still-getting-pharma-funds/
Allyse Bamonte
6 years 8 months ago
Oops. Should have reread my comment. Spelling errors: increase* and all three times I spelt psychiatrist* wrong.
Lynde Kayser
6 years 8 months ago
I found this entry to be really shocking.  It seems to me pretty absurd that medication is being substituted for therapy.  I think that behavoiral therapy is a healthier and more effective means of redirecting unhealthy behavoir, rather than simply pumping patients full of medication.  Although there is the time and place for the use of medication in psychology, it should not be the first technique of treatment. 

Upon further research, I found an article reinforcing this thought (http://www.healthyplace.com/anxiety-panic/insights-into-anxiety/cognitive-behavioral-therapy-vs-medication/menu-id-1233/) 

Researchers cited on this page found that in the case of anxiety and panic disorders, 80% of CBT treatment was effective versus the only a 50% rate of efficacy in medication based treatments. 

As an intern at an autism center, I have witnessed first hand the lack of interaction between psychiatrist and patient.  Although the students at the center receive constant ABA style education and are thouroughly cared for, it is still surprising to see that psychiatrist's diagnosis are often based off data in a behavoiral support plan rather than first hand interaction with the students. 

I think that this disconnect is something that desperately needs to be addressed in the world of psychology.  Medication should be a last resort rather than a first response, and should never act as a replacement for talk therapy. 
6 years 8 months ago
The concept of 15-minute practices seems a little ridiculous to me. There is no way that a psychiatrist can accurately analyze and diagnose a patient in such a short amount of time. According to the research I did on the subject, though, this practice has become almost a standard in the field of psychiatry. I believe that all patients deserve much more time and attention than they are receiving. This article was very helpful in informing me on the topic, and opened my eyes to just how common and harmful this practice is. 
http://www.currentpsychiatry.com/pdf/0906/0906CP_Malpractice.pdf 
6 years 8 months ago
I was very disturbed by the information in this article regarding the practice of psychiatrists today. It seems that every profession is changing for the worse. I immediately thought of how recorded music is now replacing the performance of live music. Society today is looking for the cheapest and easiest way to complete a task. It is not about performing at one's best or helping others but rather completing tasks in a fast and ''efficient'' manner. During a 15 minute session it does not seem likely that a psychiatrist can give the patient the best care possible. It does not seem right that psychiatrists are using medication as a fast method to solve the personal problems of their patients. 

Colleen Baker
6 years 8 months ago
Excellent article and excellent responses.  Allyse deserves an A for comment #51.  The incestuous relationship between psychiatry, big pharma, and for profit insurance is what most of this change is all about, but not all of it.  Another angle is a sort 'cartesian' attitude to the human condition in that all human difficulties are biochemical in nature and can be treated by the right chemical combination.  Unfortunately what we find in practice is that the chemical composition of human beings is all to often synergistic and hugely interdependent and complicated.  Hence the severe side effects of the second generation of psychotropics which have led to huge weight gain,  type II diabetes, and liver damage.  Fifteen minute sessions aren't enought time to cover the very real side effects of these drugs much less determine if they are necessary.  Having noted that, I will also state that for schizophrenia and some forms of bipolar disorder they can be a godsend.

I also think Bill's point about spiritual health is well taken and that as we begin to discover more about the true potential of human consciousness there will be another paradigmatic shift in how we define and interpret 'mental illness'.

 
6 years 8 months ago
As a future educator, I will have my share of students who are seeing a psychiatrist, psychologist, therapist, or social worker, and other students who may need to see these types of professionals, but are unable to. At a time when it seems that more and more individuals are being diagnosed with mental health problems, as clearly seen by the drastic increase of number of patients seeing Dr. Donald Levin, our states are facing budget crises and cutting mental health funding. How sad it is to think that those who need assistance are not receiving the proper care. Dr. Van Ornum’s article posted here: http://americanmentalhealthfoundation.org/entry.php?id=231 quoted, what was for me, a chilling example provided by Michael Fitzpatrick, executive director of NAMI, of the extreme consequences that can happen when those who need the help of mental health professionals are unable to receive it: the unfortunate, and chilling event that occurred two months ago when Arizona Congress woman, Gabrielle Giffords, was shot. Although an extreme example, and thankfully a rare occurrence, this event proves that there are individuals who, without mental health care, can be dangerous.
It is rather unthinkable that psychiatrists, the ones who truly care about their patients, are no longer able to properly perform their jobs as they once did, or as Dr. Van Ornum stated above, that “the profession (psychiatry) has become different from the profession [they] signed up for.” And all because of money.
I certainly hope that Dr. Donald Levin is an extreme case. I feel for the individuals who are swept in and out of his office mechanically. Rolling one out and one in every 15 minutes. How he feels, or others like him feel, that prescribing medication to patients without spending more than 15 minutes with them every so often, and barely able to remember their names is beyond me. How can he be sure what he is prescribing is best for that patient? What if after those 15 minutes he underestimates the turmoil of a patient? What happens if a patient really no longer needs medication, but this can’t be determined within 15 minutes? Then what happens to that individual? All because there is no longer enough time due to the fact that he wants “to keep the kind of lifestyle he was accustomed to before the insurance industry made sweeping changes in the 1990s and 2000s.” Don’t get me wrong, I am not blaming Dr. Donald Levin for his actions. He has every right to keep living as he once did, but I believe mental health professionals must come together, and quickly, in an attempt to fix this system before the situation becomes even more out of control.
6 years 8 months ago
This is really shocking to me.  It does not seem possible to help people in a 15-min. session even if they are prescribing medications to "help".  There are a lot of things that need to be treated not only with medications but also with talk therapy.  This article I found talks abou the 15-min. medcheck, as well as the author's negitive view on it.
6 years 8 months ago
Katie (#37)- I think your line “It’s a tricky situation and a fine line between doing something quick just to get it done and doing something quick because it is correct” sums it up quite perfectly. As future mental health providers, it should be our duty to draw the line at engaging in this practice, because we understand the importance of utilizing psychoanalysis in addition to medicating (if necessary) as treatment options. On the other hand, after reading the New York Times article, I have a better understanding of why (some) psychiatrists have disregarded talk therapy. My interpretation is this shift has occurred as the result of what else- money issues.
 
This poses several threats to the licensed professionals prescribing these medications in addition to those who are actually seeking out mental health treatment. In recent news, a relatively new phenomenon has unfolded in which patients actively seek out prescription drugs such as Adderall, a psychostimulant commonly used to treat attention defecit hyperactivity disorder. What’s shocking to think about is people are actually establishing plans to deceive the doctors because they know they can. I find Dr. Levin’s reality of once working to keep his patients happy and fulfilled but now must instead work to simply “keep them functioning” to be quite disturbing. In fact, it’s almost like he’s just working to meet a financial quota.
 
The Center for Disease reports that the number of reported incidents relating to the teenage abuse of ADHD prescription drugs has risen to a shockingly high rate of 76% since 2006. This means that there must be an easy outlet for teenagers to obtain these medications. Personally, I feel this is extremely scary to come to terms with, as you would think doctors would be more elaborate in diagnosing a disorder that involves prescribing mood altering drugs. It is my hope for us as future mental health providers that we will return our focus to the quality of our work, rather than be so concerned with overall quantity.
 
Check out this article from the Journal of American College Health:
 http://heldrefpublications.metapress.com/app/home/contribution.asp?referrer=parent&backto=issue,8,20;journal,13,81;linkingpublicationresults,1:119928,1
 
-Very interesting on the misuse of ADHD medication on college campuses!
6 years 8 months ago
Colleen (#56),  I appreciate your pointing out that for schizophrenia and some forms of bipolar disorder the medications can be a godsend.  That point seems to have been lost in this discussion.  When your adult son is found walking on the freeway thinking he is on the way to Cleveland 2000 miles away, one doesn't have many options if you want to keep your son alive.  I don't know that insight oriented therapy would be of any use for people with schizophrenia.  I found that the combination of the psychiatrist's management of the meds and getting supportive counseling from a licensed social worker works well for him, as long as I am involved in monitoring it all.  That is not possible for many families of mentally ill persons because of their civil rights and the ensuing restrictions on sharing information. One has to obtain conservatorship and how many people are able to do that?

I agree with you about the need for incorporating spirituality in mental health practices.  Many people gain great comfort and support from their spirituality.
Thanks!   Janice
we vnornm
6 years 8 months ago
Talia,

Your article takes us in an important direction-examing how primary doctors follow the treatment guidelines set ouit by the American Academy of Pediatrics in treating ADHD; how many use medication, regular meetings, follow-up, behavior therapy. Thanks!
we vnornm
6 years 8 months ago
Kayna,

Thanks for the specific figures. The dollar figures you cite give us an even better idea of the different in reimbursement between talk therapy and medication management. You picked good journals and this makes the numbers you provide even more solid. I suspect the prices have gone up in the few years since publication. best, bvo
Alyssa Cariani
6 years 8 months ago
http://answers.yahoo.com/question/index?qid=20091028092722AAGwHCs

I know this is yahoo answers, but the person writing is a counseling student from Canada. He provides reasons why fewer and fewer psychiatrists provide counseling, although they are fully qualified to do so.
The reason i post this article is because i have had my own experiences in this area. I admit that i do attend a psychiatrist. I remember days when he used to ask me about how I was doing. We would have great discussions where he would truly listen. Now, however, he seems to shut down when i talk about what's going on. He immediately brings up meds in an attempt to change the subject. This is confusing to me because life events are so important with what type and how much medicine a person should take. This seems counter-intuitive.
Samantha Rooney
6 years 8 months ago
http://www.scientificamerican.com/article.cfm?id=psychiatric-drugs-replacing-talk-therapy

I found this link interesting because it discusses how insurance companies may add to a psychiatrist's pressure by reimbursing less for psychotherapy sessions, rather than medication management sessions.  Between 1996 and 2005 the percentage of psychiatry office visits involving psychotherapy decreased from about 44.4 percent to 28.9 percent.
6 years 8 months ago
Some final thoughts on this subject  (when have I ever had final thoughts on anything!):

I first read the NYT article on Evander Lomke's blog for American Mental Health Foundation, "It's the Money Stupid" (3-5-11) and then read it in our local city newspaper in the Business Section.  Yes, the Busines not the Health and Well-Being Section.  That tells us something about how the profession of psychiatry is regarded by some:  a business not a healing profession.

Bill, from my CPS experience I completely agree with what you wrote in your AMHF blog:  "Infants, Toddlers and Mental Health Treatment" (2-27-11).  Given that there are only 1,000 board certified child psychiatrists in our country, treatment for these very vulnerable children has to be picked up by other healing professions.  Foster care needs to be therapeutic rather than just custodial.  There are a few foster care agencies here that provide more intensive services to foster children than the ordinary foster homes.  The need is for many more.  Also there is need for more facilities such as Astor in NY and San Pasqual in SD County.  Another of your AMHF blogs, "States Cut Mental Health Funding"  (2-21-11) highlights how many states have severely cut funding.  This is a tragedy for the children and their families who so badly need mental health treatment.  Please keep writing on this subject.  Janice
6 years 8 months ago
Some final thoughts on this subject  (when have I ever had final thoughts on anything!):

I first read the NYT article on Evander Lomke's blog for American Mental Health Foundation, "It's the Money Stupid" (3-5-11) and then read it in our local city newspaper in the Business Section.  Yes, the Busines not the Health and Well-Being Section.  That tells us something about how the profession of psychiatry is regarded by some:  a business not a healing profession.

Bill, from my CPS experience I completely agree with what you wrote in your AMHF blog:  "Infants, Toddlers and Mental Health Treatment" (2-27-11).  Given that there are only 1,000 board certified child psychiatrists in our country, treatment for these very vulnerable children has to be picked up by other healing professions.  Foster care needs to be therapeutic rather than just custodial.  There are a few foster care agencies here that provide more intensive services to foster children than the ordinary foster homes.  The need is for many more.  Also there is need for more facilities such as Astor in NY and San Pasqual in SD County.  Another of your AMHF blogs, "States Cut Mental Health Funding"  (2-21-11) highlights how many states have severely cut funding.  This is a tragedy for the children and their families who so badly need mental health treatment.  Please keep writing on this subject.  Janice
Katie Bianco
6 years 8 months ago
According to an article I found, http://psychology.about.com/od/psychotherapy/f/psychvspsych.htm, there are only a few distinctions between psychologists and psychiatrists.  The first focus was that psychologists receive a certain amount of schooling, receiving either a Ph. D. or a Psy. D. that require at least 5 to 7 years of school and training whereas psychiatrists must go through the M.D. process and residency for mental health training which can take the time span of medical school plus 4yrs of residency.  
A link to another site from that page, http://psychology.about.com/od/psychologycareerprofiles/a/psychiatrist.htm, also discusses the roles of a psychiatrist.  According to the article, it sounds as though the role of a psychiatrist is very similar to a psychologist in that therapy sessions, counseling and talks with the clients are essential to the client - therapist relationship along with the ability to prescribe medications when necessary.  It seems as though this 15 minute therapy is a new technique being tried out.  One that isnt necessarily taught but being used in this day and age to keep up with the fast paced lifestyle we all lead.
we vnornm
6 years 8 months ago
Vanessa,

Many others in the mental health field write about resiliency, optimal functioning, fulfillment, actualization and other concepts so it it indeed saddening to me also when we set the bar at treatment to be for "functional." The field can aspire to better. tx bvo
we vnornm
6 years 8 months ago
Janice F. #66:

It says alot about how needy and lonely people are that anyone would use an Internet site such as you use as an example. Now there may be ways the Internet can be put to good use by therapists (and I would like to see examples of them) but they would have to involve credentials, professional ethics, and security. How would someone know who is at the other end of the internet connection? Although the payment area for the site you mentioned is secure with payPal (htts: no http:) there is no assurance that communicating via Skype offers any confidentiality (nor do cell phones or email.) bvo
we vnornm
6 years 8 months ago
Dr. Chris:

Thank you for letting us know about your practice and the combination of approaches being used. I wish you success in your work. thanks nfor reading. bill
we vnornm
6 years 8 months ago
Allyse #51:

Not off topic at all. The pharmaceutical companies no doubt have a huge infliuence and I suspect this includes to well-paid lobbyists in Washington who are engaging legislators to persuade them on the benefits of medication over psychotherapy. Thanks for sharing your source. bvo
we vnornm
6 years 8 months ago
Lynde #53:

I'm glad that you mentioned centers for autism where the treatment will be cognitive behavioral therapy (CTB)-not specifically talk therapy although that can have its place especially when talking with parents about the emotional repercussions and stresses they experience. Often the psychiatrists lack training in behavior therapy-especially intensive adaptive behavior therapy (ABA). It's important to point out that the training of psychologists prepares them esepcially well in many case to undertstand the wider meaning as well as the specific details of intensive behavior therapy. Psychologists learn research and statistical methods which help in evaluating interventions (RTI-response to interventions). And psychological testing and assessment must often be adapted. See books by Foxx and Azrin, Increasing the Behaviors of Severly Retarded and Autistic Persons and Decreasing the Behaviors of Severely Retarded and Autistic Persons. I hope you decide to stay in this specialty as you will be able to help many children, adults, and families. bill
we vnornm
6 years 8 months ago
Kailee #54

Thanks for providing some further substantial information which gives further validation to the entire discussion. It's important to find as many sources as one can with complicated issues. New York Times (or "In All Things") is not the last word. :-) bvo
we vnornm
6 years 8 months ago
Victoria,

Sometimes I wonder if the teaching field is going to go the way of psychiatry-less interaction. Now technology can be a good thing but do we really want third graders staring at tablet computers for hours and hours? There seems to me to be a rush to embrace technology withlut concern for that "law of unintended consequences." We've heard alot in the news about how boards of education need to cut school budgets. Will education start to use some of the techniques of the m.d. featured in the NY times? bvo
we vnornm
6 years 8 months ago
Colleen #56,

I have incorporated "spiritual health" into the blog that will appear on Monday March 28th. Thanks for bringing awareness of this interaction. bill
Janice Feng
6 years 7 months ago
Prof. Van Ornum-#74

I would be worried about the confidentiality of having such a personal conversation/therapy session on Skype. It is still unknown whether or not the company themselves can listen to conversations held via Skype. The Chief Security officer of Skype was quoted on saying "I will not tell you whether we can listen or not." I also found an article from November 2010(attached below) stating then new legislation being devised by the Obama administration. The new legislation would allow the governement to monitor/listen in on social networking sites such as Skype and Facebook in order to prevent terrorism. Such possibilities of lack of privacy already have me worried about my participation in Facebook. I would then certainly not be comfortable or willing to increase the possibility of having a conversation such as one I would have with my therapist be breached. If I were to be at the point where I need a therapist, I would definitely put a little more effort in seeking out face to face(in person) interaction. I believe that the physical presence of another allows a connection between the professional and client to be made that cannot be created through a computer screen.

http://www.standard.net/topics/features/2010/11/01/worries-arise-about-possible-government-monitoring-social-media
Katrina Ferrer
6 years 7 months ago
The Recession is on, and mental health care is on the chopping block. It is sad to think that the state of being of the mind is being sacrificed for the almighty dollar. A sudden selfishness has taken over a once noble practice. This has turned something properly taken holistically, and professionally for the betterment of humanity and made it no less routine and blunt as an oil change. The only difference is this is about a person's  health, their mental health that, if not totally understood, could meet a disastrous fate.

Insurance company's today are all about the finding a cheaper way out. From someone who used to work in a dermatologist office, we would constantly battle insurance companies who would refuse to cover acne medication (medication that is worth in the $200-300's) to anyone over the age of 24 as they did not believe in adult onset acne. The health care industry is no longer about taking care of people but about how insurance companies can find a cheap way out. A little bit off topic, but still somewhat related, below is an article I found noting the differences between generic and brand name medicines. I've experienced having always taken a brand name medication and then no longer being able to afford it because a generic version came out and the insurance companies not only forced my doctor to prescribe me the cheaper brand but also forced me to have to purchase that as the brand name medication was just way out of control expensive!


http://www.roadback.org/index.cfm/fuseaction/studies.display/display_id/120.html

 
Katrina Ferrer
6 years 7 months ago
The Recession is on, and mental health care is on the chopping block. It is sad to think that the state of being of the mind is being sacrificed for the almighty dollar. A sudden selfishness has taken over a once noble practice. This has turned something properly taken holistically, and professionally for the betterment of humanity and made it no less routine and blunt as an oil change. The only difference is this is about a person's  health, their mental health that, if not totally understood, could meet a disastrous fate.

Insurance company's today are all about the finding a cheaper way out. From someone who used to work in a dermatologist office, we would constantly battle insurance companies who would refuse to cover acne medication (medication that is worth in the $200-300's) to anyone over the age of 24 as they did not believe in adult onset acne. The health care industry is no longer about taking care of people but about how insurance companies can find a cheap way out. A little bit off topic, but still somewhat related, below is an article I found noting the differences between generic and brand name medicines. I've experienced having always taken a brand name medication and then no longer being able to afford it because a generic version came out and the insurance companies not only forced my doctor to prescribe me the cheaper brand but also forced me to have to purchase that as the brand name medication was just way out of control expensive!


http://www.roadback.org/index.cfm/fuseaction/studies.display/display_id/120.html

 
we vnornm
6 years 7 months ago
Janice #81,

One thing I have seen questioned is the extent of Facebook's ability to monitor a person as they browse websites...it is something to think about when you use sites like this. There must be immense profit in being able to provide data about subscribers....onen must ask why a site like Facebook is "free"...they must be making billions of dollars through advertising, etc. bvo
we vnornm
6 years 7 months ago
Katrina #83,

We seem have evolved into a wider (and relevant) theme concerning how mental health services and health services are changing to accomodate economic trends. "The devil is in the details" whenone studies this; it is important and details such as you provide are helpful not only to consumers (as we all are) but in understanding the entire system. bvo
we vnornm
6 years 8 months ago
Robert,

Conversely, I wonder if making "economic cuts" within healthcare to make healthcare more affordable may also dilute professionalism. Very tricky, as many opine that the proferssional associations themselves became financially-oriented rather than patient-quality driven. bvo
William deHaas
6 years 8 months ago
Mr. Van Ornum - interesting story but it is 20 years late.  This shift has been occurring since the early 1990's.  Would suggest that you need to add and make a number of clarifications:
- even in the 1980's, very few psychiatrists did actual talking therapy and it was usually based on Freudian analysis (which is rarely used these days or covered by most insurance companies)
- most good talking therapies have transitioned to brief therapy models that target depression, anxiety, etc. and trained psychologists and social workers, LPCs, LMFTs, etc. do a very good job with therapy
- good behavioral health companies have moved to networks of counselors who are primarily master or PhD and trained in specific brief therapy models.....evidence based research and outcome studies have proven this approach
- psychatrists are primarily used to do inital psych assessments; determine the need for psychotropic medication, and then manage that treatment in conjunction with a talking therapists.  Again, national evidence based research indicates that medication with talking therapy is the best in terms of outcomes
- most psychiatrist work in facility based higher levels of care or in practices that manage psychtropic medications (both mental health and substance abuse)
- in fact, in the past three years there has been a significant increase in medications to treat substance abuse managed by psychiatrist
- there is an increasing shortage of psychiatrist esp. child/adolescent....waiting times for appointments can be long  (so, add in MDs doing therapy and you would only exacerbate the current issues)

So, again, interesting story but it would be relevant in 1990; not now.
we vnornm
6 years 8 months ago
Ed,

I sincerely hope psychologists/nurse practitioners receive the same high level in side effects as well as the systemic effects of using powerful drugs...sometimes it amazes me that psychologists want to take over the specialty of another profession when they have a powerful craft of their own-psychotherapy-which continually needs restudy and scientific review. I hope the VA's and miitary are not doing what they do as a cost cutting measure. I have great respect for pscyhiatry and have worked closely with a number of exceptional psychiatrists. I think it's difficult if not impossible for another profession to duplicate their training and experience. best, bill
Beth Cioffoletti
6 years 8 months ago
Do the skills (and talents) of a good talk therapist require, and correlate with the skill (and talent) of a medical doctor?   Is the doctor who can prescribe the correct medication the same one who can plumb the depths of the psyche?

Do the psycic and physical manifestations of imbalance require separate treatment?

I have a lot of questions :-) ... leads me into thoughts about healing and how we can best offer healing to each other.  I wish that the discussion didn't always revolve around money, compensation and financial efficiency.  Do you suppose that financial insecurity is at the root of our inability to be more creative in solving some of our problems? 

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