Tuesday, April 22, 2014

Can you Know if a Broken Mind is Healed? Thoughts on Mental Health Care Parity

"President Obama’s latest effort to divert public attention ignores a fundamental problem: it’s much easier to know when a broken bone has healed than a broken mind.  That ambiguity opens the door to overtreatment and fraud." - Forbes.com, "New Mental Health Mandate Will Make Obamacare More Expensive, Increase Fraud And Canceled Policies"


Image courtesy of Ambro / FreeDigitalPhotos.net

Before you assume that all of us therapists are out there for your time and money, please take a deep breath and consider the benefits of mental health parity.

Now, I am usually all for a more conservative approach to treatment, both medical and psychological. A good counselor will know when a client no longer needs treatment. A great counselor will actively work with a client to ensure that they are not in treatment longer than is absolutely necessary for his or her health. 

Having an academic and professional background in counseling, I am trained to assess, conceptualize, and put together treatment plans for my clients. Sometimes symptoms warrant a diagnosis, but when diagnosing can be avoided I am of the camp that believe that it should. It stands then to reason that many would find it suspect that one's treatment can be ever finished; if the problem has no name, how can there be a treatment? If there is no standardized treatment, how can you know what a successful outcome would be? And if you can't measure the outcome, how can you ever truly be finished?

 If you are seeing any professional counselor, you have the right to know what treatment modality your therapist is using, and you should ask him or her. All licensed therapists are required to use only empirically supported treatments that are appropriate for your unique situation, and have been shown to be effective. Similar to doctors who have taken the Hippocratic oath, counselors too are ethically bound to do no harm to clients and provide only treatment that is efficacious and appropriate. That is not to say that there aren't swindlers out there, but to view the profession as fraudulent is grossly untrue.

Regarding length of treatment, if you, the client, never left therapy, it would mean that our work together isn't really working, and that would make me, the therapist, a failure. And trust me, therapists do not want to fail their clients. Long gone are the days of psychoanalysis which took years to finally uncover the unconscious. Today, most providers utilize brief and concise empirically supported treatment modalities that are specifically designed to achieve symptom relief quicker and more efficiently. 

Treatment outcomes are not vague, in fact, they should be specific and discussed from the initial session. So if you are concerned that you will be stuck forever in treatment, make sure you know what it is you hope to accomplish...For some the goal is less frequent arguing with a spouse. For others it is being able to go from a 6 on a scale of sadness (1-10) to a 3. There are measurable goals in therapy, and if you are working with a good therapist they are attainable.

In previous posts I address the stigma of mental illness and the difficulty many have in getting treatment. Sometimes the difficulty lies in treatment being not affordable, or simply not covered by insurance. Is it possible that some people in this country take advantage of benefits? Yes. However, with 1 in 4 of us experiencing clinical depression in our lifetimes, to ignore the necessity and validity of therapy would be unethical. And yes, it is true also that there are professionals and paraprofessionals out there who would gladly take advantage of you and keep you coming as long as they could. But then again, don't we see that with nearly every other profession, too? 

There is a fine balance between appropriate treatment and over treatment in both mental and medical healthcare. However, there are far more serious and sincere medical and psychological cases that need attention. As long as health care professionals are held accountable for the efficacy and necessity of their treatment, mental health parity should help our neighbors get back to living and loving the life they have.

Thursday, April 17, 2014

In response to Fort Hood: Are Counselors Doing Their Job?

Image courtesy of Gualberto107 / FreeDigitalPhotos.net

After the news of the Fort Hood shooting perpetrated by Spc. Ivan Lopez, who was being treated for anxiety, depression and evaluated for post-traumatic stress disorder, many have speculated about the quality and efficacy of care being given to our veterans. To the lay person, it seems that the mental health system failed not only Lopez, but his victims and their families. How could someone in treatment commit such heinous crimes? Certainly the counselor must have missed some major red flags, or perhaps therapy just doesn't work at all.

As a counselor who has worked directly with individuals struggling with anxiety, depression, and post-traumatic stress disorder, I can assure you that therapy does work. Can it work miracles? Can it work for everyone in every situation? Perhaps not. But study after study, year after year, support the efficacy of mental health counseling overall. In fact, with roughly 25% of the country meeting diagnostic criteria for a mental illness at any given point, therapy is a vital part of the healthcare system and integral in helping individuals, couples, and families live productive lives.

The real issue is not whether or not counseling in and of itself works; the bigger issue is whether or not the counseling at Fort Hood works. Recall that Fort Hood had previously experienced a massive shooting in November of 2009, ironically perpetrated by a psychiatrist. In an article from WDN by Chelsea Schilling, an independent news network, the limitations and barriers to quality mental health care are discussed in detail. Shockingly, Fort Hood has been using free tests found on the internet to evaluate the psychological health of soldiers. Not only is this unethical, as these free tests may not have been designed for such purposes, but this is preposterous. Psychological tests are created by seasoned researchers, and take years and several trials before being widely used as measures for a given diagnosis. They are statistically proven to be both valid and reliable, and cost money in part due to the extensive research that goes into their development. While I am not saying that Fort Hood is using any old test found online, it is troubling that their mental health department is not utilizing, perhaps due to budgetary confinements, proven methods of psychological testing. If we ourselves needed medical attention, we would not want our diagnosis or condition to be evaluated by methods that have not been proven effective or valid. Why would we ever think it is okay to use potentially ineffective tools to treat mental health issues?

Furthermore, inadequate funds are perhaps the least of the barriers to providing quality care for Fort Hood soldiers. Wait-lists upwards of a few months for treatment, an incredible 1 : 50,000 ratio of trained neuropsychologists to solders, and reported forced retirement of senior mental health professionals are among the short list of hurdles. This, in my humble opinion, is unacceptable. The men and women of our national services do not merely deserve respect, but they deserve to be treated for their psychological and emotional wounds with the same care and attention as they are treated for physical wounds.

As a nation, we need to be more aware of the conditions in which we welcome our veterans home, and we need to advocate for better care for them. We can start by being informed. Did the mental health system fail?I cannot say with any degree of certainty one way or another, as the details of his treatment remain confidential. However, it is clear to me that the mental health system was failed by larger systems, and has not been supported enough to provide the absolute best care to our returning soldiers.