How Broken is the Mental Health Delivery System?

Most psychotherapists agree that the mental health delivery system is broken. Where two or more psychotherapists are gathered together, complaints abound. While this article addresses the broken mechanics is the mental health delivery system, it does not even begin to address the mishandling of individual cases.

People, in general, and psychotherapists, in particular, are afraid to “buck the system.” Fear masquerades in a variety of acting out, defensive behaviors, such as anger, denial, criticism, withdrawal and aggression.

This is especially true when discussing the managed care system. Most psychotherapists in the US have chosen to practice as in-network providers for the insurance companies. That means that the therapists have agreed to a discounted fee, in hopes of receiving more referrals, because they are in-network. It also means the therapist usually must have their services authorized prior to seeing the clients.

After all, our present mental health delivery system, which has been around since the early 1980s, has developed inbred power, not only in individuals but in the system itself. I can remember the anger of my clients 25 years ago, when the found their insurance company dictating the amount and kinds of service they could receive, but within five years, as a nation we accepted the managed care concept without a fight.

Therefore, I am challenging a very large, money-hungry system, established to feed on itself, but not adequately supply services that meet the needs of its members or the realistic needs of the health care providers.

So I challenge anyone to deny that our present mental health delivery system is fragile and broken. Here are eight reasons why;

  1. Diagnosis is made by professionals who are not in intimate touch with those individuals who come for help. Insurance companies and third party payers demand a medical diagnosis before they will reimburse for a claim, starting with the first visit. It is unrealistic that under the present delivery system today that most psychotherapists can positively and accurately determine the diagnosis code required.
  2. The diagnosis criteria often change from one edition of the Diagnostic and Statistical Manual(DSM) to the next Diagnostic and Statistical Manual, the psychotherapists diagnostic bible. For instance, a common presenting problem is identity disorder. Yet identity disorder is no longer listed in the DSM, so therapists may have to “fudge” a bit on the diagnosis…if they want to get reimbursed. Further complicating the situation is the fact that not all DSM diagnoses are reimbursible. Because many insurance companies will not reimburse for autistic spectrum disorders, therapists become creative.
  3. Thousands of individuals who need therapy are not receiving it. In these economic times, small businesses are dropping health insurance as a benefit. Because of the high cost of insurance for even large corporations, many are increasing the cost of insurance to their employees, and many benefit packages have very high deductibles and larger co-payments due at the time of visits.
  4. All therapists are not created equal, when it comes to their skills. I recommend that the terminal degree for all psychotherapists (except hypnotherapists) would be a Ph.D., not necessarily in psychology. Many agencies use B.A. degreed graduates or even interns “to do therapy,” because they are supervised by licensed clinicians.
  5. Costs of our present mental health delivery system are often prohibitive, while third party payers often offer fewer benefits with higher deductibles for mental health. Mental health still appears in all practicality to be exempt from the Parity Law. My personal clients generally have seen higher co-payments for specialists (mental health is a specialty), while being given unlimited visits. What my clients do not realize is that some of them are paying almost my entire fee, leaving the insurance companies responsible for $10 or $15 per session in many cases.
  6. Managed Care companies often outsource their customer service to India, Argentina or the Philippines, and benefits are quoted inaccurately by people struggling with basic language skills.
  7. Some of the largest managed care companies simply require a completed computerized form to obtain an authorization for service. Upon submission of the form, initial visits or additional visits are granted automatically without any human review. I assume that there is a pre-set criteria, set by the company, that must be met for this to happen. In some cases immediate authorization is not given but forwarded for further evaluation by a live body.
  8. Most important of all, mental health care is not directed by the client and the health care professional. Until 2010, therapists could see individuals for a specific, often limited number of sessions based upon their insurance benefit package and/or the authorization from the insurance companies. Furthermore, many therapists feel that therapy is something that is done to the client, rather than building a partnership for brief therapy treatment planning.

If this does not mean the mental health system is broken, what does?

Nursing Careers – What Is Mental Health Nursing?

Mental health nursing is a field of nursing that delves into psychiatry, caring and assisting mentally challenged people. A mentally ill individual requires a lot of caring, empathy compassion and support in addition to administering treatment. Since mental patients are often stigmatized, supporting them and making them feel important restores normalcy the patient had before hisher illness. Common mental disorders include Alzheimer’s, dementia, bipolar disorder and epilepsy. A complete list of mental ailments can be found in the Diagnostic and Statistical Manual of Mental Disorders.

The stigma associated with mental health is gradually reducing thus there is an increase in the demand for mental health nurses and psychiatrists. A mental health career is satisfactory personally and financially it has its perks even though it is complex and demanding as it involves dealing with the human mind. Nurses specializing in this field have been quoted as earning over $80,000 dollars a year besides having same number of titles as a doctor.

Mental health nurses are required to have an impeccable knowledge of human behavior in order to be able to handle violent patients. They also need to have knowledge of the law as it will benefit them when dealing with police or other relevant authorities.

To become a mental health nurse one is required to possess communication and interaction skills such as listening, talking and writing in addition to knowing medicine and anatomy. One is required to also be empathetic and understanding because of the nature of patients being dealt with. Mental patients need help in doing ordinary tasks such as bathing, grooming or engaging in leisure activities. They need to express their thoughts like everyone else so a nurse should be prepared to listen to them without being judgmental. The nurse should also be prepared to support the patients through therapy in order to ensure their recovery. Thus one should carefully consider why he/she should become a mental health nurse and not do it just because of the money.

The career path to becoming a mental health nurse requires four years degree training course and to be a registered nurse. The syllabus includes biology, nursing theory, stigma, discrimination, law and policy, psychotherapy, developmental psychology, team- working and care management. After that, you need a master’s degree in order to become anAdvanced Practice Registered Nurse (APRN) or Psychiatric Mental Health Nurse Practitioner (PMHNP).

Advanced Practice Registered Nurses (APRNs) assess clients, create healthcare plans and ensure all the patients’ needs are catered. They also meet with the patient’s family and assist in communication between all parties and the doctor in charge. In addition, they can arrange for counseling sessions and run group therapy sessions.

A PMHNP is concerned about improving the patient’s physical health besides bettering a patient’s mental health. A PMHNP also needs to know substance abuse counseling because many patients try to self-medicate with drugs or alcohol.

A Registered Nurse with experience in mental health nursing can sit for the certified Nurse Specialist in Psychiatric Mental Health (CNS-PMH) exam. This certification can help one in getting a pay increase. There are also some mental health nursing programs available online.