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 … Continue reading “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?

Memorial Health System – Committed For Your Well Being

Hospitals and clinics all over the world are now moving towards a more wholesome approach as far as treating their patients are concerned. They seem to be focusing on complete solutions, offering their clients treatments as well as services related to it rather than just the treatment itself. Quite obviously, patients too seem to prefer clinics and hospitals such as these as they make everything simpler.

Complete health care

Clinics in Orlando are now offering complete health care solutions to all of their patients. Most hospitals now have stroke care, surgical centers, diabetic centers, rehabilitation centers and even a Heart Center in Florida. Providing you with all these services under one roof make it easier simpler as you only need to have one medical center that you visit for any sort of health problem.

Family services

The provision for complete family healthcare is a major deciding factor when most people choose a clinic or a hospital. It is easier to have one physician to take care of your entire family than to visit multiple physicians. Most clinics in Orlando understand that and therefore they ensure that they have some of the best family care physicians working with them, like Dr Seema Kamat for example. Clinics make sure that they have good doctors as their patients’ welfare takes importance over all else.

Extra services

In addition to just healthcare clinics in Orlando also offer additional services like laboratory services and sometimes even a diagnostic imaging center. These services as part of the facility not only save patients a lot of time, but a lot of anxiety and trouble as well. A laboratory and a diagnostic centre on the premises means that the patients and their families can get results and reports faster than they would if they were to get it from an external lab.

Multiple locations

In order to provide you with the best possible service even when you travel clinics now have branches or tie ups with other clinics in various part of the country. All of this is done in an effort to ensure that you have the best care no matter where you go. There are some clinics in Orlando that even have affiliations to clinics in Gulf Coast. With these kinds of affiliations and tie ups you can be assured that you have the best treatment at all times.

Health Informatics Specialists Are Essential to Reform and Transform Our Health System

Much of the American health system is outdated, inefficient and excessively expensive. Many have written about what is wrong with our system, and how important is the process of health reform. But relatively little has been written about what is required to improve the care of all Americans, and how we are to arrive at comprehensive solutions that both disrupt our current system of care, and replace it with improved approaches. One thing we can be certain about is that any changes that we make will be dependent on our capacity to harness information technology, and to use computerized systems intelligently to reform and transform our patient care environments and processes.

Clayton Christensen, in a recent ground breaking book, “The Innovator’s Prescription”, has argued that disruptive innovation is now necessary in our health industry and that this consists of three elements. The first requirement is for sophisticated technologies to simplify healthcare processes, the second is for business models that deliver more affordable and patient focused solutions, and the third is a commercial and information infrastructure to act as a value-added network.

For this vision to be implemented at a practical level, his model requires strong leadership and the training of substantial numbers of health informatics and change implementation specialists to take up transformative roles within our healthcare system.

Let’s look at how this model might work for the average American academic medical center currently trying to provide a full range of sophisticated medical services while using our antiquated and exponentially increasing fee-for-service cost model, and running a series of regional primary care clinics.

The first element is to implement sophisticated technologies to simplify healthcare processes. This includes a full electronic medical record, accessed by patients and clinical staff, available anytime anywhere, sharing data with competitors systems, fully available for research and clinical trials and including a sophisticated set of decision rules to assist all users. This academic center would have extensive telemedicine and internal and external communications systems, online platforms for all types of continuing education, and an active virtual community profile and social networking program. All of the technologies would be continuously improved and evaluated by a team of health informatics specialists, part of whose role is to train their colleagues and the next generation of change implementation specialists.

The second element is to transform the clinical and cost-approach taken by the medical center which will need to focus on specialized areas of internally acknowledged strength to become, as Christensen notes, a “solution shop” in its areas of strength, while no longer providing a full range of all types of medical and surgical services. This may mean dropping certain types of care completely, and negotiating for such specialist services to be delivered at another hospital instead. It may mean creating specialist community clinics with capitated payment models. It will certainly mean doing more of what it does well, and less of what it does not see as core clinical activities. It means taking on services that are already efficient and technologically supported, and adding value to these services through technological and clinical innovation. This second element requires both business and technological expertise.

The third element in the model is developing what Christensen calls “facilitated networks” which he defines as enterprises in which people exchange things with each other. This is where the academic center might decide to partner with previous competitors, promote pre-paid preventative health approaches, support health savings accounts linked to employer groups and encourage all patients to have personally controlled health records. All of these activities are underpinned by the need to have extensive expertise in health informatics – the discipline that is, above all others, required to transform American healthcare.

So the question is, can a modern academic medical center in the USA afford to be without a strong health informatics program as it moves forward in this era of health reform?

And the answer?

A resounding “No”.