Search This Blog

Friday, December 21, 2012

Psychiatric Care in the United States

Dr. Ablow who I quoted a few days ago says this about improving mental health care in the United States. Here's the current state of affairs:
Social workers, psychologists, nurses and non-psychiatry physicians can each have an extremely important role to play in rendering care to psychiatric patients, but they should not be the orchestrators of such care.

Largely to save money, insurance companies are most responsible for decimating the mental health care system in America by demanding such low payment scales that social workers and nurses have been trying to do the heroic work of trying to act like psychiatrists, while psychologists have been agitating for the right to prescribe medications so they can make more money and while internal medicine physicians and family physicians have too often tried to treat complex mental illnesses with medications alone, ignoring the fact that psychological factors fuel those illnesses and must be addressed.
And his proposal for improvements? He includes psychiatrists regaining supervision of patient management (as opposed to undertrained social workers), that insurance companies be required by law to cover monthly visits instead of quarterly visit, that insurance companies don't force hospitals to discharge mental health patients prematurely, that long-term psychiatric care be expanded in each state to save both hospitals and insurance companies the added expense by charging fees on a sliding scale dependant on patient income, the development of a "violence assessment tool" to better track patients highly at risk for injuring themselves or others, enforced treatment of those who have committed violent crimes with mental instability, etc.
All this would be a beginning. We have allowed the disassembling of the mental health care in America, giving into the lowest common denominator of treatments and handing control of our gutted system to insurance companies and drug manufacturers. Some may argue we did this in hopes of dialing back overzealous treatment strategies during the period of "deinstitutionalization." But I believe the real decline was fueled by the stigma still indefensibly associated with mental illness. Because such a shoddy system of care would never be allowed to exist in the world of cardiology or endocrinology or oncology.

This is by no means a complete plan. Elements of it may be challenged, and should be challenged. I hope others could contribute more creative and comprehensive solutions to some of the shortcomings I have noted.
Read more of the details yourself.

No comments:

Post a Comment