Remember when your psychiatrist would actually talk to you and provide therapy before handing out a script for medication? Yeah me neither. Yet back in the heyday of psychotherapy, it was a psychiatrist who usually conducted this type of therapy. But those times are long over. In a provocative article published in early March in the New York Times entitled, Talk Doesn’t Pay, so Psychiatry Turns Instead to Drug Therapy, author Gardiner Harris points to the changes in insurance reimbursement as the cause of the decline in psychiatrists who treat patients with psychotherapy. Talk therapy simply doesn’t pay. What does pay? Most psychiatrists nowadays write prescriptions to earn their salary.
This trend towards promoting drug therapy as opposed to talk therapy began in the 1980’s if not sooner. I was a witness to it. When I was a teen I would wait in the waiting room for my mother, who suffers from schizophrenia, when she had an appointment with her psychiatrist. When she would emerge some thirty minutes later I would marvel at how a doctor could spend so little time with her when she had so many challenges to discuss. When I would ask if the doctor had helped her, my mother would show me her prescriptions for new medications. It soon became apparent that there was very little therapy going on. Instead there was an over reliance upon drugs to treat her mental illness. What I didn’t realize then was that her thirty minute session with a psychiatrist was luxurious compared to what we are able to receive today.
Today the trend is for psychiatrists to provide brief consultation visits for 15-minutes or less to their patients. As the New York Times article points out, doctors make more money this way. Why spend 45-minutes with a patient earning less than $100 when you can make $150 dollars for seeing three patients for 15-minutes each for a medication consult? In essence, the insurance companies are dictating which treatment options you will likely receive if you visit a psychiatrist. In my opinion, it has produced a mental health system where doctor’s offices are becoming prescription mills. Volume is key so you are just one of many who go through the mental health revolving door, here is your prescription, now get out. It is of little wonder that so many of us find the system cold and impersonal. Who is taking the time to get to know us as people?
I don’t need to tell you about the inherent dangers in this prescription mill mentality which seems to dominate our mental health care system. For example how does a psychiatrist arrive at an accurate mental health diagnosis for a patient within a first initial visit? It seems incredible that a mental health diagnosis could be given in such a short time. An assessment leading to diagnosis used to take weeks or months but is now taking less than 45-minutes. Again, the insurance companies dictate that if the doctor wants to get paid, a diagnosis must be made quickly. This is leading many mental health professionals to make light of or disparage the integrity of an accurate diagnosis. I had one therapist tell me that he needed to put down something for my diagnosis so he gave me several choices and told me to pick one. It makes one wonder if there is any usefulness in a diagnosis other than as a way for the mental health practitioner to get insurance reimbursement.
