There are dozens of empirically proven treatments for a wide range of mental disorders. Drugs. Psychotherapy. Self-help books and support groups . Other stuff. It all works, and it works even better when you combine it together. This isn’t so much rocket science any more as “common sense.”
So you’d think every family doctor and general physician out there wouldn’t just be prescribing the latest psychiatric medication to the patients who ask for it — they’d tell them they need a complete treatment program that includes a referral to an experienced mental health professional for proper diagnosis and treatment.
And, as is so often the case here on World of Psychology, you’d be wrong.
Maggie Mahar over at Health Beat has an interesting blog entry about how mental health treatment options take a back seat, entitled Evidence-Based Mental Health Treatments: Lost in Translation.
In one survey published in 2002 on depression patients, for example, prescriptions were up and people who said they went to psychotherapy went down 11%. But the survey was conducted during two specific periods of time 1987 — before the advent of modern antidepressants like Prozac — and 1997, after such antidepressants were widely prescribed. So its results may be reflective of a particular unique point in time. It’ll be interesting to see if this survey was replicated in 2007, and what those results show; I suspect we’ll see an increase once again in psychotherapy, but prescriptions keeping even pace.
This is a problem I’ve long noted — that every time a drug gets released or new research is published about it, the drug company makes sure you and everyone else knows about it. Through press releases, news brief, and numerous other strategies, drug companies’ profits depend on you getting the news.
No such incentive is in place for any type of effective psychotherapy, like cognitive-behavioral therapy. No company is making more money if you go see your therapist more often (although your individual therapist might enjoy the increase!). And while organizations like the American Psychological Association (and folks like us) try to get out the news on new psychological treatments, their marketing budget doesn’t compare to that of a dozen pharmaceutical companies’ budgets.
Sadly, given the amount of effort on a patient’s part in order to make psychotherapy work, this situation isn’t likely to change any time soon. It’s not simply about money and pharmaceutical budgets, it’s also about effort and the desire for change. Psychotherapy requires hard work, and it generally takes more time than medications do to kick in. And in America, hard work isn’t something a lot of us want to do when it comes to our mental health (I mean, don’t we work hard enough at our jobs, relationships, with our kids, etc.?!?).
Given the choice between a pill and months of hard work, most people will opt for the pill and a “wait and see” attitude when it comes to the psychotherapy. And doctors regularly reinforce this choice by not only not pushing psychotherapy as an important component of effective treatment for their mental health concerns, but also sometimes not even mentioning it.
7 comments
Um, people in the public mental health system rarely even have an option to pursue therapy so it’s a bit harsh to say patients are part of the problem because they find pills easier than therapy. Most have never had the chance to find out what is involved in therapy. It simply isn’t available. For folks outside the public system, insurance doesn’t cover much unless you can afford expensive co-pays and if you are on Medicare it only pays 50% instead of the usual 80%, some folks just can’t afford to try therapy.
I know many folks with mental illnesses of various kinds, including PTSD for which psychotherapy is the only effective treatment, who have not been able to access therapy after years of trying.
Psychiatrists and psychologists and other mental health professionals need to speak up about lack of access to psychotherapy, not just about its success rate.
I agree with the above post, as someone who would much rather do the hard work than medicate. My insurance coverage does not encourage psychotherapy. My number of sessions are limited, yet it seems as though I would be approved to take all the medication I wanted. Even though the work is very difficult, I know I receive far more benefits from therapy sessions, than I could ever receive from a pill. It infuriates me as this seems to be all about money. Psychotherapy is expensive, pills are reletively cheap.
This is why passage of a mental health parity bill into law is so important.The debate is going on now in the House and Senate. Weigh in with your congressperson! And by the way, the Democrats support this legislation, while the Republicans have largely ignored it.
Wendy Aron, author of Hide & Seek:How I Laughed at Depression, Conquered My Fears and Found Happiness.
wendyaron.com
My wife practices Psychiatry and ALWAYS includes associative disciplines whenever she sees a patient. Often the patient has been refereed by a Psychologist. Perhaps those Psychiatrists should be required to involve the other disciplines as part of their practice and perhaps the only law that should be made would be that INSURANCE COMPANIES PAY FOR ANY ASSOCIATIVE ASSISTANCE NEEDED. Yes, the Psychiatrists may complain but there are many regulations constricting their practice and this one would only improve the patients care.
I agree with the first comment that people in the public mental health system rarely get the chance to even find out what therapy is all about, much less choose whether or not they want to have it. For a fortunate few it may be the case that they have a choice, but they are probably not very representative of what it’s like for most people being treated for mental health problems today.
As with so many other things in the United States today, those with money have options but most have to take whatever is offered to them – which in the case of psychiatric treatment usually means something like drugs or ECT, and nothing else.