When will the American health care establishment stop distinguishing between mental health care and physical medicine? I cannot even number how many of my friends and relatives have run into this lack of integrated care which is causing daily tragedies in our country.
This post isn’t going to be eloquent. I may not be sufficiently articulate in my arguments. I’m basically going to lay out the observations I’ve made in the past few years.
1) Many HMOs have psychiatrists and therapists on staff, but they are not available to patients except for employees. Kaiser Permanente is one of the few systems where I have witnessed a network of therapist, psychiatrist, and primary care physicians who actually coordinate their care in-house.
2) If a patient requires mental health care, the referring physician often has no list of appropriate, pre-screened providers. This includes OB/GYNs who do not have connections to specialists in prenatal depression and OCD.
3) mental health insurers do not provide accurate or useful lists of in-network providers. Often, the list of providers will include research scientists who are not clinicians. Moreover, records of who is available to see new patients are not kept. I have known people to call six or more therapists before finding one who is currently practicing, has a clinical practice, and is available for new patients. Imagine doing this while having a depressive episode and crying hysterically.
4) There are very few therapists and psychiatrists actually included in mental health insurance systems. Many providers do not know how to register themselves with insurers or find the process too burdensome to do so.
5) Mental health screenings are not included with primary care except for postpartum mothers.
6) Primary care physicians fill or refill medications–for sleeplessness, depression, anxiety, or other ailments–without providing information on how therapeutic interventions might resolve these problems. They are also poorly trained in prescribing for psychological ailments which may require two or more medicines working together.
7) Mental health impacts physical wellbeing–whether it’s because of the exhaustion brought on by OCD’s vigilance and compulsive checking, the risky behaviors sought in mania, the hallucinations of severe postpartum
psychosis, or any condition which impacts the ability of a person to take medication on schedule… I think you get the idea.
8) Many ailments have physical and psychological components and need to be treated holistically. Fibromyalgia is an obvious example of this, but there are also psychological components to many acute and chronic diseases (like diabetes) which are frequently ignored.
9) Many mental health insurers have a limit in the number of appointments a person can have have, irrespective of progress or diagnosis.
10) Poorly treated mental health predisposes individuals to joblessness and homelessness, with even less access to needed resources.
I’m done venting for the moment and am hoping to hear some opinions from others out there.
Update: a friend sent me a great opinion piece from CNN.com by Patrick Kennedy on this theme. Find it here.
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I have 3 boys in talk therapy with psychiatrists and I’ve been pleased with the “experimental” program they are in at UCLA. I would like to see more of that as a normal occurrence. If/when they need meds, the people who prescribe them actually know them and are able to see for themselves on a weekly basis how things are going.
I’m also thinking there is a need for a sort of medical mom. A lot of people have trouble keeping up with their medical issues and appointments. I know I let more time go by than I should between visits to the doctor and I think I would benefit if someone was watching out and paying attention other than me. If that person was not only a professional nagger and appointment keeper, but also understood how multiple issues might actually paint a larger picture and be able to identify things we may be missing because we don’t have that broader knowledge, it would save, or at the very least, improve lives.
P.S. I checked and medicalmom.com is available for a measley $1895.
I am totally with you about the Medical Mom need. It can feel like a full-time job to manage even non-life-threatening chronic health needs due to poor
bureaucracy, poor communication, and non-integrated resources. It can be overwhelming for even extraordinarily capable people to keep track of health maintenance visits, locate the best resources, take medications if needed, keep on top of innovative treatments, and get it all paid-for.
It sounds like the UCLA program the kids are in is terrific. I think that there are simply not enough places which integrate prescription care and therapy under the same roof, whether in the form of a psychiatrist or a well-coordinated practice of therapists and psychiatrists practicing together.