This post was written by Dr. Misty Hook, and was originally published on the Counselling Resource website. It is a followup to her post, The Pay is the Thing. A licensed clinical psychologist in private practice in Texas, Dr Misty Hook received her PhD in counseling psychology from Ball State University. She was a professor of counseling psychology at Texas Woman’s University for five years where she taught classes in counseling, family psychology, social psychology, the psychology of mothering and gender issues. Her areas of specialization include families, couples, gender issues and giftedness and she has several publications in these areas.
The government is a major player in the future of healthcare, so mental health professionals must engage it if we want to make a larger difference. In order to do this, we must let go of our differences and unite so that we can speak with a loud voice.
My post on mental health reimbursement got a lot of buzz. While the response was more than I thought it would be, the intensity of it isn’t surprising. Most of the mental health professionals I’ve had contact with are confused and upset and rightfully so. Just at a time in which we thought we may finally get our due and be able to help in the ways we know we can, insurance reimbursement has gone down and that may only be the beginning of the changes negatively affecting our field. That was the rationale for my blog.
So what are we to do? Many of the commenters suggested that mental health professionals should simply stop accepting third party reimbursements and no longer work with insurance companies. Not participating in insurance panels is a very valid vocational option. People who work outside of the insurance system make excellent points about confidentiality, being paid what we’re worth, and the freedom to make clinical decisions based on what is best for the patient instead of what’s good for an insurance company’s bottom line.
However, as valid a choice as it is, let’s not pretend that having an exclusive fee for service practice is something that will solve the mental health crisis we have in this country. Fee for service is a system that addresses the mental health needs of patients who can afford it. Sure, many of us can and do offer pro bono services but, if we are to make a decent living, those patients cannot be the lion’s share of our practice. Thus, in such a system, the vast majority of people who may not even be able to afford copays – you know, the ones who probably need mental health services the most – will not get served. The same would be true for people living in rural communities which could not sustain a fee for service practice due to the low numbers.
Leaving a broken system is indeed an option but it is akin to one partner leaving a contentious argument and never returning. Sure, it stops the fighting and one person is happier but it never resolves the conflict. So, if we want things to get better for everyone – for mental health professionals and the public who needs our services – then we must figure out how to coexist in a healthy way with our partner. And that leads us to the partner with whom we must engage: the government.
A lot of people seem to believe that the government has little to do with our healthcare system but I do not believe that is the case. If anything, government is actually the driving force behind most of what we do.
The amount insurance companies reimburse for services is largely built around the program that pays for a huge share of health care in every region of the country and that is Medicare. Guess who oversees the delivery of and reimbursement for Medicare? That’s right: the government. We really started having trouble with healthcare in this country when insurance companies moved from being non-profit to more profit oriented businesses. Guess who set that plan in motion? President Richard Nixon (the government). And if the insurance companies were more regulated, we might see some different practices. And who is in charge of regulations? Give yourself a cookie if you said the government! Finally, the recently passed Affordable Care Act (ACA) is going to significantly change the way we deliver and pay for healthcare services. And, the entity in charge of the ACA’s conception and implementation is (wait for it) the government!
When the people running this country think it is advisable for the population at large to change our behavior, they start campaigns and initiatives to educate people, like they’ve done with litter prevention (remember the crying Native American?), forest fires (Smoky the Bear anyone?), and various public health crises. They pass laws and pour money toward the problem. My original post started with the Obama administration’s plan to help increase access to mental health services. Guess who is planning on implementing this program? Yep, the government! So please don’t tell me that government doesn’t contain most if not all of the answer to our healthcare woes. Besides, we have a much larger chance of persuading the government – an entity created by and for the people – than we do insurance companies whose motivating factor is profit. Consequently, we need to start working with the government and the sooner we need to wrap our minds around that idea, the better.
For example, the ACA is going to dictate what a large portion of our future healthcare services will look like and mental health professionals, particularly psychologists, need to have a seat at that table. If we don’t, the government may decide that what we do can easily be done by nurses and other non-mental health professionals. Unfortunately, I don’t believe that the mental health profession in general and psychologists in particular have done a good job of making others aware of how vital we are. As I’ve written about before (Psychology Gets No Respect), we need a psychology rock star so that people can understand just how much we have to offer. Another post (Let’s Make Psychology Roar) talked about how we need to take back the services we have allowed other professions to take over (I’m looking at you, family lawyers and mediators!). Thus, we must start making noise and talk up just what it is we do now and can do in the future to make a positive difference in people’s lives.
In short, we need to raise awareness about the importance of mental health. People need to know that talk therapy is 32 times more cost effective at increasing happiness than monetary compensation and that mental health factors are sometimes even more important than physical ones in overall health. The general public needs to realize that we are the ones on the front lines dealing with those suffering from chronic mental illness, substance abuse, and violence. As bad as things are, they would be worse without us. And we also must point out that we are the ones who can prevent some of these problems and increase happiness and well-being by providing the right interventions early.
There are things both we and the government can do to not only increase access to mental health but also make sure that it is effective and skimping on our pay is not the answer. That will only guarantee less access to qualified providers who are experienced enough to take on those with the highest risk profiles. I have lots of ideas, like putting mental health strategies into academic curricula, funding more free standing mental health facilities, and integrating mental health professionals more thoroughly into our educational, legal and healthcare systems but people need to be ready to listen. And if we want them to do that, we need to unify our voices so that they’re loud enough to hear.