Monday, August 15, 2022

Comments by J Q

Showing 2 of 2 comments.

  • And on and on it goes. Now the people who rebutted the rebutters of the original paper will rebut the rebutters. I have read the original paper and the rebuttal and find value in both of them. Does the answer have to be one or the other? As has been pointed out, the most common theory of mental health today is the biopsychosocial model. In my experience, the medicalization of mental health problems has more to do with insurance companies greed than anything else. When I started in the mental health field, many people came into psychiatric hospitals voluntarily and often stayed for a month or more, while a team of psychiatrists, psychologists, social workers, and other therapists worked to find the right combination of medicine, therapy, and social supports to help people. Even those who were committed and resistant often came to value the treatment they received and asked to stay longer. We could send people out on passes so they could see how they’re functioning had improved or not, and they were grateful for the care they got. But the insurance industry put a stop to that. The insurers said, keeping people in the hospital that long was not “cost effective” for them. Get them in and get them out fast, and if you don’t give them medication, you won’t get paid! Therapy? We’re not paying for that! Just give them the drugs! Passes? If they’re well enough to go out on a pass, they’re well enough to go home! Capitation, a concept that reduced payments to mental health providers, forced hospitals and providers to cut staff and services. Hospitals and providers struggled to provide adequate care, being told they had to do “more with less,” but nobody ever said how this was to be accomplished. Public funding entities began to use the same approach, and funding dried up. As I have said elsewhere, there are good psychiatrists and very bad psychiatrists, and finding the good ones isn’t easy. Medication helps some people and not others, but when the reviewer at the insurance company says “we’re not paying”, it becomes a matter of survival and that makes for bad decision-making and leads to abuse. If we want to improve the mental health system, we need to take on the insurance companies and take the profit motive out of it. The mental health system is not perfect by any stretch of the imagination (is any system?). Do we have to have to throw the baby out with the bath water? Do we have to be at each other’s throats? Nobody goes into the mental health field to become rich–including psychiatrists, who are the worst compensated physicians. Everyone started out with good intentions, but the need to survive and corporate greed turned many people in the wrong direction.