I have worked in the mental health community for several decades now. As a marriage and family therapist, I have worked in agencies and private practice. As a school counselor, I have worked in the educational setting. The need for improved mental health services is not news to me. There are roadblocks that have existed for years in order to get services to the people who need them.
First, there is the stigma that has been attached to those who have mental illness or disabilities. There’s that stigma so readily seen in the movie “To Kill a Mockingbird,” when the viewer gets a look at Boo, a grown man whose family kept him in the basement because that was what people did back then with someone who was mentally ill.
In some ways, we have not progressed much further than that. For many individuals and families, acknowledging that someone in their family has mental illness remains a “hush hush” situation. Unfortunately, this can interfere with the treatment and successful life ventures of those with mental illness.
This leads to the next roadblock: understanding what mental illness is, and that with adequate treatment many people can live successful and productive lives.
All ages can suffer from mental illness. For many, the idea of a child being anxious or depressed to the extent that it cripples them and impacts the quality of their lives is hard to believe. Mental illness especially seen in children is harder to treat as the child cannot advocate for themselves and may have limited ability to describe what they are experiencing. Unlike adults, they are dependent on the adults in their lives to get them the help they need. And when that doesn’t happen, there is nothing they can do about it.
Too many times I have seen untreated mental illness issues result in children getting criminally involved rather than getting mental health services. Our criminal justice system has become the new institutionalization unit for the untreated mentally ill for both children and adults.
The DSM IV-TR is the manual that clinicians use to assign a label and a code number to the present mental health issue, which is similar to the medical coding that doctors use. In this codebook, there are categories such as mood disorders, personality disorders, learning disorders, anxiety disorders, gender identity disorders, pervasive developmental disorders, etc. A diagnostic code is necessary in order to create a common language in mental health services and also to bill insurance when available.
The next roadblock is the cost of mental health services.
Services for mental health issues are not always covered under a private insurance plan, so insurance is not the answer for many people. Those without private insurance might gain services under Medicare or Medicaid.
In the middle of these provisions are all those individuals without any insurance who would need to pay out-of-pocket expenses. Fees could range between $75 and $200 per therapy session, with testing and evaluations billed separately.
With the use of insurance or not, there is a limit as to how long or how many sessions or which providers can bill for what services — another roadblock.
There are a wide variety of mental health practitioners: social workers, psychologists, psychiatrists, marriage and family therapists, licensed professional counselors, addictions counselor — to name a few. All these professionals are licensed by the state of Michigan. Their fees will vary. Insurance companies choose whom they will reimburse for mental health services.
In order to contain costs, insurance companies have cut back therapy sessions from 55 minutes to 45 minutes, and reduced reimbursement payments. They also limit the amount of sessions a person can have based on their diagnosis.
As one of my professors stated many years ago, successful mental health treatment is being reduced to point that “it’s like a surgeon doing open heart surgery with a pocket knife — and once surgery gets started, (insurance companies) ask you to stop.”
If we truly want to provide the services that meet the needs of those with mental health issues, then we must honestly look at what it takes to do this. First, we need to boot up the services for initial assessments. A full assessment is not done in 45 minutes. It takes time to bring together all the developmental, behavioral, medical and educational information that funnels into an assessment.
Reaching a diagnosis is only the beginning of treatment. For many with various kinds of mental illness, the use of medication along with counseling is the agenda, and neither can be accomplished in a few sessions. The use of medication to treat some mental illnesses is an art, not a science, in that each person responds differently to medication and therefore it takes time to reach a therapeutic level. At the same time, counseling sessions can be taking place to help the person gain new insights and behaviors for self-care.
For as many years as I have been in the mental health field, there have been roadblocks to adequate services for those with mental health needs. I can only hope that the more informed people are about mental health issues, the more push there will be to improve the system for all the right reasons and not as a knee-jerk reaction to episodes of shocking violence.
— By Janice Beuschel, who can be contacted through her website, JaniceRBeuschel.com.