Saturday, May 15, 2010

One problem (of many) in modern mental health.

Im sort of tired of people, but that's not the topic for tonight's rumination, just an observation that seems particularly salient. Today I want to talk about a particular problem in modern psychology. If you have some sort of anxiety disorder your insurance will cover medications, likely standard anti anxiety drugs like attivan and klonopin, and if you have some particular subsets of anxiety disorder, or depression along with your anxiety (which nearly everyone who is anxious all the time does, obviously) also some sort of anti depressant, usually an ssri. What your insurance won't pay for, or won't pay for as much of, is a particular kind of therapy, called cognitive behavioural therapy.

CBT is one of the most effective methods of dealing with anxiety disorders like OCD genralised anxiety and panic disorder, as well as one of the most effective for depression. When done in concert with antidepressants the rates go even higher. However, if you want this sort of therapy and you don't have money (likely because you can't work because you're spending all your time being anxious) no therapy for you.

This hits at the root of a serious problem with modern psychology. Though the tools are there, the systems to provide services aren't. With budget cuts and the general problems associated with the current financial climate most county mental health systems don't have psychologists on staff. They have psychiatrists, as they must, so drugs can be prescribed, but psychologists period (much less those from the subset of CBT specialists) are not paid for.

Some of this is due to the view of therapy as pointless (spurred on by the low effectiveness of nearly every other sort of therapy) and some of this is simply due to lack of money, but the ultimate result is alonger course of illness and greater rates of disability and hospitilisation for people with anxiety disorders and depression. There are many great CBT specialists who work privately, but if a patient doesn't have money, (and even if you have insurance the co pay is likely to be rather large) the they're shit out of luck.

This is a general problem in mondern mental health care. It's something I probably see more of because the facility in which I work has many clients who are on medi- cal or who don't have any insurance. People lucky enough to have money don't usually come through our facility, and usually can afford to pay for therapy. That's not to say that the problem isn't still valid.

I could explain further, cite sources, and give a personal speil on parts of it, as my OCD is currently in remision because of CBT along with SSRI's (though other problems did arise after this period) but right now I don't feel like putting the time in. Look for the numbers yourself, or if you're interested leave a comment and I'll make an essay with citations and evidence that's a bit more objective.

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