Increases in funding and updates to the insurance system, at both state and federal levels, are long overdue in the field of Mental Health. Patients, providers and administrators are facing many problems in acquiring access to innovative treatment methods, emergency care, and hospitalization. Furthermore, it is growing increasingly difficult to find consistent, high quality treatment in outpatient mental health, and patients who truly need help are not able to find it.
I believe that a large part of the problem is the public’s perception of mental health care. Mainstream media has ensured that the average consumer is only consistently aware of two types of mental health treatment: psychotropic pharmaceuticals and “talk therapy.” Advertisements for medications used to treat anxiety and depression are in our magazines, on the websites we visit, and on our televisions. With this kind of exposure, it is not surprising that many people believe medication is one of the best and only options for treating mental illness. The longstanding cultural myth of talk therapy as the predominant form of psychotherapy has been perpetuated through popular television shows such as Frasier and The Sopranos. This has left many with the idea that therapy uniformly involves a patient lying on a couch and talking while a psychiatrist listens, paraphrases, and offers advice. In addition, it is my opinion that the persistent use of the title “psychiatrist,” as opposed to “psychologist,” in fictional representations of therapy, has also perpetuated some confusion. It is surprising to discover how many people do not know that a psychiatrist’s primary job is to provide a patient with medication, while a clinical psychologist’s main focus is to provide therapy.
I feel that it is due to cultural misconceptions that many people seeking treatment do not realize that there are many different options available. Currently, more physicians are recommending evidence-based treatments such as Cognitive Behavioral Therapy (CBT) to patients seeking mental health solutions. Unfortunately, genuine CBT is difficult to find. Training clinicians how to properly administer therapies like CBT costs time and money, and consequently, many facilities continue to focus on talk therapy. In some cases, patients spend hours with therapists who claim to use CBT, only to later discover that they were experiencing talk therapy with only snippets of CBT methodology thrown in. Often, when patients do find a legitimate CBT therapist, they are met with long waiting lines and difficulties with insurance coverage.
In the past, the federal government has tried to change the perception and practice of mental health. In April 2002, the Bush administration turned its focus to mental health treatment. Psychologists were invited to provide significant input in creating “The President’s New Freedom Commission on Mental Health, ” a federal plan whose agenda included the advancement of evidence-based mental health throughout the United States. Unfortunately, with the change of administration came changes in focus, and the plan has been all but forgotten.
Here in Connecticut we have been currently making strides to improve the mental health system. Early last year, in the wake of the Newtown tragedy, Connecticut created a legislation-backed task force that included insurance company representatives, mental health professionals, and advocates. The mental health working group consisted of eight state senators and eight state representatives. They were asked to study Connecticut’s mental health system and issue recommendations in time for the 2014 legislative session. Agendas included plans to promote mental health first aid training for school faculty members, a program that would provide liaisons between people with mental illness and the court system, and to initiate additional training for pediatricians treating children with mental illness.
This is a great beginning, and I certainly do not want to diminish the efforts the state has already made. However, things need to be taken further. New initiatives must be approached at the federal level, picking up where the previous administration left off. Here in Connecticut we need to follow through with those initiatives we have already begun. I strongly believe that reforms need to include improvements in consistency of care, access to care, and quality of care through the increased use of evidence-based treatments. More focus needs to be placed on all mental health options available. If reforms are applied at both state and federal levels, then perhaps insurance companies will change their views on therapy and its effectiveness, and patients and providers will finally have access to all the necessary resources.
Thomas A. Cordier
The Newtown catastrophe has raised numerous questions concerning the state of mental health in Connecticut as well as throughout the entire nation. It is my personal opinion that mental health was reaching a pivotal point where it was finally shedding its negative stigmas and gaining the respect it deserves. It was beginning to be taken more seriously by the public and many individuals have been seeking help with mental health issues without feeling shame, embarrassment and the fear of being scrutinized by others. However since the Newtown incident and after reading an array of current articles it is my belief that mental health is in danger of returning back to darker ages. For example, the state of CT has made mention of new tactics designed to red flag individuals who may be suspected of having mental health problems by their overall appearance. How? By empowering the public to report people who look like they are unstable. This may very well create (in a sense) witch-hunts and cause a flood of alarming reports to an already stressed mental health system.
The CT State Department of Children and Families (DCF) is taxed with an overwhelming caseload as well. Many local professionals suggest that when an oral and/or written DCF report is filed concerning a suspicious situation, the response is often measured by “how serious the situation sounds”. There was a time not long ago, when each and every report was tended to rather quickly. DCF workers are doing the best they can to cover each and every case as expediently as possible, but the department is overly burdened with reports. I believe that overburdening an already taxed mental health system with too few providers is not a viable solution to the problem.
So what are some viable solutions? One proposed solution rather than utilize the public (i.e., store clerks, mechanics, office co-workers etc.) as mental health vigilantes is to encourage parents, family members, caregivers, teachers, school administrators, coaches and general practitioners, to be the overall eyes and ears of mental health and to, without question, take action in seeking effective treatment that really works for those that need help.
In order for mental health to become a fully effective system we as a community need to demand that more providers be trained in treatments that are medically and scientifically deemed effective. These treatments are known as Evidence Based Treatments (EBTs). One form of EBT is a self-empowering technique known as Cognitive Behavioral Therapy, or CBT. Once more accurate behavioral health diagnoses are provided, as well as medications that are deemed useful and, above all, excellent psychotherapy is delivered, people will finally get the help they need and deserve. When our treatment standards improve, the overall system will begin to improve.
Insurance and pharmaceutical companies need to be taken out of the drivers seat. As long as insurance companies continue to dictate the general importance and financial worth of mental health therapy as compared to medication by underpaying providers who are up to their ears in debt and student loans, the system will continue to falter. The health insurance and pharmaceutical industries believe that it is far easier and far less expensive to push inadequately tested and often times dangerous medications on the general public than to pay for weeks, months, and even years of psychotherapy that these industries themselves often deem as ineffective. There is still is so little known regarding the prolonged effects of psychotropic medication on the developing brain.
If we up the treatment anti and drive the mental health system toward more EBTs and prove that effective and briefer psychotherapy is much more effective than medication alone or works better when combined with medication (in some cases), then the insurance companies may begin to bend. Once standards are met and insurance companies begin to pay providers what they are worth, more mental health providers will agree to accept insurance, therefore serving people who are desperate to obtain professional help but can’t afford to pay astronomical out of pocket costs.
Health insurance companies need to begin making complex, confusing and competitive paneling an easier task for providers in order to allow providers to accept insurance plans. The state of Connecticut needs to make the acceptance of Medicaid by providers more appealing by paying out more money to providers who deliver EBTs and also by making the standards of accepting Medicaid a bit less stringent paneling wise. When more providers begin accepting insurance, more providers will be accessible and this will hopefully diminish some of the long waiting lists for treatment that providers have.
How do we promote and assure Evidence Based Treatments? By handpicking a permanent state sanctioned Mental Health Task Force armed with only providers who already practice EBTs in order to evaluate and approve those institutions who claim to utilize EBTs. Certain perks can be provided by the state (i.e., EBT certification, training seminars, classes, referrals, marketing and advertising for providers utilizing effective treatment modalities). Currently some insurance companies hold a list of providers, who deliver EBTs, but they do not enforce this referral list, nor do they pay providers any more money for utilizing EBTs which are more work to deliver and teach to patients than your standard “talk” psychotherapy.
A statewide referral system needs to be implemented strictly with school systems in mind, so that students are being referred out to excellent providers. The state and nation need to step forward and provide above adequate EBT training seminars and EBT certification to providers, mental health institutions and the educational system. Patient progress needs to be tracked and validated by each provider session upon session through weekly psych testing to insure that patients are getting better. School psychologists’ primary focus need to be on treatment within the school systems and on EBTs and emotional and social intelligence rather than utilizing testing as their primary function. Preventative measures in our school systems through provider ran class seminars targeting the student populous need to be initiated and school social workers and psychologists need to work more closely with outside providers so that each child’s outside treatment is better understood. Lastly, children’s improved behaviors as a result of positive treatment outcomes need to be witnessed and noted in school and social environments.
We need to stop compromising our children’s mental health well being now! We as a caring and concerned community need to face the facts that until the “wild west” is taken out of mental health treatment and the mental health system is better regulated, people will continue to (without choice) gamble on the outcome of mental health wellness in our state and our nation.
NECBT Psychiatrist Dr. Sunanda Muralee quoted in informative Sandy Hook PTSD article
Most of the students and other children exposed to the Sandy Hook Elementary School shootings and aftermath will, in time, recover from the distress caused by the massacre in Newtown.
But some children may be at risk of developing post-traumatic stress disorder, a condition that manifests differently and is treated differently in children than adults, experts said.
"The form of disruption and the symptoms are relative to where people are developmentally," said Steven Marans , the director of the Childhood Violent Trauma Center at Yale University.
Affected children may not exhibit what are viewed as the classic symptoms of PTSD such as recurring dreams or reliving the trauma. Instead, a child's symptoms may be more general behavioral changes or mood problems.
Children also might not be able to articulate their feelings of dread or agitation, so they will exhibit them during play or in drawings.
Of children exposed to trauma, 3 percent to 15 percent of girls and 1 percent to 6 percent of boys develop PTSD, according to the National Center for PTSD . The different rates are associated with past traumatic experiences, proximity to the trauma, the severity of the trauma and the strength of a child's support network.
At this point, nearly three weeks after the shooting, distress among Sandy Hook students is close to universal. And returning to school this week will likely provoke some problems for many of the students.
Dr. Sunanda Muralee , a child and adolescent psychiatrist at St. Vincent 's Behavioral Health Services , and New England Center for CBT and Psychiatriy said struggles at school do not mean students will face a lasting post-traumatic condition.
But Muralee and Marans emphasized seeking counseling early if a child is displaying post-traumatic symptoms such as changes in behavior and eating patterns, or fears of being alone.
"These kids are going to be vulnerable for a long period of time and it's always better to do early intervention rather than to catch it later," Muralee said.
Doctors do not start diagnosing PTSD until more than a month after a trauma occurs, and studies have found that steps taken in the meantime can reduce the likelihood that a child will develop a post-traumatic condition such as PTSD.
Child and Family Traumatic Stress Intervention, a therapy program developed by Marans and his colleagues at Yale, has been shown to calm symptoms in children and to decrease the risk of forming PTSD. The treatment focuses on working with caregivers as well as the children to help patients process the trauma they experienced.
"In this phase, the degree of social support with the most important people in their lives, especially their parents, is an important predictor of positive outcomes," Marans said. "When kids don't have those social supports, they're more vulnerable for the symptoms to continue."
There are also child-specific strategies for fighting PTSD once it is full blown, experts said. Play therapy, for example, involves getting children to express their emotions and how they view their trauma through activities and games.
In another treatment called trauma-focused cognitive behavioral therapy, specialists try to help children recognize the connection between their experience with trauma and their behavior. The hope is to get them to come to terms with the memory of what happened in a way that does not trigger a negative response.
"Children are also very resilient," she said. "They have that peer support and can move on and be OK."
Research into any long-term developmental problems caused by trauma exposure as a child has been inconclusive, Muralee said.
"If they're having difficulties at school, it might just be a matter of time," Muralee said.