The Future of Therapy and Recovery
There is not a one track solution to this problem. Various schools of thought will need to come together to thoroughly evaluate the best ways to make high quality care affordable and accessible. The World Health Organization promotes ways for institutions to integrate mental health services into primary health care, aiming to raise awareness of the importance of treating mental health as part of essential medical services. Simply put, mental health screenings and treatment should be as regular as physicals or blood tests. A strong nationwide healthcare system, both for physical and mental health, is something that we all need in order to protect ourselves and our families across the lifespan.
However, this requires more staff, proper training of those workers to understand the intricacies of different mental illness, and — the big missing piece — money. Immediate changes in federal and state funding is necessary in order to rebuild our broken healthcare industry. At the moment, hospitals across the country are dealing with a psychiatric bed shortage that is an undeniable crisis. Last week, the Treatment Advocacy Center released a report stating that more than 96% of U.S. population-adjusted state mental health beds have been eliminated over a 60 year period. (24) Today it is estimated that there are only about 11 psychiatric beds per 100,000 people, the fewest that we have seen over any other time in history since the 1850’s. (25)
The proposed Mental Health Reform Act of 2016 is now being discussed with senators and U.S. leaders to help allocate federal dollars to state mental health budgets, hopefully bringing much needed change to the system. Recent recognition of the lack of access to mental health services has led some of America’s larger corporations to hire on-site counselors and social workers, as this reduces staff absences and turnover. The unsustainable pricing rates of healthcare have also prompted the 2016 formation of the non-profit Health Transformation Alliance, a band of 20 companies that plan to cut rising costs for their collective four million employees and the employers who partially pay for health plans.
In an additional effort to increase access at lower costs, telemedicine is now a spreading movement, providing mental healthcare services such as psychotherapy via phone and two-way video. These delivery methods may help those who do not have easily available care, especially the disabled, elderly, or those living in rural areas. Dr. George Nitzburg, who earned his Ph.D. in Clinical Psychology and has spent the past four years as a lead researcher at the Psychology, Technology, and Disclosure Lab at Columbia University, gives insight into this emerging field.
“People are turning to the collaboration between psychology and technology to find ways for psychological and medical services to cut costs not by limiting the amount of sessions with a provider, but by changing the delivery system. If a therapist uses text messaging, video or a modality that eliminates an office, this is a strong cost cutting measure that could retain effectiveness while still limiting expenses.”
What about critics who believe that in-person therapy is the most effective way to obtain treatment? “Clearly face to face therapy with adjunctive medication is well known to be the ‘gold standard,’” Dr. Nitzburg remarks. “But what do you do for people who live in a rural area with one therapist where they can’t really retain confidentiality? Or if they are in a war zone where therapeutic interventions through technology are a necessary option? There is a need for those who can’t find access to that gold standard because otherwise people just don’t do therapy.”
“For the majority of people suffering from a mental health issue, it is not the case of the gold standard versus lesser, it is something versus nothing. We do need to understand more about whether or not technology systems are effective, however we shouldn’t just dismiss an alternate system for delivering psychotherapy, but instead study it. This will help us understand what to tell providers and think about how we can close this access gap, which is unfortunately giving rise to very disastrous tragedies.”
Telepsychiatry studies are showing positive results, with many participants reporting high satisfaction rates, reduction in symptoms, and significant cost reduction for providers and patients. (26, 27) Additionally, human-computer behavior research has shown that certain personality types, particularly depressed and introverted individuals, are less apprehensive when communicating online than face to face without deterioration in communication comprehension. (28) Nevertheless, it is important to consider individual personality types, patient case history, and treatment efficacy when utilizing technological communication for healthcare, as it is a budding area where there is still much to learn.
Unfortunately, ongoing stigma and budget cuts contribute to our societal problem where mental welfare is downplayed and those who need assistance are made into outcasts, even when they responsibly seek help. There are often only brief moments of awareness through flashy headlines of violence, such as the infamous Boston Marathon bombings of 2013 that resulted in part from untreated mental conditions. The negative attachments to these scenarios sometimes prompt doses of political funding to ease public concerns, however negative media attention also leaves many afraid to speak up, allowing cases to be hiding in plain sight every day.
Assessment, treatment, and the road to recovery for mental illness is undoubtedly complex. Feelings of anguish may cause some to wonder if help is even possible, or that a lost brain is a lost cause. However, there are plenty of people who can attest that recovery or at least stability can be very real. Up to half of those with serious mental illness, such as affective psychosis or schizophrenia, have been found to achieve either full or independent social recovery. (29)
It can take years of gradual rehabilitation for some, while others have described a moment of brilliance that flashes like lightening through their darkness. Regardless of the path, there tends to be that moment of enormous clarity, where in the despair of utter hopelessness there is realization that drastic change is possible. Maybe that’s the only hope in the sadness and confusion of life. That more often than not, the triumphant stories that make our eyes swell and chest puff with inspiration are born from tragedy.
Right around the time of Deinstitutionalization in the mid-1950’s, American science fiction writer Rod Serling opened the door to a middle ground between science and superstition, in the pit of our fears and summit of knowledge, where the dimension of imagination exists as the “Twilight Zone.” Maybe the secrets of mental illness live there. Maybe that is where synapses in the brain are firing erratically in a dance with chemical imbalance. Or maybe the mind is a powerfully changing beast that we will continuously need to learn to understand. Maybe, we will never really know…
This is the third of a three-part series about the state of mental health care in America. Please check out Asylum Was Once a Place of Safe Haven, Part 1 and Asylum Was Once a Place of Safe Haven, Part 2 too.
24. Treatment Advocacy Center. (2016, September 20). RESEARCH WEEKLY: Psychiatric Beds: Getting from Not Enough to Safe Minimum [Press release]. Office of Research & Public Affairs. Retrieved from http://www.treatmentadvocacycenter.org/fixing-the-system/features-and-news/3652-research-weekly-psychiatric-beds-getting-from-not-enough-to-safe-minimum-
25. Torrey, E. F., Fuller, D. A., Geller, J., Jacobs, C., & Ragosta, K. (2012). No room at the inn: Trends and consequences of closing public psychiatric hospitals. Arlington, VA: Treatment Advocacy Center. Retrieved from http://tacreports.org/storage/documents/no_room_at_the_inn-2012.pdf
26. Tutty, S., Spangler, D. L., Poppleton, L. E., Ludman, E. J., & Simon, G. E. (2010). Evaluating the Effectiveness of Cognitive-Behavioral Teletherapy in Depressed Adults. Behavior Therapy, 41(2), 229-236.
27. Pan, E., Cusack, C., Hook, J., Vincent, A., Kaelber, D. C., Bates, D. W., & Middleton, B. (2008, June). The Value of Provider-to-Provider Telehealth. Telemedicine and E-Health, 14(5), 446-453. doi:10.1089/tmj.2008.0017
28. Hammick, J., & Lee, M. (2014). Do shy people feel less communication apprehension online? The effects of virtual reality on the relationship between personality characteristics and communication outcomes. Computers in Human Behavior, 33, 302-310. doi:10.1016/j.chb.2013.01.046
29. Green, C. A., Perrin, N. A., Leo, M. C., Janoff, S. L., Yarborough, B. J., & Paulson, R. I. (2013, December). Recovery From Serious Mental Illness: Trajectories, Characteristics, and the Role of Mental Health Care. Psychiatric Services, 64(12), 1203-1210. doi:10.1176/appi.ps.201200545