Talk, Talk, Talk


People use to talk. Families would talk around the dinner table; folks would sit on the front porch and talk with their neighbors. You would find men chatting at the barbers or the POW or Elk’s clubs. Women would be home during the day and would talk with the other housewives. Garden clubs were an opportunity for the ladies to talk about everything except gardening. Of course, these are all things I’ve only heard of. Certainly I’m not old enough to remember anything like these.

Today everyone is too busy working, too busy working out, too busy watching television. No one seems to talk anymore. Kids were an exception for awhile. They at least talked on their cell phones, but now that even seems a dying breed. Today you rarely see a kids face. They are always looking down at their cell phones while their fingers go at warp speed text messaging instead of actually speaking.

Families aren’t the only ones not talking enough anymore. On Tuesday Healthday Reporter reported that psychiatrists are talking less these days. Apparently a National Ambulatory Care Survey, confirmed that the proportion of visits to psychiatrists’ offices that included psychotherapy dropped from 44.4 percent in 1996-1997 to 28.9 percent in 2004-2005. 29% What the hell???

What do they say has caused this? The decline coincided with changes in insurance reimbursement, the rise of managed care and a boom in the availability of different psychiatric medications – basically, they’ve all become pill pushers. Make a prescription, have a nice day and then “Next!” Those psychiatrists who do still provide psychotherapy tend to have self-paying clients.

Self paying clients? We all know who self paying clients are. They’re the ones who can afford to pay $200 an hour for psychotherapy. There’s also another group that receives psychotherapy. Surprisingly enough it’s the poor. I basically fall under this category. I get excellent therapy from my psychologist at a county mental health facility. My wonderful doctor is a resident who spends a full hour with me every week. Apparently that’s true of most government facilities which are run by either psychiatrists donating their time, or as in my case a resident completing their training.

What does all this mean? Once again it’s the middle class that gets the shaft. Those who make too much to go to a government facility and who cannot afford to pay for their own visits. These are the individuals who are stuck with a shitty insurance plan that limits what a psychiatrist can provide and typically limits them to 12 visits a year.

I don’t have much else to say about this. It’s just another example of why there needs to be major health care reform in the U.S. Is it any wonder we’ve dropped dramatically in health care compared to other industrialized nations?

I’m interested to hear from those outside the U.S. regarding how this compares to their mental health care. Those of you in the U.S. I’d like to ask what you think the solution should be.

  12 comments for “Talk, Talk, Talk

  1. August 11, 2008 at 06:34

    another related topic are those people who are “high functioning”. people whose mental health is precarious but not so debilitating that they can’t work. almost by definition, most people in that category fall into the middle class or working poor category. if they’re lucky, they have an insurance that will pay part or all of 5-10 psych visits a year. and then … either you scrap your vacation and pay for the therapist or you’re back to reading books.i’m working on a scheme right now where i can hopefully come up with a way of offering good ol’ talk therapy in affordable ways.(you know what, this is the first place where i’ve said that publicly – you’re welcome to check up on me on this promise in a little while 🙂

  2. August 9, 2008 at 20:59

    I hope you don’t mind me leaving a link here and there, but here’s an update from Liz Spikols Blog(a mental health blog authored by a journalist w/bipolar.)The Spikol Blog:Insurance Parity Update.

  3. Michelle
    August 9, 2008 at 02:20

    Seems the onus is on us the sick to try and find ways to heal ourselves since government or medicine won’t.

  4. August 8, 2008 at 16:25

    @old man and stephany both of you are examples of what’s wrong with our ridiculous system. I’m sorry that both of you are dealing with such financial issues as a result. I firmly believe Universal Health Care is the only way to go. Anything else will be a band aid.

  5. August 8, 2008 at 15:31

    The solution is for our mental health appointments to have co-pays and rates charged the same as going to a PCP for a check up.By the time my daughter was 17 her lifetime cap of inpatient insurance paid stays ran out for hospitals, landing her on medicaid and bad hospitals because I ran out of money paying out of pocket for private hospitals.My psychiatrist charges 140.00 for 30 minutes and he talks to me alot, we have great conversations, and when I went into bankruptcy in July…he has not allowed me to pay a dime. His office does not accept insurance at all, it’s pay up front only. So here I am, bankrupt and broke with a kid on medicaid–why? a decade paying for her care and private psychiatrists, hospitals, meds etc. and look where it got us. (sorry off on a tangent about medications not always efficacious!)Example about the “head and brain” and “mental health”:My daughter had a brain malformation that required a neuro sergeon, and several 3000 MRIs of her head and spine. Never had to pay a dime.It was all covered.Psychiatrist fees 200 an hour, out of pocket to manage psych meds during that process.I hope I make sense here: mental health should be treated like any other thing covered by insurance, but it’s not. How to change it? hard call because the parity bills never get passed in Congress. I’ve been writing to Representatives for a decade. It has to start with our government taking charge of insurance and health and it’s not gonna happen in a country where pharmaceutical companies have such a stake in the business, those people lobby the same people we do for insurance parity bills.It’s very complex, but that’s where you need to start reform, is by writing letters and making phone calls to your elected officials.

  6. August 8, 2008 at 15:03

    Bradley, talk about a messed up system. I just got another bill, and I am estimating, with this last bill, I will have $5000 more in medical expenses this year than my gross earnings. Here’s where it gets kooky. I don’t qualify for any assistance with meds, etc, because I make too much money.

  7. August 8, 2008 at 12:29

    I had a serious illness a couple of years ago and even with “good” insurance, I had to spend a fortune of money I didn’t have to get care. I remember checking into the hospital and them asking for a deposit before they would admit me.I think socialized medicine is the only way to go. There are many people who need access to care who just can’t afford it and have to decide between eating and medical care. It’s shameful.As to Memes, I’m with you!

  8. August 8, 2008 at 09:42

    @clueless 20 visits per year is ridiculous for people with serious mental illness and to deny coverage for your meds is inhumane. I can only sigh at this point. @april anarchy may be the right [email protected] restriction to migraine pills sshows how pathetic our system is. It’s like saying “Your migraines were important before, but now you’re going to just have to learn to deal with them.” Yeah on Obama, too. @CK I understand. I use to live in the state of Nebraska which is huge and mostly empty from massive farms. That resulted in not much money coming in for a huge state which limits state programs. Very similar to the situation you describe. Sounds good overall for you though. The U.S. can really learn from its friends.

  9. August 8, 2008 at 04:43

    I’m in Australia. We have less of a dramatic gap for the middle classes but it’s still there. Our health care system doesn’t leave too many folks totally out in the cold though because the government subsidizes health care costs for everyone (particularly medications). Our insurance coverage isn’t such a mess because we have coverage that’s independent of job benefits. If you have health issues you still do a lot better if you have private health cover but it’s not such a difficult system to navigate. The main problem is lack of basic infrastructure for us. There just aren’t enough beds, well trained professionals etc. to go around. And there basically aren’t any public facilities left that are designed with long-term care in mind. Unlike the US we don’t have the population to support a lot of big, private clinics either. As a nation Australia can afford universal coverage measures because our population is just so much smaller. But that also means we don’t have as much money to go around.

  10. August 8, 2008 at 03:02

    /me raises my hand and sighs… count me… middle class… insured… thank goodness but being sucked dry by medical costs despite insurance.It never ceases to amaze me how decisions are made regarding insurance. Did you know the insurance gets to decide how many migraine medicine pills I’m allowed every so often and then they won’t cover it? They aren’t narcotic… what would I be doing with them? We soooooo need change in this country. Please please please tell me change is coming regarding healthcare, among other things… among LOTS of other things. Go Obama Go!

  11. August 8, 2008 at 01:23

    hmmm solution? anarchy? at this point…I don’t know. but I can tell you I enjoyed your post

  12. August 7, 2008 at 23:53

    No more MEMEs…I completely understand…maybe that is why I still have not picked up my award, yet because I don’t want to pay it forward. However, I really appreciate it coming from you because I know that you mean it.I am so glad that you asked what other countries are like. It is an outrage what has happened in the US to the mental health system, so I won’t even go there. I’m having my own difficulties with it and even had a panic attack. I’m still fighting for more than 20 visits per year for psychiatry and psychotherapy services, but what pushed me over the edge into a panic attack is that my prescription insurance company denied me coverage for my anti-depressant. You know what…it is finally working at that dosage. It has taken three years to get here and now they won’t cover it…okay, spend the money to hospitalize me. My wonderful husband won’t let that happen, but thank God I have him and we HAD savings.Hi Bradley, it is good to have you blogging again. How are you? Luv ya!~Goofball

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